Evidence-based Practice (EBP) Robin Newhouse, PhD, RN, NEA-BC

Transcription

1 Evidence-based Practice (EBP) Robin Newhouse, PhD, RN, NEA-BC

2 Participants will be able to: Objectives 1. Describe the evidence based practice process for decision making to promote quality patient care. 2. Identify the elements of evaluating research evidence.

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5 Nurses should. 1. practice to the full extent of their education and training. 2. achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. be full partners, with physicians and other health professionals, in redesigning health care in the United States. IOM (Institute of Medicine) The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

6 Effective workforce planning and policy making require better data collection and an improved information infrastructure. IOM (Institute of Medicine) The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

7 Core Measures Research Safety EBP QI Newhouse, R.P. (2007). Diffusing Confusion Among Evidence-based Practice, Quality Improvement and Research, Journal of Nursing Administration, 37(10),

8 EBP is. a problem-solving approach to clinical decisionmaking within a health care organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence. EBP considers internal and external influences on practice, and encourages critical thinking in the judicious application of evidence to care of the individual patient, patient population, or system. Newhouse R, Dearholt S, Poe S, Pugh LC, White K. (2007). The Johns Hopkins Nursing Evidencebased Practice Model and Guidelines. Indianapolis, IN: The Honor Society of Nursing, Sigma Theta Tau International, p. 3-4.

9 Council for Training in Evidence Based Behavioral Practice (EBBP) Bonnie Spring, Ph.D., ABPP Northwestern University Robin Newhouse, Ph.D., RN University of Maryland Ross C. Brownson, Ph.D. Washington University Jason Satterfield, Ph.D. University of California San Francisco Edward Mullen, D.S.W. Columbia University Stephen Persell, M.D., M.P.H. Northwestern University EBBP.org is funded by a National Library of Medicine contract N01-LM from the Office of Behavioral & Social Sciences Research, National Institutes of Health (N01-LM ) to Northwestern University.

10 Resources for Training in Evidence Based Behavioral Practice ( EBBP.org is funded by a National Library of Medicine contract N01-LM from the Office of Behavioral & Social Sciences Research, National Institutes of Health (N01-LM ) to Northwestern University. Satterfield, J., Spring, B., Newhouse, R., Mullen, E., Brownson, R., Walker, B. & Whitlock, E. (2009), Toward a transdisciplinary model of evidencebased practice. Milbank Quarterly, 87(2),

11 Resources for Training in Evidence Based Behavioral Practice ( EBBP.org is funded by a National Library of Medicine contract N01-LM from the Office of Behavioral & Social Sciences Research, National Institutes of Health (N01-LM ) to Northwestern University.

12 Ask P Patient, Population or Problem I Intervention C Comparison with other treatments O Outcome Richardson WS, Wilson MC, Nishakawa J, Hayward RS. (1995). The well-built clinical question: a key to evidence-based decisions. ACP J Club, 123(3): A12- A13.

13 Acquire Database search (CINAHL, PubMed) Cochrane Library National Guideline Clearinghouse Internet resources (e.g. AHRQ, CDC, NIH) Books Footnote chasing and hand searching Consultation with colleagues Professional associations Experts

14 Search Strategies Key words MESH terms Boolean operators (AND, OR, NOT) Spellings (organization vs. organisation) Limits

15 Appraise Study Quality Design Quality Strength of Evidence Quality Quantity Consistency Systems to Rate the Strength of Scientific Evidence. Summary, Evidence Report/Technology Assessment: Number 47. AHRQ Publication No. 02-E015, March Agency for Healthcare Research and Quality, Rockville, MD.

16 Intervention Research Experimental Quasi-experimental Nonintervention Research Non-experimental Qualitative Study Design

17 Research Hierarchy Level I Level II Level III Levels of the Evidence Experimental study/randomized controlled trial (RCT) or meta analysis of RCT Quasi-experimental study Non-experimental study, qualitative study, or metasynthesis. Newhouse, R.P., Dearholt, S., Poe, S., Pugh, L.C., White, K. (2007). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Sigma Theta Tau International: Indianapolis, IN.

