BY JORDAN KESSLER RN, BSN

Implementing Evidence Based Practice at BJU

EVIDENCE-BASED PRACTICE

What is Evidence Based Practice? (EBP)

Best Evidence Research

Clinical Expertise

Patient Values &

Preferences

EBP

Evidence based practice has 5 simple steps,

known as the 5 A’s

Provide an algorithm to guide the EBP process

Step-by-step process

Use as a guide when there is not up-to-date evidence based protocol/procedures for them to use

Types of EBP Models

47 different types of EBP models exist today in literature

Of those 47 models, they can be characterized into 4 main categories

Knowledge Transformation Processes Strategic/ Organizational Change Theory to Promote

Uptake and Adoption of New Knowledge Knowledge Exchange Synthesis for Application and Inquiry

Examples: Stetler Model, Iowa Model, PARiHS Model, & Colorado Model

Here is an example ofThe Colorado Patient- Centered

Interprofessional Evidence-Based Practice Model

Organizational Support

Leadership Mentorship Facilitation

All of these components are

important to sustaining an

evidence-based culture

Teamwork P

ositive W

ork

Environment

Autonom

y

Best practice

Professional D

evelopment

Training & Education

Quality & Safety

Excellent Nursing Care

Commitment 2

Service

Culturally Sensitive

Evidence-based Practic

e

Respect

BJU Current Model

Current Practices at BJU

Journal Club

Hourly rounding

Up2DateEducation

Practices are

evidence

informed

Presentation of Case Studies

Curriculum Training

Barriers to implementing EBP

Not enough time to read, review, research or implement new ideas

Overwhelming patient work loadNurse unaware of hospital resources, such as

usage of Up2date & journal clubThe amount of research can sometimes be

too overwhelming

Survey Conducted at BJU

Sample survey at BJU

Survey Questions

What level nurse are you?

Years of nursing experience ________ years

What type of nursing degree

Have you heard of Evidence based practice (EBP)?

Have you implemented EBP for clinical decision making in the past year?How many times per month have you accessed the following online database systems (Up2date) to search medical information?What is your motivation to access online database systems?

Are you willing to participate in evidence based projects or activities in the coming years?

Survey Results42 surveys completed

72% of nurses with a bachelors degree, 64% Level III nurse

79% of nurses know what evidence based practice is

MORE THAN ½ of the nurses have implemented evidence based practice for clinical decision making in the past year

21%

16%

17%11%

11%

25%

Why do you use Up2date?

a.        Improve clinical practice

b.       Research

c.        Patient discharge instructions

d.       Unsure of patient di-agnosis

e.       Promotion exam

f.         Self-learning

98% of the nurses use Up2Date 90% of nurses are interested in getting involved

18%

19%

14%18%

31%

Future interest

a.        Journal Club

b.       Evidence based practice committee

c.        Research team

d.       Revising procedures to be aligned with EBP

e.       Education

How can BJU change its current EBP and continue to provide quality

patient care?

Choose an EBP Model

Nursing Change Theory

SUCCESS!

Nursing Change Theory

Kotter 8 Step Model, created in 1996, based on a 8 step process

“According to John Kotter, 70 percent of all major change efforts in organizations fail because

organizations do not take the holistic approach required to effect that change”

8 step model increases changeImproves operating process and effectivenessChange is difficult both for the organization and for staffThis models offers a road map for implementing change

Create

urgency

Form a pow

erful coalition

Create a vision for

change

Com

municate the vision

Empow

er action

Create quick w

ins

Build on the change

Make it stick!

Kotter 8 Step Model

Quality & Safety

Excellent Nursing Care

Commitment 2 Service

Culturally Sensitive

Evidence-based

Practice

Respect

Kotter Change Model + EBP

Using the Kotter Change Model you can follow the EBP steps Construct a patient question or clinical case

P- Patient/population/Problem I-Intervention/Exposure C-Comparison O-Outcome

Research the literature Look for valid applications Apply the evidence to your practice Evaluate

How to continue to improve EBP at BJU

TrakCare Implementation of standardized nursing terminology

Exit Writer

Improvement in discharge instructions

Journal Club

Continuation and creation of Evidence Based Practice

Committee

Promotion Exam

Incorporate evidence based practice questions into exam for

Level III/IV

2016 Future

THANK YOU!

References

Goode,C., Fink,R., Krugman,M., Oman, K., Traditi,L. (2011). The colorado patient-centered interprofessional evidence-based practice model: a framework for transformation. Worldviews on Evidence-Based Nursing. Retrieved from https://www.researchgate.net/publication/49660700_The_Colorado_Patient-Centered_Interprofessional_Evidence-Based_Practice_Model_A_Framework_for_Transformation

Gawlinksi, A. Rutledge,D. (2008). Selecting a model for evidence-based practice changes: a practical approach. AACN Advanced Critical Care, 19(3), 291-300. Retrieved from http://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf

Kotter International (2016). The 8 step process to leading change. Kotter International. Retrieved from http://www.kotterinternational.com/the-8-step-process-for-leading-change/

Melnyk,B., Fineout-Overholt,E., Stillwell,S., Wiliamson,K. (2009). Igniting a spirit of inquiry: an essential foundation for evidence-based practice. AJN, 109 (11), 49-52. Retrieved from http://evidencebasednurse.weebly.com/

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html

http://qsen.org/evidence-based-practice/ (example print out)