8. DBP40302 Implementing evidence into practice.pdf
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DBP40302 EVIDENCE BASED PRACTICE IN HEALTH PROFESSION Implementing Evidence into Practice Elza Othman, Ph.D. School of Medical Imaging Faculty of Health Sciences Universiti Sultan Zainal Abidin Learning objectives 1)...
DBP40302 EVIDENCE BASED PRACTICE IN HEALTH PROFESSION Implementing Evidence into Practice Elza Othman, Ph.D. School of Medical Imaging Faculty of Health Sciences Universiti Sultan Zainal Abidin Learning objectives 1) To learn how research findings can be translated into practice 2) To learn about evidence-practice gap and methods that can be used to demonstrate an evidence-practice gap 3) To determine the various types of barriers and enablers to successfully implementing evidence Introduction ❑ Implementing evidence in practice is a process where health professionals are supported to use research findings more routinely in practice ❑ Knowledge must be translated into clinical practice to improve patient care and treatment outcomes ❑ Unfortunately, most published research is often not applied routinely in practice for a range of reasons ❑ Health professionals need to do more than read about research to be an ‘evidence-based practitioner’ Implementing evidence into practice ❑ Implementation is a complex and active process which involves individuals and teams, systems and organizations ❑ The process of implementation comprises activities that can be summarized into five (5) steps: Step Demonstrating an evidence-practice gap 1 Step Planning for change 2 Step Identifying barriers and enablers to change 3 Step Preparing for and commencing implementation 4 Step Evaluating and planning 5 Implementing evidence into practice 1. Demonstrating an evidence-practice gap a common first step is to identify and clarify the evidence-practice gap often there is a ‘gap’ between what is known and what is done in practice this evidence-practice gap may relate to testing procedures/treatment a new procedure/treatment should be more accurate, sensitive, or effective than the one(s) in current use a test procedure/treatment may either be underused (e.g. DTI, collimation) or overused (e.g. X-ray, gonad shield) in both instances, changes in practice are required Implementing evidence into practice 1. Demonstrating an evidence-practice gap methods to identify underused/overused evidence-based practice: i. Survey ▪ a survey is more suited for situations where anonymity is preferred ▪ a survey can be developed and used to explore knowledge, attitudes, and current practice behaviors among health professionals or clients ▪ a survey can also identify barriers to change and strategies to overcome barriers ▪ if a large proportion of health professional admit to knowing little about, or rarely using, an evidence-based practice, this information represent the evidence-practice gap Implementing evidence into practice 1. Demonstrating an evidence-practice gap methods to identify underused/overused evidence-based practice: ii. Interviews ▪ interviews allow a topic to be approached from the point of view of participants and where anonymity is not a priority ▪ the advantage of interviews is the possibility of going deeper into the topic without the need for structured questions in advance ▪ an interview can be used to explore knowledge, attitudes, and current practice behaviors among health professionals or clients ▪ an interview can also identify barriers to change and strategies to overcome barriers Implementing evidence into practice 1. Demonstrating an evidence-practice gap methods to identify underused/overused evidence-based practice: iii. Focus group ▪ focus groups can be helpful if the group is homogenous and participants are willing to talk openly about the topic ▪ figures of authority can however influence the results, so the choice of the participants in the focus group needs careful consideration Implementing evidence into practice 1. Demonstrating an evidence-practice gap methods to identify underused/overused evidence-based practice: iv. Observation ▪ observation can be used to count how often practice activities are being delivered, and quantify the way things are done Implementing evidence into practice 1. Demonstrating an evidence-practice gap methods to identify underused/overused evidence-based practice: v. Medical record audit ▪ a clinical audit is a detailed review of selected clinical records ▪ an audit is usually completed by health professionals in order to help improve the quality of patient care and outcomes ▪ an audit seeks to determine how much of a procedure or treatment is being delivered as recommended by a clinical guideline ▪ information sought includes the percentage of clients screened/receiving an intervention, the number of sessions provided per client, and the content of sessions Implementing evidence into practice 2. Planning for change evidence-based practice need careful planning