QAH HospitalPortsmouth Hospitals NHS Trust 10/12/2015Page 1 Stepping up to Evidence Based Practice - Ideas into Action 3 Debra Ugboma January 2010 Finding the Evidence

QAH HospitalPortsmouth Hospitals NHS Trust Objectives  Develop your idea for action and turn it into a clearly defined question  Discuss strategies to identify the evidence and structure any search  Identify resources for finding the evidence  Have a go at accessing some of the electronic resources  What do I need for this session: –Your/your team’s idea for action –Access to a computer/Library website –Worksheet 3

QAH HospitalPortsmouth Hospitals NHS Trust Page 310/12/2015 Ideas into action…  Let’s just think about your care idea or issue that you want to explore..  What is it?  Whose idea was it?  How did it come about?  How do you know it is an issue or problem that needs to be addressed?

QAH HospitalPortsmouth Hospitals NHS Trust Page 410/12/2015 Developing your idea/question?  Be really clear about what you want to explore.  Brainstorm your ideas with colleagues?  How does it fit with the values of your team?  Can you gain some consensus?  Does it sound like a feasible idea – best to start with small successes?  Can you frame it in a specific question e.g. how effective is manuka honey in healing leg ulcers?  Undertake exercise 1 worksheet 3

QAH HospitalPortsmouth Hospitals NHS Trust Using PICOT The acronym PICOT is a tool to help you refine and identify the question you want to address.  Quantitative –Population –Intervention –Comparison –Outcome –Time e.g. Does education about alcohol (intervention) reduced alcohol consumption (outcome) in patients with liver disease (population) admitted to hospital (comparison) after transplant (time)  Qualitative –Population –Issue –Context –Outcome –Time e.g. Why (outcome) do patients with liver disease (population) admitted to hospital (context) after transplant (time) continue to consume alcohol (issue)

QAH HospitalPortsmouth Hospitals NHS Trust Refining your question….  Try writing out your question or care issue that you want to explore using the PICOT process (exercise 2 worksheet 3).  Time may or may not be relevant – you don’t have to use it.  Has your question changed?  Does it feel clearer or more focussed?

QAH HospitalPortsmouth Hospitals NHS Trust Evidence and audit?  Is the problem/care issue you have identified a result of audit?  Do you need to audit the aspect of care before making any changes?  Do you have any other evaluation e.g. feedback from patients, other members of the multi-professional team?  If you plan to audit… use an already validated tool if possible.  Does the audit also reflect the need for change?

QAH HospitalPortsmouth Hospitals NHS Trust Page 810/12/2015 Finding the evidence..  Do you know if the evidence exists already? –Is it linked to a new policy or national guideline? –Is it the output of someone’s EBP project –Can you trust this evidence?  Access NHS Evidence (at the end of this session) and try a small investigatory search to begin withhttp://  Think about the search terms. How clear are they? Do they focus on the right thing? Do you get the results you want?  Decide which databases you want to search (Library will support)  Firm up your key terms/search terms – look at the key words used in highly relevant papers to help with this

QAH HospitalPortsmouth Hospitals NHS Trust Find the evidence..  Once you have a clearly framed question and your key terms..  Either ask the Library outreach team to undertake a search for you…  Or book a session now to search the evidence with library support…  Or if you are confident in your search skills, undertake a systematic search of the databases  Remember to think about inclusion/exclusion criteria e.g. studies over 10 years old, studies of adults etc.

QAH HospitalPortsmouth Hospitals NHS Trust Top tips…  It is time-consuming and so schedule in time  Get help from Library staff (or colleagues)  Remember you can access all the Library resources from home  Develop a comprehensive and systematic approach to your search – keep a record  Don’t just rely on electronic searching of databases  Read abstracts to decide if useful  NHS Evidence is a useful resource and depending on your topic, also try starting with Cochrane Library/NICE  Don’t get distracted (off topic) and remember to call it a day!

QAH HospitalPortsmouth Hospitals NHS Trust Page 1110/12/2015 Finding the evidence.. Quality and availability of evidence Ideally less than 5 years old Generalisable? From a range of sources? Peer reviewed for research derived? Are limitations acknowledged? Any potential conflict of interest?

QAH HospitalPortsmouth Hospitals NHS Trust Hierarchy of evidence.. Systematic reviews, Meta-analysis Randomised controlled trials Cohort, case controlled studies Surveys Case reports Qualitative studies Expert opinion Anecdotal opinion Sackett et al, 1996 Highest Lowest

QAH HospitalPortsmouth Hospitals NHS Trust Using the hierarchy of evidence…  It can be misleading – geared towards medicine and treatment intervention  If you can find a systematic review/meta-analysis which helps answer your question – great!  Also try Cochrane database/library, NICE guidelines and National Service Frameworks  Any local policy should be underpinned by evidence – if not evident, contact the author of the policy who may be able to help  In some topics, qualitative research may be more appropriate and be “higher up” the hierarchy!

QAH HospitalPortsmouth Hospitals NHS Trust Cannot find much or any evidence?  Search outside of the usual databases  Look at similar topics/issues in different populations.  Try cross-referencing e.g. finding a very good paper, policy and looking at the reference list.  Author searching – using the names of experts in the field

QAH HospitalPortsmouth Hospitals NHS Trust Steps of the search (summary)..  Define/refine the question  Identify key terms – and inclusion/exclusion criteria  Undertake search: –Using appropriate databases –Using a variety of strategies –Seeking guidance/support as required  Record search strategy  Manage and store literature effectively (make use of the tools to save searches electronically, print off hard copies as you need)

QAH HospitalPortsmouth Hospitals NHS Trust Making a start (exercise 3, worksheet 3)..  Go to the library (or a desk with computer access)  Access via the PHT intranet/Libraryhttp://  Undertake a preliminary search of your topic and begin to identify what your key search terms might be  Do you know the code to access the electronic journals (this is NOT your usual PHT login or your Athens login)? To obtain it, you must either visit or call the Library (you will need your library card number).  Go and find a full text version of this article (via any electronic route): Tagney, J. and Haines C. (2009) Using evidence-based practice to address gaps in nursing knowledge. British Journal of Nursing Vol 18 (8):

QAH HospitalPortsmouth Hospitals NHS Trust Page 1710/12/2015 Resources  Aveyard H and Sharp P A beginners guide to evidence based practice in health and social care. Maidenhead: Open University Press  Bandolier (Evidence based thinking about Health Care:  Cochrane Library: bin/mrwhome/ /HOME?CRETRY=1&SRETRY=0 or bin/mrwhome/ /HOME?CRETRY=1&SRETRY=0  Craig JV and Pearson M 2007 Evidence-based practice in nursing In: Craig JV, Smyth RL (Eds) 2007 The Evidence-Based Practice Manual for Nurses, Edinburgh: Churchill Livingston Elsevier  Evidence for Health  Centre for Reviews and Dissemination (useful resource if looking for systematic reviews in particular):  Trip database – helps with answering EBP questions