18 Comparative Effectiveness Research The terms comparative clinical effectiveness research and research mean research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of 2 or more medical treatments, services, and items described in subparagraph (B). PUBLIC LAW MAR. 23, Subtitle D- Patient Centered Outcomes Research Institute (PCORI). Section Available At:

19 Appraisal of Evidence The quality of the study is dependent on how well bias is controlled.. Intervention Blinding Selection (sample and setting) Sample size Methods

20 Synthesized Evidence Systematic Reviews Guidelines

21 Non-Research Evidence Expert opinion Quality Improvement Patient Satisfaction Clinical operations Newhouse, R.P., Dearholt, S., Poe, S., Pugh, L.C., White, K. (2007). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Sigma Theta Tau International: Indianapolis, IN.

22 Summarizing Overall Evidence A concise summary of results based on the quality, quantity and consistency of evidence.

23 U.S. Preventive Services Task Force Grade Definitions Grade A B Suggestions for Practice Offer or provide this service. Offer or provide this service. C D Offer or provide this service only if other considerations support the offering or providing the service in an individual patient. Discourage the use of this service. I Statement Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms. U.S. Preventive Services Task Force Grade Definitions After May May Agency for Healthcare Research and Quality, Rockville, MD.

24 Levels of Certainty Regarding Net Benefit Level of Certainty* High Moderate Low Description The available evidence usually includes consistent results from well-designed, wellconducted studies in representative primary care populations. The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained. The available evidence is insufficient to assess effects on health outcomes. U.S. Preventive Services Task Force Grade Definitions After May May Agency for Healthcare Research and Quality, Rockville, MD.

25 Apply Design and tailor strategies to apply the evidence to the setting and patient population Incorporate implementation strategies into standard organizational or unit processes. Pilot the implementation strategies locally

26 Analyze & Adjust Evaluate processes and outcomes Make adjustments as needed. Disseminate findings when it is determined the intervention was successful

27 Case Example Does the continuous infusion of enteral tube feedings compared to withholding enteral tube feedings for two hours before and 2 hours after the administration of phenytoin suspension have an effect on phenytoin levels in adult patients? Dearholt, Fitzsimmons, James-White, Corn, Boyle, Adams, Lewin, & Carlson. (2007). In Newhouse, R.P., Dearholt, S., Poe, S., Pugh, L.C., White, K. Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Sigma Theta Tau International: Indianapolis, IN, p

28 PICO-Ask P- Adult patients receiving tube feedings and phenytoin suspension I- Continuous infusion of enteral tube feedings C-Withholding enteral tube feedings for two hours before and 2 hours after the administration of phenytoin suspension O-Therapeutic phenytoin levels

29 Acquire & Appraise Five sources of evidence retrieved and reviewed: 1 Experimental 1 B 1 Quasi-experimental II B 3 Expert Opinion IV and V A 0 Guidelines 4 Responses from practice network (1 did not hold tube feedings, 3 held tube feedings for 1 hour before and one hour after tube feedings)

30 Apply, Assess & Adjust Policy revised No longer hold tube feedings before and after phenytoin suspension Interdisciplinary team Pharmacy and Therapeutics Committee approval No adverse events

31 Accelerating Nursing Engagement in EBP Nursing curriculum revisions Engaged clinicians at all levels Conceptual development and consensus Capacity building Newhouse, R.P. & Spring, B. (2010). Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy. Nursing Outlook, 58(6),

32 EBBP Training Modules EBBP Process Module Search for Evidence Module Systematic Review Module Critical Appraisal Module Randomized Controlled Trials Module Shared Decision-Making with Individual Clients Collaborative Decision-Making with Communities Located at

33 Questions? EBBP Website Located at Interactive online EBBP training modules Located at