Evidence-Based Nursing Part Two Integrating EBP Knowledge into Clinical Practice

Four Tools for Integration Iowa Model for Evidence-Based Practice Journal clubs Critical Appraisal of Topics Clinical Audit

Iowa Model for EBP

Highlights of the Model Triggers: Problem-based and Knowledge-based Organizational Priorities Sufficiency of the Research Base Appropriateness of change for the patient population/organization Continuous feedback loops

Triggers

Triggers Problem focused Knowledge focused Risk management data Process improvement data Internal / external benchmarking data Financial data Identification of clinical problem (first and last are original) Knowledge focused New research or other literature Nat’l Agencies or Organizational standards Philosophies of care Questions from Institutional Standards Committee (first is new)

Priorities of the Institution

If Yes then…. Form a team Assemble relevant research & related literature Critique and synthesize research for use in practice Sufficient research to guide practice? (“no” is not a stopping point) Develop a guideline or standard of practice Pilot change in practice / is change appropriate? Monitor process and outcome data / share results

Journal Clubs

Journal clubs Teaching-based: emphasis on skill building, such as honing searching skills Topic-based: often focused on critical appraisal EBP skills-based: participants go through each step of EBP process Can be nursing staff only or multidisciplinary All clubs need a clinically meaningful context for their topics!

Critical Appraisal of Topics (CATS) Assess the quality of a single study Can results be applied to your patients? Refer to handout from Evidence-Based Nursing Click on CEBM site; show EBM tools link, refer to handout for Systematic Review

Critical Appraisal of Topics National Guideline Clearinghouse http://www.guideline.gov Journals such as Evidence Based Nursing EBM Tools at Centre for Evidence-based Medicine site http://www.cebm.net

Clinical Audit Examine your care practices and compare your results with clinical guidelines or best practice statements Define best practice Measure and compare Act to achieve change

Audit Cycle (simplified) Defining quality Take action to improve Measuring and comparing

Reilly, L et al. “Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice.” AACN Advanced Critical Care 17(3):272-83

Change: the final step

Method Smackdown Discuss strengths and weaknesses of each method/approach to integrating EBP Best area(s) for application of a method? Image courtesy WWE

Method Review Iowa Model for Evidence-Based Practice Journal clubs Critical Appraisal of Topics Clinical Audit Strengths and weaknesses Best time/place for application

Good Luck!