Evidence-Based Practice in Healthcare

Evidence-Based Quality & Patient Safety Management

• Evidence-Based Practice (EBP) is an approach to improving healthcare
• EBP involves using the best scientific research evidence with clinical experience and patient values
• Steps in EBP include: framing clinical questions, finding evidence, assessing the evidence, and making clinical decisions.
• A cornerstone of the evidence-based movement was established by Dr. Archie Cochrane, a British epidemiologist.

Introduction to Evidence-Based Practice and Inquiry

• Part I covers the history, definition, components, advantages, disadvantages, and benefits of Evidence-Based Practice (EBP).
• Part II covers barriers to adopting EBP, strategies for overcoming those barriers, the necessary skills for EBP, implementation challenges, and problems faced in implementing EBP.

Brief History of EBP

• Dr. Archie Cochrane highlighted the need for rigorous reviews of research evidence.
• Cochrane advocated for the use of randomized clinical trials (RCTs) to determine preferred treatments and practices.
• The Cochrane Library was developed as a systematic repository for this research evidence.
• The term "evidence-based medicine" emerged during the 1980s, prioritizing scientific evidence in clinical decision-making.
• The term shifted to "evidence-based practice" to emphasize the importance of several factors, not just scientific evidence in clinical decision-making.

Evidence-Based Practices versus Practice Based Evidence

• Evidence Based Practices (EBP) integrates the best research evidence with clinical expertise and patient values.
• Practice Based Evidence is a range of approaches and supports that are locally derived.

Comparison between EBP, research, and QI process

• A table comparing EBP, Research and QI processes is presented, but the table has not been included in the summary.

Importance of EBP to practice

• EBP leads to better patient outcomes.
• EBP keeps practice current.
• EBP increases confidence in decision-making.
• EBP supports regulatory requirements.
• Integration of EBP into healthcare is crucial for high-quality care.

The Benefits of Evidence-Based Practice

• EBP promotes positive patient outcomes through a shared decision-making strategy.
• EBP reduces hospital-acquired infections by using proven, evidence-based procedures.
• EBP empowers patients by allowing involvement in their care planning.
• EBP prompts method changes when evidence conflicts with current practice, resulting in improved care.
• EBP helps to reduce healthcare costs by preventing complications.

Increased Patient Safety

• EBP plays a vital role in ensuring safe and effective care, minimizing errors, and preventing adverse events.
• EBP provides up-to-date information on best practices for medication administration, infection control, and fall prevention.

The Principles of Evidence-Based Practice

• EBP is based on two principles - understanding that scientific evidence alone is insufficient for decision-making and that a hierarchy of evidence exists where some sources are more valid than others.

Component of evidence-based practice

• Key components of EBP include clinical expertise, management of patient values and preferences, practice management and decision-making, integration of best available evidence in clinical practice

Four Elements of Evidence-Based Practice

• The four elements of EBP are the best research available, expertise or clinical experience of the clinician, patient values/preferences, and the immediate surrounding environment.

Advantages of evidence-based practice

• EBP improves consistency of care across professional boundaries
• EBP allows for client-focused care and establishes structured dissemination processes for best evidence
• EBP makes practices more transparent and less open to misinterpretation
• EBP makes information more readily available to the public and improves clarity regarding known versus unknown aspects, allowing for better research
• EBP helps develop the scientific knowledge base within healthcare

Disadvantages of evidence-based practice

• EBP takes time and resources.
• Limited evidence in some areas of practice.
• Does not cater to all patient needs, especially those with complex or multifaceted needs.
• May reduce professional judgment and autonomy.
• Evidence not always available for certain areas of practice

Barriers of evidence-based practice

• Lack of value for research in practice
• Difficulty in adopting changes
• Lack of administrative support
• Lack of credible knowledge mentors

Strategies for overcoming barriers to adopting an EBP

• Various strategies are presented, but the specific strategies are not included in the summary.

Lack of knowledge about EBP and research

• Methods for addressing strategies for overcoming the lack of knowledge and resources about EBP are presented, but the specific strategies are not included in the summary

Lack of technological skills to find evidence

• Ways to address barriers related to technological skills in finding evidence are included, but not in this summary

Lack of resources to access evidence

• Ways to overcome these barriers are outlined in the text but are not included here

Lack of ability to read research

• Ways to encourage a willingness to read and understand research are included in the text but are not included here

Resistance to change

• Ways to foster an environment of change are listed but not detailed here

Organizational does not embrace EBP

• Strategies for encouragement of EBP implementation are listed here but not detailed.

Sources of EBP

• EBP is based on four main sources: scientific literature, organization internal data, practitioner experience and stakeholders' values and concerns.

5 Main Skills Required for Evidence-Based Practice

• Critical thinking
• Scientific mindset
• Effective communication
• Identifying knowledge gaps
• Integrating findings into relevant practice

Major Challenges Face in the Implementation of EBP

• Lack of understanding or value
• Fear of not being accepted.
• Negative attitudes toward research and EBP.
• Lack of knowledge in research methods
• Resource constraints
• Work overload
• Inaccurate or incomplete research findings
• Disconnection between patient needs and evidence-based practices
• Lack of internet access

Process of Evidence-Based Practice & critical appraisal of evidence

• Process of EBP
• Rating evidence/scientific evidence using a hierarchy
• PICOT search steps

The 5 Step EBP Process

• ASK: Formulate an answerable clinical question
• ACCESS: Identify and access the best available evidence
• APPRAISE: Evaluate the validity and usefulness of evidence
• APPLY: Integrate best evidence with your practice and patient needs
• ASSESS: Evaluate the success of the EBP process

Searching and accessing the evidence

• Finding relevant evidence.
• Using experts and librarians.
• Locating primary sources such as original research and secondary sources like summaries or reviews, policy guidelines etc

Hierarchy of evidence

• Ranking based on trustworthiness of evidence (e.g., Systematic reviews are prioritized over individual case reports).

Case control studies, Cohort studies, Meta-analysis, Randomized controlled clinical trials, Systematic Reviews

• Descriptions and characteristics of each type of study design.

Summary Studies definition

• Definitions of Meta-analysis and Systematic review to summarize results; Randomised controlled trials, cohort studies, case control studies and case reports to aid in the apprasial of the evidence

Application of best evidence to practice

• Considering resources, staff, equipment, environment, time, funding.
• Evaluating if evidence is compatible with wider service philosophy.
• Review implications of EBP for other processes.

Literature summary table

• Table format for summarizing articles.