Chapter 20: Developing an Evidence-Based Practice

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performance gap assessment

informs members at the beginning of change about a practice performance and opportunities for improvement

characteristics that influence change

EBP offers an advantage EBP is more compatible with current norms EBP complexity

formulate question

PICO

decision to change practice

based on evidence derived from several sources consider relevance to practice, consistency, sample characteristics, feasibility, and risk/benefit ratio

three components of EBP

current best practice clinical expertise patient values

retrieve evidence

electronic databases identify key search terms group articles into categories

last step in EBP

evaluation of results

Iowa Model

evidence-based practice to promote quality care

outcome evaluation standards

expected outcomes being achieved comparison to baseline data

evaluation of EBP

goal: to collect and analyze data with regard to use of new EBP and then modify practice as needed should include process measures and outcome evaluation

process measures

how change is implemented is staff using the practice and implementing the practice as written in the new guideline or standard

continuous loop of EBP

improve quality care identify questions conduct research new knowledge disseminate knowledge use findings in practice

form a team

key stakeholders who will be directly affected by change who can facilitate project who will put up barriers

methods of communicating change

mass media educational strategies such as posters, train the trainer, computer assisted training competency testing

opinion leaders

members of peer group viewed as respected source of influence considered as technically competent

audit and feedback

ongoing audit of perfomance indicators aggregating data into reports discussing findings with practitioners occurs during practice change

change champions

practitioners expert clinicians passionate about innovation committed to improving quality of care positive working relationship encouraging and persistent very effective with nurses

develop EBP

put evidence base of practice in writing include type of evidence

strategies for implementing practice change

reinvention of current EBP guideline quick reference guides clinical reminders

first step in EBP

select a topic problem-focused triggers knowledge-focused triggers involve staff in selection of topic

core groups

select group disseminates information members represent various shifts and days of week members are knowledgeable about basis for practice take responsibility reinforce on a daily basis provide positive feedback

research utilization

subset of BEP focuses on application of research findings

educational outreach / academic detailing

topic expert meets one-on-one with practitioners

critique/grade evidence

using team approach determine method to be used quality strength use summary tables to synthesize data


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