Evidence-based Practice What Does it Mean for Nursing? Nancy Wells Vanderbilt Medical Center October, 2007

What is evidence-based practice?

Evidence-based Practice Process by which clinical decisions are made using: Best available research evidence Clinical expertise Patient preference

Historical Perspective Variation in practice leads to: Variable quality of care Higher cost of care Potential for errors that may cause harm

Translating research into practice

Skills Required for EBP Clearly identify practice problem or new knowledge ( innovation) Find research literature Critically evaluate research findings Apply to practice through change process

Identifying Practice Problem Why are we doing this? Why are we doing it this way? Can we produce better outcomes with greater consistency?

Clinical practice problems in your setting?

Critically Evaluating Research Literature review Integrative literature review Systematic literature review Meta-analysis

Strength of the Evidence Level I – systematic review, met-analysis, well-designed RCTs Level VII - opinion

Resources for Reviews Nursing journals Clinical work station sites Up-to-date Zynx Eskind Digital Library Cochrane Reviews

Clinical Practice Guidelines Agency for Healthcare Research & Quality (AHRQ) Early examples Skin integrity Acute pain guideline Urinary incontinence

AHRQ Evidence-based Reports Examples of reports available Cancer symptom management (2002) Coronary heart disease in women, systematic review (2003) Mechanical ventilator criteria for weaning (2000) Wound healing, laser treatment and vitamin-assisted closure (2004)

Evidence-based Nursing Practice AHRQ clinical nursing practice guidelines To be released in December Joanna Briggs Institute (JBI) JBI Connect National Guideline Clearinghouse Guidelines.gov

Application to Practice Does the research apply to my patient population? Would this practice change improve process of care? Patient outcomes? Is there support for this practice change?

EBP Models CURN project  Research utilization Review, synthesis, application, evaluation Stettler Model of Research Utilization Critical thinking & decision making Iowa Model of Research in Practice Quality assurance meets research utilization

Planned Change Assess current practice (processes and outcomes) Identify and implement changes to modify processes Evaluate effects on processes and/or outcomes

Evaluation Processes of care Outcomes of care

Documentation of Groin Sites Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe 1 month trial of education and coaching to improve documentation of groin sites post-catheterization

Groin Site Documentation

Summary Reduce variations in practice Improve the quality of care provided Maintain or improve patient outcomes