implementing evidence based practice in icu

8/8/2019 Implementing Evidence Based Practice in ICU

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Implementing EvidenceImplementing Evidence

Based Practice in ICUBased Practice in ICU

DongOak Debbie Kim, RN, PhD,DongOak Debbie Kim, RN, PhD,

Associate Professor, Daejeon University,Associate Professor, Daejeon University,KoreaKorea

2010. 10. 05 72010. 10. 05 7thth. WFCCN, Manila. WFCCN, Manila


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Basic concept of21st. C

Evidence

Based

Paradigm shift inhealth care services

& edu.

Cost-effective

Nursing

Quality Improvement

of Nursing services


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Definition of EBPDefinition of EBP

Integration of the best researchIntegration of the best research

evidence with clinical expertise andevidence with clinical expertise and

patient valuespatient values (Sackett , 1996)(Sackett , 1996)


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Definition of EBPDefinition of EBP

AA process of shared decision makingprocess of shared decision makingbetween practitioner, patient & othersbetween practitioner, patient & others

significantsignificant to themto them based onbased on researchresearchevidenceevidence, the, the ptpts experiences &s experiences &preferencespreferences,, clinical expertiseclinical expertise or knowor know--how, & otherhow, & other available robust sourcesavailable robust sources ofof

information. (Rycroftinformation. (Rycroft--MaloneMalone et al,et al,2004; Sackett2004; Sackett et alet al, 2000), 2000)


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EBP ModelEBP Model

(Satterfield, J.M.,(Satterfield, J.M., et alet al., 2009)., 2009)

Best available

research evidence

Resourcesincludingpractitionersexpertise

Client

sCharacteristics,

status, needs,

values,

& preference

Decision Making

Environment &

Organizationalcontext


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Components of EBPComponents of EBP

The most relevant evidence to answer aThe most relevant evidence to answer aclinical questionclinical question

Clinical expertiseClinical expertise PatientPatients preferences & valuess preferences & values

But!!! Implementation be considered in theBut!!! Implementation be considered in the

context of available resources, organizationalcontext of available resources, organizational

policies, & prioritiespolicies, & prioritiesCf. Research utilization: The use of knowledgeCf. Research utilization: The use of knowledgetypically based on a single study, does nottypically based on a single study, does nottake into account clinical expertise or pttake into account clinical expertise or ptss

preference/valuespreference/values


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Steps of EBP :Steps of EBP :

Identifying/ Appraising/ SynthesizingIdentifying/ Appraising/ Synthesizing

1.1. Ask : utilize PICO formatAsk : utilize PICO format

2.2. Acquire : search evidenceAcquire : search evidence

3.3. Appraise : critical appraisal for the validity,Appraise : critical appraisal for the validity,relevance, applicability of evidencerelevance, applicability of evidence

4.4. Apply : Integration of the results ofApply : Integration of the results ofsystematic reviews with clinical expertise &systematic reviews with clinical expertise &

ptpts preferences/valuess preferences/values5.5. Assess : evaluation for the effectiveness ofAssess : evaluation for the effectiveness of

results/applicationresults/application


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Steps of EBPSteps of EBP

ClinicalClinical

questionsquestions

Searching evidencesSearching evidences

Critical appraisalCritical appraisalApplication to PracticeApplication to Practice

(Demonstration)(Demonstration)

Evaluating theEvaluating the

effectiveness of resultseffectiveness of results

Changing &Changing &

disseminatingdisseminating


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PICOPICO

Formulation of the clinical issue into aFormulation of the clinical issue into a

searchable and answerable questionsearchable and answerable question

PP : Patient population, Problem: Patient population, Problem

II : Intervention or Interest: Intervention or Interest

CC : Comparison with other treatment, if: Comparison with other treatment, if

applicableapplicableOO : Outcome: Outcome


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Hierarchy of EvidenceHierarchy of Evidence

Pyramid from: Evidence-Based Practice Tools Summary. University of Washington, Health

Sciences Library

Strong

Weak


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Influencing factors toInfluencing factors to

implement EBPimplement EBP

Evidence dimensionEvidence dimension

Nurse dimensionNurse dimension

Organizational dimensionOrganizational dimension


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Process of Implementing EBPProcess of Implementing EBP

ToTosucceedsucceed

in implementing EBPin implementing EBP

strong evidence itself canstrong evidence itself cant lead EBPt lead EBP

establish strategies considered influencing factors;establish strategies considered influencing factors;

evidence, nurse, organizationevidence, nurse, organization

require multidimensionalrequire multidimensional complex actioncomplex action

Change in anOrganization


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Strategies for evidenceStrategies for evidence

the evidencethe evidence

has high priority & consensus among expertshas high priority & consensus among experts

is strong enough & congruent with ptis strong enough & congruent with pts needs &s needs &organizational policiesorganizational policies

the guidelinesthe guidelines

have to be developed multidisciplinaryhave to be developed multidisciplinary

are clearly describedare clearly described

have specific recommendations & userhave specific recommendations & user

convenience.convenience.


