Application of Evidence-based Practice to Nursing

00:00 Welcome back everyone.

00:02 Have you ever wondered why nurses started using alcohol gel in between routine patient contact instead of washing our hands with soap and water? Or why we stopped administering aspirin to children with fevers? It's all because of evidence-based practice.

00:18 Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well-designed studies, patient values and preferences and a clinician's expertise in making decisions about a patient's care.

00:33 The elements of evidence-based practice includes seven steps, they inform clinical guidelines and they contribute to improved patient outcomes.

00:44 Now let's review the seven steps of evidence-based practice.

00:48 First, cultivate a spirit of inquiry or continual questioning of clinical practices within an EBP culture and environment.

00:57 Second, ask the burning question in a PICOT format.

01:02 Third, search for and collect the most relevant best evidence.

01:08 Fourth, clinically appraise the evidednce, for example, use a rapid clinical appraisal, then evaluate, then synthesize and come up with your recommendations.

01:18 Next, integrate the best evidence with one's clinical expertise and the patient's preferences and values in making a practice decision or change.

01:27 Next, evaluate the outcomes of the practice decision or the change based on the evidence.

01:34 And finally, disseminate or share the outcomes of the EBP decision or change.

01:39 Now let's go into each one a little bit further.

01:43 The first step in EBP is to cultivate a spirit of inquiry which is a continual questioning of clinical practices.

01:50 Cultures and environments that support a spirit of inquiry are more likely to facilitate and sustain a questioning spirit in clinicians.

02:00 When delivering care to patients, it's important to consistently question current practices.

02:06 One example of a great question would be, Does double checking pediatric medications lead to fewer medication errors? After clinician ask the clinical question, it's important to place that question in PICOT format to faciliate an evidence search that is effective in getting to the best evidence in an efficient manner.

02:25 PICOT represents: Patient population, the Intervention or Interest area, the Comparison intervention or group, the Outcome, and Time if relevant.

02:42 So here's an example of a constructed PICOT question.

02:46 In hospitalized children, how does double-checking pediatric medications with a second nurse compared to not double-checking affect medication errors during a 30-day time period? Now, let's break it down a little further.

03:01 When we say in the question, "in hospitalized children", we're referring to the patient population.

03:08 In the question where it says, "how does double-checking pediatric medications with a second nurse", that's referring to the intervention or the interest area.

03:17 The next part of the question when we say, "compared to not double-checking", that speaks to comparison intervention or group.

03:26 When we say," affect medication errors", that relates to the outcome.

03:31 And then finally, when we say," during a 30-day time period", that refers to the time.

03:39 Now, after placing the clinical question in PICOT format with the proper template, we do the next steps.

03:45 We want to use each keyword in the PICOT question to systematically search for the best evidence, that's called keyword searching.

03:54 Next, we wanna extend the search to include all evidence that answers the clinical question.

04:00 Then, we're going to enter and search each keyword or phrase from the PICOT question individually.

04:07 And finally, we're going to combine keywords that were previously searched, which typically yields a small number of studies that should help answer the PICOT question.

04:17 Next, it's important to conduct a rapid critical appraisal of each study from the data search to determine whether they are what we call keeper studies, that is they indeed answer the clinical question.

04:29 Be sure to ask to ask these questions: First, are the results of the study valid? Meaning, did the researchers use the best methods to conduct the study which speaks to study validity? For example, assessment of a study's validity determines whether the methods used to conduct the study were rigorous.

04:47 The next question you'd like to ask would be, What are the results? Do the results matter and can I get similar results in my practice? That speaks to study reliability.

04:58 And finally, will the results help me in caring for my patients? Is the treatment feasible to use with my patients? which speaks to study applicability.

05:09 Rapid Critical Appraisal checklist can assist clinicians in evaluating validity, reliability, and applicability of a study in a time-efficient way.

