Implementing Evidence in Clinical Settings

1. Implementing Evidence in Clinical Settings Dr Samira Alsenany

2. EBP in Clinical Practice • Knowledge must be translated into clinical practice to improve patient care and outcomes • The understanding of care based on evidence is often far removed from clinical practice • Developing an environment that fosters a culture of EBP is key

3. Vision for EBP • Begin with a vision and an understanding of the goals to be accomplished • An image of the future is created to begin the transformation process • Often this vision is mandated • Regulatory bodies • Insurance providers • Magnet recognition

4. Developing a Vision for Change • Begins with a few passionate individuals • Involvement of clinical experts and EBP mentors is key • Preparation and planning are essential • Sharing the vision for excellence in practice is the most essential catalyst for promoting EBP

5. Promoting Engagement • Engage • Clinical staff • Administrators • Members of other disciplines

6. Assessing and Eliminating Barriers • Even when change is welcome, it is stressful • Stakeholder resistance to change must be explored early • Barriers to be addressed include • Inadequate knowledge and skills • Weak beliefs about the value of EBP • Poor attitudes toward EBP • Lack of EBP mentors • Social and organizational influences • Economic restrictions

7. Question • Tell whether the following statement is true or false. • Implementation of EBP is the responsibility of graduate-prepared nurses and members of the nursing leadership.

8. Answer • False • Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines.

9. Question • What is the most effective strategy for engaging care providers in a proposed EBP change? • Disseminate the evidence that underlies the change • Remind staff of their obligation to provide optimal care • Bring in EBP experts to speak to staff members • Organize discussions and meetings with EBP mentors

10. Answer • d. Organize discussions and meetings with EBP mentors • Rationale: Interactive discussions between EBP mentors and care providers are an effective way to increase knowledge and address attitudinal barriers. Other strategies, such as bringing in outsiders to teach, disseminating research findings, or telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change.

11. Promoting Engagement • Prioritize clinical issues • Start with a clinical issue of direct interest to clinicians • Evaluate the infrastructure • Resources, time, and administrative support • Develop experts in the EBP process • Mentorship

12. Integrating EBP into Practice • Education alone will not change behavior • Establish formal implementation teams • Advanced practice and graduate-prepared nurses • Build excitement • Focus on the potential improvement in outcomes • Disseminate the evidence • Use active and engaging educational techniques

13. Integrating EBP into Practice (cont’d) • Develop clinical tools • Written guidelines, EBP summaries, pre-printed orders, algorithms, prompts, and reminders • Pilot test the practice change • Preserve energy sources • Develop strategies to maintain excitement and preserve energy resources • Choose a timeline carefully • Celebrate successes along the way

14. Evaluating Outcomes of EBP Change • An important, yet often overlooked, step in EBP • Evaluation indicators • Outcome measures – quantifiable healthcare results • Quality care improvement • Quantify how interventions impact the quality of patients’ and families’ lives • Patient-centered quality care • The value patients and families place on the healthcare received

15. Evaluating Outcomes of EBP Change (cont’d) • Efficiency of processes • E.g., appropriate timing of interventions, effective discharge planning, and efficient utilization of hospital beds • Environmental changes • E.g., evaluation of policy and procedure adherence, unit resource availability, and healthcare professional use of supplies and materials • Professional expertise • Establishing expectations for adherence to accepted standards of care essential for best practice

16. Question • Which of the following evaluation indicators can be quantified and statistically analyzed? • Environmental changes • Professional expertise • Outcome measures • Patient-centered quality care

17. Answer • c. Outcome measures • Rationale: Outcome measures are quantifiable healthcare results, such as health status, death, disability, iatrogenic effects of treatment, health behaviors, and the economic impact of therapy and illness management. Environmental changes, professional expertise, and patient-centered quality care are measures that equally important, but which are more qualitative in nature.

18. Summary • An EBP environment promotes excellence in clinical care resulting in improvement of patient outcomes • Transforming a healthcare institution into a setting where an EBP culture exists requires persistence, patience, andperseverance