evidence based implementation

8/8/2019 Evidence Based Implementation

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Presented by:Ku Badlisyah Ku Aziz

Lily Fairuz Md. Yasan

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Content

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Content Slide

What you have learned?

What is Evidence Based Implementation?

The important of finding evidence of advanced in

clinical practice

The important of finding of effect of

intervention/prognosis and diagnostic test/experience

Explain why changing is hard (practice/management)

Explain evidence based practice physiotherapy in the

context of continuous quality improvement

What you want to know?

Content Slide

What you have learned? 3

What is Evidence Based Implementation? 4

The important of finding evidence of advanced in clinical

practice

8

The important of finding of effect of

intervention/prognosis and diagnostic test/experience

11

Explain why changing is hard (practice/management) 14

Explain evidence based practice physiotherapy in the

context of continuous quality improvement

17

What you want to know? 20

References 21


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What you have learned?

Definition of evidence basedpractice/implementation

Importance of finding evidence ofadvanced in clinical practice

Importance of finding of effect ofintervention/prognosis and diagnostictest/experience

Why changing is hard

Evidence based practice physiotherapy inthe context of continuous qualityimprovement

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What is Evidence Based

Implementa

tion? Evidence-based medicine is the

conscientious, explicit and judicious use

of current best evidence in making

decisions about the care of individual

patients. The practice of evidence based

medicine means integrating individual

clinical expertise with the best availableexternal clinical evidence from

systematic research (Law et al,2002:5)

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Cont

EBP is portrayed as a rational, moral, rightand superior decision-making framework thatprevents clinical errors or the provision of

suboptimal care (Mantzoukas & Watkinson,2008:131)

The process of implementing EBP involvesthe ability to frame, ask and address clinical

questions, translating best evidence intopractice and leadership strategies to shape aculture for EBP (Pipe et al, 2008:265)

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Cont

Technically, evidence based medicinerefers only to the medical field, whereasevidence based practice/implementation

encompasses more aspects of healthcare,including rehabilitation

Is based on self directed learning model,whereby practitioners must not only

continue learning but also continueevaluating their techniques and practice tosee what can be improved

(Law et al, 2005:5)

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Evidence based practice model

Has 6 steps:1. Assess the need for change in practice

2. Link the problem with interventions and outcomes

3. Synthesize the best evidence

4.D

esign a change in practice5. Implement and evaluate the practice

6. Integrate and maintain the practice change

This model provides a pragmatic framework forempowering clinicians at the unit level to engage in

EBP process and is helpful in creating anorganizational atmosphere where EBP initiativescan thrive

(Pipe et al,2008:265-266)

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Importance of finding evidence of

adva

nce in clinica

l pra

ctice For patients

y Offer the safest and most effective

interventions

y Produce best possible clinical outcomes for

patients

y Provide high quality clinical research for

patients if patients are to make informed

contributions to decisions about the

management of their conditions

(Herbert et al,2005:6)

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Cont

Physiotherapists and the profession Preparedness to act on the basis of

objective evidence about good practice

regardless of how unpalatable the evidencemight be

Gain respect and trust of patients and publicat large

Have the patients best interest at heart andhave high ethical standards

Provide transition of autonomy


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Cont

For funders of physio service

y Public are confident that healthcare does

good, and not harm.

y Ensuring value for money and health

benefits in situations where health resources

are always scarce


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The important of finding evidence of effects of

intervention / prognosis and diagnostic test or

experience.

Intervention

To interpret whether the intervention is

effective.

To satisfy patient with the effective

intervention applied based on research.

(Herbert et al, 2005:20)

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Diagnosis

To know the probability of misclassification

so we can know how much certainty to

attach to diagnosis based on a test findings.

To obtain relatively unbiased estimates of theaccuracy of diagnostic test

(Herbert et al, 2005: pp17)

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Experience

Personal and professional judgments ,experiences and preferences of practitioner

and patients are considered to bequintessential components of evidence inEBP

Privileged as the ones capable of acquiring

unique understandings and satisfyingindividual needs in a holistic manner

(Mantzoukas et al,2008:132)

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EXPLAIN WHYCHANGING IS

HARD

Change is always difficult, in every area

of human life

Knowledge alone is often not sufficient

for behavior change. when it comes to

physiotherapists behavior there might

be a number of factors that determine

practice patterns(Herbert et al,2005:208)

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Barriers to implementing the

steps of EBP Patients demand for treatment despite lacks of evidencefor effective treatments

Lack of time and workload pressure

Lack of skills

Insufficient staff resources

Doctor would not cooperate with physiotherapyimplementations

Felt that they did not have enough authority to changepractice

Poor access to library facilities and difficulties in meeting

with peers Problems with culture working against EB physiotherapy

where senior staff were resistance to change

(Herbert et al,2005:208-209)

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Barriers to implementinga change in

specific practice behavior

Lack of knowledge or skills of

physiotherapist in both the diagnosis

and treatment processes

Problems with getting cooperation of the

referring physicians

Issues about higher expectations of

patients Lack of time, skills and culture problems


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Explain EBP physiotherapy in context of

continuous quality improvement

Making EB physiotherapy happen shouldhave benefits for patients, as they receivemore effective care, which should in turn

lead to better health outcomes However, EB physiotherapy is only one

dimensions of quality improvement andshould not be implemented in a way that isisolated from an overall organizationalquality improvement system


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Cont

Good organizations strive to continuallyimprove their process of care (continuousquality improvement) and physiotherapists

should engage in this process Organization should empower staff to

identify the potential for improvement andinstigate change. They should also have aculture of striving for improvement andplaces high importance on staff learning


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Continual improvement requires leaderswho can support and nurture individualsand who believe that individuals wants to

do better, to learn and to develop Physiotherapist can set up their own

continuous improvement cycles throughthe measurement of their practice (audit,outcome evaluation) and by reflectivepractice and peer review


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What you want to know?

How to apply EBP in clinical practice

How to promote change in clinical

practice

Steps to apply EBP in clinical setting

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REFERENCES Herbert,K., Jamtvedt, G., Mead,J. & Hagen, K.B (2005)

Practical Evidence Based Physiotherapy, Elsevier,Philadelphia

Law et al (2002) Evidence based rehabilitation: A guide

to practice, SLAC

K incorporated, USA

Mantzoukas, S & Watkinson, S (2008) Redescribingreflective practice and evidence-based practicediscourses. International Journal of Nursing Practice14:129-134

Pipe, T.B., Cisar, N.S, Caruso, E & Wellik, K.E (2008)Leadership strategies: Inspiring evidence-based practiceat the individual, unit and orgabizational level, J NursQual23(2):265-271

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