in order to succeed four (4) aspects need to be identified before implementing evidence into practice: i. Team ▪ who will be responsible for implementing this evidence in practice? ▪ who will be the coordinator? ▪ should other people be involved and meet regularly as a steering committee? ▪ what roles will each person have? Implementing evidence into practice 2. Planning for change ii. Stakeholders ▪ do you need to liaise with patients or clients? ▪ who could potentially sabotage the project and need to be involved early? ▪ will departments like transport need to be involved? or other disciplines? Implementing evidence into practice 2. Planning for change ii. Resources ▪ financial, transport, and access to medical records iii. Ethical clearance ▪ will ethics clearance be required? ▪ will the findings be published or disseminated? Implementing evidence into practice 3. Identifying barriers and enablers to change a series of barriers and enablers to change may be contributing to the evidence- practice gap barriers are factors that may decrease the likelihood of successful implementation of evidence enablers are factors that increase the likelihood of successful implementation of evidence when barriers and enablers have been identified, an evidence-based practice can be implemented Implementing evidence into practice 3. Identifying barriers and enablers to change Barriers include: i. Lack of skills and knowledge ▪ evidence-based practice cannot be implemented without skills and knowledge ▪ not all health professionals are equipped with the required skills and knowledge ▪ experienced health professional may be reluctant to acknowledge a lack of skills or knowledge Implementing evidence into practice 3. Identifying barriers and enablers to change Barriers include: ii. Beliefs and attitudes of professionals and team roles ▪ attitudinal barriers are easy to recognize ▪ most health professionals know someone in their team or organization that resist change ▪ not all health professionals are open to evidence-based practice Implementing evidence into practice 3. Identifying barriers and enablers to change Barriers include: iii. Limited resources ▪ resources may be needed to implement evidence-based practice ▪ lack of resources (e.g. equipment or transport) can hinder evidence-based practice Implementing evidence into practice 3. Identifying barriers and enablers to change Barriers include: iv. Clients' expectations about treatment ▪ clients may be reluctant to accept the new treatment ▪ not all evidence-based practice can be implemented to the clients Implementing evidence into practice 4. Preparing for and commencing implementation to implement a practice change within a healthcare setting, we need to understand the knowledge level of the relevant staff then develop an educational plan for those involved in the practice change and determine the outcomes to monitor during the educational process, using the teach-back method will help verify that the staff implementing the practice change has a clear understanding of why and how the practice change is occurring and what outcomes they will be monitoring once the staff has been educated, initiate the practice change Implementing evidence into practice 5. Evaluating and planning after implementing the practice change for a specific period, the staff should monitor outcomes to determine whether the practice changes have improved patient outcomes it is important to determine if change has occurred, and if so, how large the change has been? proper documentation is required to show that the organization is using evidence to improve practice Summary ❑ Patients deserve the very best care, based on the latest evidence ❑ Using the evidence improves practice, patient outcomes, and cost efficiencies ❑ All healthcare professionals need to understand that EBP does not mean just taking the latest research article and implementing it into practice ❑ EBP means using the latest evidence, combined with clinician expertise and patient preference, to deliver the highest quality care References 1. Howlett B, Rogo E, Shelton GT. (2013). Evidence Based Practice for Health Professionals. Jones & Bartlett Learning. 2. Hoffmann T, Bennett S, Del Mar C. (2017). Evidence based practice across the health professions. Elsevier. 3. Kramer T, Burns B. (2008). Implementing cognitive behavioural therapy in the real world: A case study of two mental health centres. Implementation Science; 3:14. 4. Melnyk BM, Fineout-Overholt E. (2011). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (2nd edition). Wolters Kluwer Health: Philadelphia, USA. 5. Pearson A, Weeks S, Stern C. (2011). Translation Science and the JBI Model of Evidence-Based Healthcare. Lippincott Williams & Wilkins: Philadelphia, USA. Class photo ❑ Class photo of Evidence Based Practice (2021/2022) Class photo ❑ Class photo of Evidence Based Practice (2021/2022) Class photo ❑ Class photo of Evidence Based Practice (2021/2022)
