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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 9Implementing Evidence in
Clinical Settings
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Promoting Engagement
Engage
Clinical staff
Administrators
Members of other disciplines
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
What is the most effective strategy for engaging care providers in a proposed EBP change?
a. Disseminate the evidence that underlies the change
b. Remind staff of their obligation to provide optimal care
c. Bring in EBP experts to speak to staff members
d. Organize discussions and meetings with EBP mentors
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following evaluation indicators can be quantified and statistically analyzed?
a. Environmental changes
b. Professional expertise
c. Outcome measures
d. Patient-centered quality care
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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, and perseverance