Getting evidence into practiceEarly Clinical Career Fellowships

Masterclass29th August 2013

Annette Thain Annette.thain@nes.scot.nhs.uk

Learning Outcomes1. Understand the aim Knowledge into Action is to

support the implementation of evidence in practice 2. Know what sources to use for different types of

evidence3. Identify knowledge management tools and

techniques to support you to get evidence into practice

4. Know where to get help and advice for you and your colleagues

Average time from research initiation to application of findings/treatments is...

17 years

Knowledge into Action review

• help practitioners to apply knowledge to frontline practice.

• embed use of knowledge in healthcare improvement.

• support practitioners and managers to translate knowledge into better health outcomes, i.e. safe, effective, person-centred, efficient care.

What is Knowledge into Action?

evidence based practice

knowledge translationknowledge implementation

implementation science

“The move beyond simple dissemination of knowledge to actual use of knowledge”

Straus, et al (2009)

From Accessing to Applying Knowledge in NHS Scotland

Knowing• 66 libraries• 116 library staff• 12 million + resources

Doing• How much of this gets used

in a meaningful way to improve safe, effective, person-centred care?

http://www.knowledge.scot.nhs.uk

Knowledge as process

Know-what

•Journals

•MEDLINE

•Cochrane reviews

•Reports

Know-where

•Systems

•Processes

•Local context

Know-who

•Service users

•Practitioners

•Teams

Practice

Experience

Research

Know-how:

•Actionable •Relational

•Organisational

Knowledge as process

Actionable knowledge•Checklists

•Pathways

•Mobile apps

Relational use of knowledge

•Communities of Practice

•Social networking

•Social learning

Organisational enablers

•Backing at national and board level

•Tests of change to demonstrate impact

•Knowledge broker

Know-how:

•Actionable •Relational

•Organisational

Discussion

• Discuss examples from your practice of – actionable knowledge ie ways of presenting

knowledge– social/relational use of knowledge ie examples of

communicating and sharing

• Feedback one example of each

Transfer of Knowledge into Quality Patient Care Clinical Knowledge

(Evidence Based Practice):

MEDLINE, Cochrane etc

Improvement Knowledge:

SPSP experience, etc

Know-What

Know-How

Quality

Patient Care

Doing the right thing

Doing it right

Clinical Decisions

Process/System Changes

Adapted from: Glasziou, P et al. Can evidence-basedmedicine and clinical quality improvement learn fromeach other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17

Mnemonic – the practical activities to support the cycle

Question What do you need to know?

Source Where will you look?

Find What words will you use?

Evaluate Is the information ‘good’?

Combine How does it all fit together?

Share How will you share it?

Apply How will you use it?

Question - Keyword

Keyword Synonym

Osteoporosis Bone density, bone loss

Adult male Elderly man, older people

Calcium supplement Adcal D3, Calcit D3, Calcichew-D3

Alternative/additional measures Diet, exercise, lifestyle

John is a 62 year old man who has been diagnosed with osteoporosis. He’s been prescribed a calcium and vitamin D supplement but is interested in other ways protect

himself.

PICO

P Person, population or problem

Adult male, elderly male

I Intervention (proposed)

Diet and lifestyle changes

C Comparison/Current intervention Calcium and vitamin D

O Outcome(s) expected

Improved bone density

Now you try an example……

Know-what

•Journals

•MEDLINE

•Cochrane reviews

•Reports

Know-where

•Systems

•Processes

•Variation

Know-who

•Service user

•Practitioner

•Teams

Practice

Experience

Research

Research

Point of care DynamedNursing Reference CenterGuidelinesEvidence summaries

Other questionsDatabasesJournalsBooks

Reliable information resources :

http://www.knowledge.scot.nhs.uk

The Knowledge NetworkIndex

Systems

Summaries

Synthesis of Synopsis

Synopsis

Synthesis of Single Studies

Studies

Computerised decision support

Guidelines/Protocols/ Evidence Based textbooks

Evidence based journal articles eg Evidence

Based Nursing

Systematic Reviews eg Cochrane Library

Original Journal Articles and Studies eg Medline

Point of Care Resources eg Dynamed

[Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model.

Evidence-Based Nursing, 12,99-101]

Know What – Evidence Triangle

Other Sources - discussion

Know-where

•Local context

•Systems

•Processes

Know-who

•Service users

•Practitioners

•Teams

Practice

Experience

Research

Possible Sources- depends on topic• Grey literature• References• Epidemiology• Drug information• Patient stories• Case studies• Improvement websites

eg IHI

• Books• Elearning• Videos• People• Communities of

practice• MCNs• GOOGLE

Demo of The Knowledge Network to find the know what and know how

Does it answer my question?Do I need to do a full scale critical appraisal?

How does all this fit with your previous knowledge and experience / local setting?

RefWorks/RefShare

Who else needs to know about whatyou’ve found?

How will you let them know about it?

Information/knowledge has little value unless it isused

How will you -Use the new information?Change your practice?Keep up to date?

Barriers and facilitators

Barriers FacilitatorsBarriers• Awareness and

knowledge• Skills• Motivation• Practicalities• Acceptance and

beliefs www.nice.org.uk

Practice based small group learning

Using real clinical problems to stimulate reflection, discussion and learning among groups of peers

• Specially prepared modules produced which “closes the gap between current practice and best practice”

• Knowledge brokers provided support to clinicians in developing a PBSGL module on cervical screening.

• Educational perspective – clinicians and knowledge brokers working together

Sepsis and VTE collaborative

• The Sepsis Collaborative aims to contribute to overall aim of the Scottish Patient Safety Programme of reducing mortality rates by 20% by December 2015

• Knowledge broker involved in a range of activities• Educational perspective – knowledge broker role combined

with tools and resources produced a positive outcome.

An informal method to stimulate and create ‘awakening and engaging of collective intelligence through conversations about questions that matter’. It is a technique to evoke and make visible the collective intelligence of a group.

A community of practice shares a specific interest that becomes a source of identification.  This creates a sense of commitment to the community as a whole, not merely connections to a few linking nodes. Eg Dementia MKN

Also known as ‘learning before doing.’ A team asks for help: people are invited to share their experience, insights and knowledge with the team.

A short, facilitated meeting of project team members (and possibly other stakeholders) to evaluate and capture lessons learned.

Task or resource lists as an aide memoire to

improve consistency.

Knowledge banks are repositories which store knowledge and allow people to retrieve and use the knowledge they contain. For example, SSKS, ASSIA

Provide understanding of causal factors, barriers and facilitators that led an event to unfold as it did. Examples on Evidence for Practice tab on SSKS.

Librarians and knowledge managers carry out expert searches of research sources. Use of Health Management Library Services

Use of the Evidence Informed Practice search option on SSKS

Directories of people with contact details and information on skills, practice experience and areas of interest eg members of Dementia MKN

Social media tools eg Blogs, Twitter, Facebook, Book Marking, News Feeds, Community Website tools

PTO for more info

KM Tools and techniques

Help and training

• Online help• Webex sessions for The

Knowledge Network and other services – sign up for monthly newsletter knowledge@nes.scot.nhs.uk

• Webex sessions from providers

• CLEAR service

• Local NHS librarians• Materials for colleagues

knowledge@nes.scot.nhs.uk

• Any problems or questions knowledge@nes.scot.nhs.uk

KnowNetScotland

TKNScotland

Thank you for listening

• Any questions?Learning outcomes1.Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2.Know what sources to use for different types of evidence3.Identify knowledge management tools and techniques to support you to get evidence into practice4.Know where to get help and advice for you and your colleagues