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Implementing Evidence-Based Practice: Strategies for Success

Implementing Evidence-Based Practice: Strategies for Success. Erin Kyle, DNP, RN, CNOR, NEA-BC Perioperative Practice Specialist AORN. Objectives. Define evidence-based practice EBP Describe two barriers for implementing evidence-based practice in the perioperative setting

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Implementing Evidence-Based Practice: Strategies for Success

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  1. Implementing Evidence-Based Practice: Strategies for Success Erin Kyle, DNP, RN, CNOR, NEA-BC Perioperative Practice Specialist AORN

  2. Objectives Define evidence-based practice EBP Describe two barriers for implementing evidence-based practice in the perioperative setting Describe two strategies that can be used to facilitate implementing evidence-based practice Discuss experience with implementation of evidence based practice in your facility

  3. Evidence-Based Experiences When you tried and either succeeded or failed at implementing EBP Imagine a time….

  4. EBP is …conscientious use of current best evidence in making decisions about patient care. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. (2000) Evidence-based medicine: how to practice and teach EBM. 2d ed. London, U.K.: Churchill Livingstone

  5. EBP Elements Problem-solving Clinical expertise, Patient values Evidence search & appraisal Problem-solving approach to practice Takes into account one’s own clinical expertise & the patient’s preferences and values Systematic search for and critical appraisal of most relevant evidence to answer a burning question

  6. Barriers & Strategies for Success Systematic search • how to find relevant evidence? • how to identify reputable sources? Critical appraisal • How is this done? Implementation in the practice setting • Asking the right question • Engaging the right people at the right time

  7. Systematic Search for Evidence Finding reputable sources Is Google considered reputable? Not for scientific evidence!

  8. Use reputable sources .gov, .org, .edu Choose keywords wisely (use PICOT terms) How to search?

  9. Reputable Sources

  10. Critical Appraisal of Evidence What is it? Value How good is it? Quality

  11. What is it? Identify the type of study or review to determine strength of evidence.

  12. What is it?Value A rigorous synthesis of research findings on a particular research question, using systematic sampling and data collection procedures and a formal protocol where all included studies are randomized control trials (RCT). A full experimental test of an intervention, involving random assignment to treatment groups

  13. What is it?Value A design for an intervention study in which subjects are not randomly assigned to treatment conditions; also called nonrandomized trial or a controlled trial without randomization. A rigorous synthesis of research findings on a particular research question, using systematic sampling and data collection procedures and a formal protocol.

  14. What is it?Value A rigorous synthesis of research findings on a particular research question, using systematic sampling and data collection procedures and a formal protocol where included studies are mixed. The investigation of phenomena, typically in an in-depth and holistic fashion, through the collection of rich narrative using flexible research design. Used for the purpose of discovering important underlying themes, categories, and patterns of relationships. Studies in which the researcher collects data without introducing an intervention; also called observational research

  15. What is it?Value Systematically developed recommendations from recognized experts based on consensus opinion that guides members of a professional organization in decision making related to practice or a particular issue of concern. Practice guidelines that are evidence-based, combining a synthesis of appraisal of research evidence with specific recommendations for clinical decisions.

  16. What is it?Value Advice or statements from individual(s) with knowledge and expertise on a particular topic or issue Initiative with a goal to improve the processes or outcome of care being delivered within a particular institution or organization A critical summary of research on a topic of interest, often prepared to put a research question into context. In-depth analysis of an individual, group, or other social unit issue or event.

  17. AORN Appraisal Tools https://www.aorn.org/guidelines/about-aorn-guidelines/evidence-rating

  18. How good is it?Quality – RESEARCH Study

  19. How good is it?Quality – RESEARCH Summary

  20. How good is it?Quality – NONRESEARCH - Literature Review, Expert Opinion, Case Report

  21. How good is it?Quality – NONRESEARCH - Organizational Experience

  22. Appraisal Score Evidence Rating in AORN Guidelines

  23. Reactive, Proactive, or a Way of practicing? Reactive: in response to a poor outcome or near miss Proactive: Improvement project, noticed practice variation Way of practicing: you approach every clinical decision by asking yourself “what does the evidence suggest?” Implementing EBP

  24. Focused effort: PICOT Question Patient or Problem Intervention Comparison Outcome Timeframe Clearly defining this question makes it easier to communicate with your team as you progress in your evidence-based practice improvements.

  25. PICOT Question – where does it come from? Wide variations in same clinical practice? Poor patient outcomes? Challenges in nursing care delivery

  26. PICOT format and example In _______________(P), how does _________(I) compared with _________________(C) affect __________________ when _______________ (T)? In neurosurgery for lumbar spine instrumented cases, how does prone positioning with a mirrored face cradle compared with a non-mirrored face cradle affect airway management when cases are longer than 3 hours?

  27. PICOT format and example In _______________(P), how does _________(I) compared with _________________(C) affect _________________ when _______________ (T)? In pediatric surgery, how does use of warm blankets compared with forced warm air affect normothermia when patient is admitted to PACU after cases using general anesthesia?

  28. PICOT format and example Among ____________(P), how does _________(I) compared with _________________(C) affect _________________ when ________________ (T)? Among OR RNs, how does a full lunch break compared with no lunch break affect morale when it is time for shift end?

  29. In/among __________(P), how does _______(I) compared with _______(C) affect _____when/after/during ____ (T)? Activity

  30. Implementation in the Practice Setting 6 Steps Develop PICOT question; gather & appraise evidence Synthesize evidence; communicate findings Recommend practice changes (or not) depending on your findings Engage leaders in efforts Acquire needed resources and permissions for policy changes if required Implement change within your team

  31. Certificate in the Fundamentals of Evidence-Based Practice AORN education online education course. Pretest 10 learning segments including review of evidence types, search strategies, appraisals, implementation steps. Posttest LINK

  32. Resources https://www.aorn.org/guidelines/about-aorn-guidelines https://www.aorn.org/guidelines/clinical-resources/nursing-research https://www.aorn.org/aorn-journal https://www.aorn.org/about-aorn/aorn-newsroom/or-exec-newsletter/2016/2016-articles/making-evidence-based-changes-stick Back to Basics: Implementing Evidence-Based Practice (2014) Implementing Evidence-Based Practice: Real-Life Success Stories (2012) AORN Certificate in the Fundamentals of Evidence-based Practice

  33. References Huang, X., Lin, J., & Demner-Fushman, D. (2006). Evaluation of PICO as a Knowledge Representation for Clinical Questions. AMIA Annual Symposium Proceedings, 2006, 359–363. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995 Nov–Dec;123(3):A12–3. Sackett DL, Straus S, Richardson S, Rosenberg W, Haynes RB. (2000) Evidence-based medicine: how to practice and teach EBM. 2d ed. London, U.K.: Churchill Livingstone. Spruce, L. Back to Basics: implementing evidence-based practice. AORN J. 2015:101(1):106-114. Spruce, L, Van Wicklen, SA, Wood, A. AORN’s Revised Model for Evidence Appraisal and Rating. AORN J. 2016:103(1):60-72. Spruce, L, Mellinger, E, Bakewell, S. Certificate in the Fundamentals of Evidence Based Practice. AORN, Inc. https://www.aorn.org/education/individuals/continuing-education/online-courses/individual-modules/fundamentals-of-evidence-based-practice. Accessed 4/11/2018

  34. AORN Perioperative Practice Specialists 2170 South Parker Road, Suite 400 Denver, CO 80231 (800) 755-2676 www.aorn.org

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