05:20 After the body of evidence from the search is critically appraised, evaluated and synthesized, it should be integrated with the clinician's expertise and also the patient's preferences and values to determine whether the practice change should be conducted.

05:35 Providing the patient with evidence-based information and involving him or her in the decision regarding whether he or she should receive a certain intervention are important steps in EBP.

05:47 To facilitate greater involvement of patients in making decisions about their care in collaboration with healthcare providers, there has been an accelerated movement in creating and testing patient decision support tools which provide evidence-based information in a relatable, understandable format.

06:03 It's important to target the "so-what" outcomes that the current healthcare system considers important such as complication rates, length of stay, rehospitalization rates and costs given that hospitals are currently being reimbursed based on their performance on these outcomes.

06:21 After making a practice change based on the best evidence, it's critical to evaluate outcomes or the consequences of an intervention or treatment.

06:29 For example, an outcome of providing a baby with a pacifier might be a decrease in crying.

06:36 Outcomes evaluation is essential to determine the impact of the practice changes on healthcare quality and health outcomes.

06:45 When we think about dissemination or sharing the outcomes, it's important to remember that silos often exist, even within the same healthcare organization.

06:55 So that others can benefit from the positive changes resulting from EBP, it's important to disseminate or share the findings.

07:03 Now, various avenues for dissemination include: Institutional EBP rounds, Poster and podium presentations at local, regional and national conferences, and also, publications.

07:16 Clinical practice guidelines are systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances.

07:27 Guidelines can be used to reduce inappropriate variations in practice, promote the delivery of high quality evidence-based healthcare, they provide a mechanism by which healthcare professionals can be made accountable for clinical activities, And they can be developed either locally, meaning internal guidelines or regionally/nationally or external guidelines.

07:51 Next, let's review the stages of guideline development.

07:54 First, guidelines are based on the best available research evidence and require a detailed literature search.

08:01 Next, using the research evidence, guideline construction takes place usually through some form of small group work, with representation from as many interested parties as possible.

08:12 Then, the guideline is tested by asking professionals not involved in the guideline development to review it for clarity, internal consistency and acceptability.

08:21 The guideline can then be tested in select healthcare settings to see whether it's feasible for use in routine practice.

08:28 And finally, the guideline should be reviewed after a specified time period and modified to take into account new knowledge.

08:37 In speaking about guideline dissemination and implementation, dissemination refers to the method by which guidelines are made available to potential users.

08:46 This can happen through publication in professional journals, sending the guideline to trageted individuals, or strategies involved in an educational intervention.

08:55 Next is implementation.

08:57 and this means ensuring that the users subsequently act upon the recommendations that you've shared with them.

09:04 Evidence-based practice is important because it aims to provide the most effective care that is available with the aim of improving patient outcomes.

09:12 Patients expect to receive the most effective care based on the best available evidence.

09:18 Evidence-based practice promotes an attitude of inquiry in health professionals and starts us thinking about questions like, Why am I doing this in this way? Is there evidence that can guide me to do this in a more effective way? As health professionals, part of providing a professional service is ensuring that our practice is informed by the best available evidence.

09:39 Evidence-based practice also plays a role in ensuring that finite health sources are used wisely.

09:45 And that relevant evidence is considered when decisions are made about funding health services.

09:52 Remember, ensuring that clinicians meet established EBP competencies, along with creating cultures and environments that support EBP are key strategies to transform the current state of nursing practice and healthcare delivery to it's highest level.

10:09 So in thinking of what we've covered today, I'd like for you to consider this question: What are the seven steps of evidence-based practice? They are cultivate a spirit of inquiry within the EBP culture and environment, ask the burning question in a PICOT format, search for and collect the most relevant best evidence, critically appraise the evidence, integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change, evaluate outcomes of the practice decision or change based on evidence, and finally, disseminate or share the outcomes of the EBP decision or change.

10:51 I hope that you've enjoyed today's video on evidence-based practice.

10:55 Thanks so much for watching.