TIGER Standards & Interoperability Collaborative. Evidence Based Practice Standards Tutorial. Tutorial Outline. Objective Definitions The Practice of Evidence Based Nursing: a. Clinical Questions b. Searching Best Evidence c. Evaluation of Evidence
TIGER Standards & Interoperability Collaborative Evidence Based Practice Standards Tutorial
Tutorial Outline • Objective • Definitions • The Practice of Evidence Based Nursing: a. Clinical Questions b. Searching Best Evidence c. Evaluation of Evidence d. Applying Evidence to Practice c. Evaluation • Case Study • Resources: Evidence Based Centers, Websites, Journals • Contact information – TIGER & Authors
Objective At the completion of the tutorial the nurse will be able to describe the process of evidence based nursing practice (EBNP) and it’s related importance to the practice of professional nursing and delivery of quality healthcare . The nurse can identify the process of translating the best available evidence into practice and will be introduced to EBP internet resources.
Definition: Evidence Based Practice A problem solving approach to practice that involves the conscientious use ofcurrent best evidence in making decisions about patient care; EBP incorporates asystematic search for and critical appraisal of the most relevant evidence toanswer a clinical question along with one's own clinical expertise and patientvalues and preferences.
Definition: Quality The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Nursing as a Research Based Profession Current Healthcare Climate Insists on the Wisest Delivery of the Best Clinical Practices and Care: FACTORS: • Explosion of Literature • Unmet Information Needs • Implementation Delays • Aging Population • Fewer Financial Resources • Higher Acuities • Fewer Staff
Definition: Best Practices Best Practices refers to nursing practices that are based on the best research evidence. Synonymous terms include research based practice and research utilization. An application example would be use of an AHRQ Clinical Guideline.
Evidence Based Advocates:1. Institute Of Medicine: Performance Standards: The Institute of Medicines’ efforts include redesigning care delivery and keeping patients safe. The IOM’s global focus is on improved quality and a transformation of 21st century care delivery. The 2003 IOM report “Health Professions Education: A Bridge to Quality” recommends integration of core competencies to include EBP into health professions education.
Evidence Based Advocates:2. AHRQ: Adoption and Consistency of Performance: The Agency for Healthcare Research and Quality’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. The AHRQ funds evidence based centers and supports the National Guideline Clearinghouse
Evidence Based Advocates:3. Specialty Organizations (i.e., AACN, NANN, Sigma Theta Tau, ONS): These organizations provide resources for nurses to identify, critically appraise, and use evidence in practice.4. ANCC Magnet Recognition Program5. Payers, Payees and Patients!
A Model for Evidence Based Practice • Rosswurm & Larrabee, 1999, Sigma Theta Tau Int. Assess Link Synthesize Design Implement/ Integrate/ Evaluate Maintain Not sure about this slide (haven’t added explanation……. It could confuse, however it is the only model I know of that Has the “link” piece which describes selecting in a standardized language
Evidence Based Practice: A 5- Step Process • Formulate a well-built question • Identify evidence based resources that answer the question • Critically appraise the evidence • Apply the evidence • Re-evaluate the application of evidence
1. Formulate a Well Built Question: *Construct a specific clinical question using PICO format. P= Patient Population I= Intervention/ Issue of Interest C= Comparison Intervention or Comparison Group O= Outcome (T)= Time
1. PICO Example In adult cardiac surgery patients (P), is morphine (I) or fentanyl (C) more effective in reducing postoperative pain? (O)
2. Identify evidence based resources that answer the question Search for an evidence based answer using PICO keywords in critically appraised sources (relevant research). Since some evidence is stronger than others and cannot be regarded equally, evidence hierarchies have been developed which rate the strength of the evidence or grade the recommendations.
An example of an evidence hierarchy from the U.S. Dept. Of Health and Human Services ( now AHRQ) National Guidelines Clearinghouse: Ia Meta-Analysis of randomized control trials Ib One randomized control trial IIa One well designed control study without randomization IIb One well designed quasi-experimental study III Well designed non-experimental study IV Expert committee reports, expert opinions, consensus statements, expert judgement 2. Identify evidence based resources that answer the question
2. Identify evidence based resources that answer the question In 1998 Stetler and colleagues made a contribution to the format which impacted nursing. The admissible evidence was expanded to include qualitative studies, quality improvement and program evaluation.