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Strategies for nurseStrategies for nurse

1. Education & training1. Education & training To improve knowledge, skill, attitude &To improve knowledge, skill, attitude &

selfself--confidence about EBPconfidence about EBP

Content : 5 EBN competencies (StraussContent : 5 EBN competencies (Strauss etetal.,al., 2005)2005) describing clinical questionsdescribing clinical questions

searching evidencessearching evidences

critical appraisalcritical appraisal

integrating the evidences in clinical decisionintegrating the evidences in clinical decisionmaking,making,

evaluating the outcomes.evaluating the outcomes.

MethodsMethods workshop : interactive education is effectiveworkshop : interactive education is effective

Staff nurse internshipStaff nurse internship


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2. Mentoring2. Mentoring Support to learn new knowledge & skillSupport to learn new knowledge & skill

Counsel & Support for the process ofCounsel & Support for the process of

reading research results & translating themreading research results & translating themto practiceto practice

During implementingDuring implementing Support the fear & skepticism to changeSupport the fear & skepticism to change

Solve misconceptions (eg. EBN needs lots ofSolve misconceptions (eg. EBN needs lots oftime)time)

Overcome the resistance against practice changeOvercome the resistance against practice change


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3. Encourage to participate in various3. Encourage to participate in various

projects related to EBPprojects related to EBP

ConferenceConference


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Strategies for OrganizationalStrategies for Organizational

dimensiondimension

Organizationalstrategies

Establishing

EBN Culture

Leadership

Change

AgentPreparing

Resources

Audit &

Evaluation


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Establishing EBN CultureEstablishing EBN Culture

Organizational mission & vision supportingOrganizational mission & vision supportingEBNEBN

EvidenceEvidence--based decision making on everybased decision making on everypolicy & procedure, & nurse executivepolicy & procedure, & nurse executivessadministrative decisionadministrative decision

Create clinical inquiry cultureCreate clinical inquiry culture

Operate journal clubOperate journal club Encourage presentation & publication ofEncourage presentation & publication ofresearchresearch

Sacred cow searching competitionSacred cow searching competition


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LeadershipLeadership

Strong and supportive leadershipStrong and supportive leadership

LeaderLeaders participation in whole process ofs participation in whole process of

developing & implementing EBN strategiesdeveloping & implementing EBN strategies Encourage nurses to share and practice theEncourage nurses to share and practice the

visionvision

Support the change agents & responsibleSupport the change agents & responsibleperson for projectperson for project

Develop the EBN model of nursingDevelop the EBN model of nursing

departmentdepartment


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LeadershipLeadership --

contcontdd--

Integrate EBN guideline/protocol withIntegrate EBN guideline/protocol withorganizational policy & procedureorganizational policy & procedure

Connect EBN to Quality ImprovementConnect EBN to Quality Improvementactivitiesactivities

Identify barriers to implementing EBNIdentify barriers to implementing EBN

& set up the strategies reducing them& set up the strategies reducing them Develop the ownership in whole level ofDevelop the ownership in whole level oforganizationorganization

etc.etc.


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Change agent, championChange agent, champion

Roles :Roles :

Facilitate for apply EBNFacilitate for apply EBN

Influence to build up EBN culture in unitInfluence to build up EBN culture in unit

Mentoring to nursesMentoring to nurses

Educational outreach visitEducational outreach visit

Selection : nursing department, unitSelection : nursing department, unit

Developing competencies for change agents,Developing competencies for change agents,

opinion leaders, & core groupsopinion leaders, & core groups


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ResourcesResources

Administrator has to allocateAdministrator has to allocate

appropriate resources for EBN :appropriate resources for EBN :

human resources, time, finance,human resources, time, finance,facilitiesfacilities

Establish EBN communication systemEstablish EBN communication system


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Audit & EvaluationAudit & Evaluation

AuditAuditUtilized as instrument for implementUtilized as instrument for implement

guideline recommendations to practiceguideline recommendations to practiceFocusing on measuring compliance of theFocusing on measuring compliance of the

guidelineguideline

providing productive feedbackproviding productive feedback

Include the process, outcomes, andInclude the process, outcomes, andevaluation plan for continuance of changeevaluation plan for continuance of change


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ConclusionConclusion

As activating and anchoring the EBPAs activating and anchoring the EBP

successfully in icu is the complexsuccessfully in icu is the complex

process required organizational changes,process required organizational changes,various strategies in terms of evidence,various strategies in terms of evidence,

nurse, and organizational dimension arenurse, and organizational dimension are

required.required.


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To conduct EBN change isTo conduct EBN change is

challengeable, but highlychallengeable, but highly

compensated work.compensated work.

Never, never, never, never, never,Never, never, never, never, never,

never quitnever quit

-- Winston ChurchillWinston Churchill --


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implementing evidence based practice in icu

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