Improving Healthcare Quality and

Patient Outcomes Through the

Integration Of Evidence-Based
Practice and Informatics
Presented by: Group 5
 Objectives

01 Define evidence-based practice.

02 Discuss how evidence-based practice impacts healthcare quality, safety,

and cost reduction.
03 Discuss barriers and facilitators for successful implementation of
evidence-based practice in the clinical setting.
04 Discuss the evidence-based practice paradigm and process.

05 Identify technology tools in clinical practice which support

evidence-based practice.
06 Discuss the role of clinical decision support systems in evidence-based
practice.
Introduction
Evidence-based practice (EBP) is crucial for providing effective and efficient patient care,
leading to higher quality healthcare and improved patient outcomes. The implementation of
EBP by healthcare professionals enhances care standardization, streamlines workflows, and
reduces costs compared to traditional practices. EBP aligns with the quadruple aim in
healthcare and has been associated with increased job satisfaction, stronger team cohesion,
and lower turnover rates among staff.

Informatics plays a vital role in supporting EBP through five key components: standard
terminology, access to digital evidence resources, data sharing for enhanced patient care,
processes tailored to clinical EBP needs, and informatics competencies. The National
Academy of Medicine aimed for 90% of healthcare decisions to be evidence-based by 2020,
and ongoing efforts focus on translating various types of evidence into practice.

Sackett and colleagues defined EBP in 2000 as the conscientious use of current best
evidence in making decisions about patient care, which has since evolved into a problem-
solving approach that combines high-quality research findings with clinical expertise and
patient preferences. Utilizing both external evidence (research findings) and internal
evidence (outcomes from quality improvement projects) is essential for effective decision-
making. The best patient outcomes are achieved when EBP is delivered within a supportive
organizational culture and caring environment.
SEVEN STEPS OF EVIDENCE-BASED PRACTICE

P = patient population
I = intervention or interest area
C = comparison intervention or group
O = outcome
T = time

Category : Prevention
P = pregnanct women
I = prenatal yoga class
C = standard prenatal care
O = reduction of postpartum depression
symptoms
T = within the first 6 months
postpartum
 Barriers and Facilitators
of Evidenced-Based Practice

Multiple barriers to advancing EBP in health- care systems

Misperceptions by clinicians that it takes too much time
Lack of EBP knowledge and skills
Organizational cultures that do not support EBP
Lack of resources, including clinical decision support tools
Executive leadersand managers who do not model and/or
support EBP
Lack of EBP mentors to work with point-of-care staff on
implementing evidence-based care
Inadequate access to databases by clinicians in order to
track patient and system outcomes, and
Negative attitudes toward research
Key Facilitators of EBP
Strong beliefs about the value of EBP and the ability to implement it
EBP knowledge and skills
Organizational cultures that support EBP
EBP mentors who have in-depth knowledge and skills in evidence-
based care as well as individual and organizational change
Administrative support
Clinical promotion systems that incorporate EBP competencies, and
EBP tools at the point of care, such as clinical decision support
systems
 Cultivating a culture that Supports
and Sustain Evidence-Based Practice

Organization must provide system-wide support for

evidence-based care.
Support begins with a vision, philosophy, and mission.
High-level administration and nurse managers must not
only “buy-in” to this vision, but also model EBP
themselves.
Ample resources and supports must be provided to
clinicians that enhance their ability to provide
evidence-based care.
 The Role of Technology in Supporting
Evidence-Based Practice
Technology Tools in Clinical Practice

Information technology (IT) has brought to healthcare a

compendium of new tools which support EBP.
A goal of informatics is to use technology to bring critical
and essential information to the point of care to increase
efficiency, make healthcare safer and more effective, and
improve quality and outcomes.
 The Role of Technology in Supporting
Evidence-Based Practice
Competencies
Nursing professionals range in age from their early 20s to their 60s with the average age of a
registered nurse today in their early 50s. This range presents a significant range of learning skills
and comfort with technology and evidence- based practice.
In 2006, a National League of Nursing (NLN) study revealed 60% of nursing programs had a
computer literacy requirement and 40% had an information literacy requirement. Less than 50% of
the respondents stated informatics was integrated into the curriculum and experience with
information systems provided during the clinical experiences (National League for Nursing, 2008).
It is imperative for nurses today to have the skills ing required students to in engage EBP 1 in and
EBP the use Preparing of the proper undergraduate technology nurs- has significance for
advancing EBP in nursing. Rush (2008) states, the preparation of undergraduate nursing students
for using evidence to guide practice is no longer optional. Evidence-based practice is imperative
for insuring quality, cost-effective safe care and more predictable outcomes for healthcare
consumers"
 Decision Support of Evidence
Based Practice

Decision Support System (DSS)

are automated tools designed to support decision-making
activities and improve the decision-making process and
decision outcome.
Clinical Decision Support System (CDSS)
are systems designed "to support healthcare providers in
making decisions about the delivery and management of
patient care"
Evidence-Based Adaptive Clinical Decision Support System
are systems designed with multiple rules and access to
multiple database for information.
 Standardization of Technology and Data

Clinical Terminology
is a factor which plays a significant role in increasing the availability of
evidence at the point of care. Clinical terminologies have not matured
to a level to be used in clinical imformation system(CIS) .

Standardized Terminology
is required for quantifiable and retrievable date. It allows for coding of
Nursing practice in the EHR.

What are the Criteria for standardized

Nursing Terminology?
Cimino, Hripsak, Johnson, and Clayton(1989) identified criteria for
design of a controlled healthcare vocabulary.

These criteria included: Domain completeness, Unambiguous terms,

Nonredundancy, Synonyms, Multiple classifications of terms.
Identification of Common Data Definitions
is not uncommon for different departments, hospitals and
systems to have different definitions of the same data elements.
Tools for Managing Clinical Data
tools can vary from excel spreadsheets and access databases
to database programs.
Data Quality
inaccurate and incomplete data will impact the quality of the
data upon which decisions will made and impact the quality.
System Selection Issues
clinicians should participate in the selection process for
clinical information systems and consider data
requirements during the selection process.
Considerations for Successful CDSS
1. Integrated, Real-Time Patient Database: A unified system that collects, updates,
and stores patient-specific data from multiple sources in real-time.
2. Data-Driven Mechanism: Automatically triggers actions or alerts based on
specific data inputs (e.g., lab results or reports). Operates asynchronously and
runs immediately when data is updated, not at pre-scheduled times
3. Knowledge Engineer: An informatics expert who is responsible for extracting
and translating the clinical knowledge into machine executable logic.
4. Time-Drive Mechanism: This allows for programs to be executed automatically
at a specific time in the future (e.g., 2 a.m.) or after a specific time interval has
passed ( 24 hours after transfer).
5. Long-Term Clinical Data Repository: A long-term clinical data repository
contains the patient-specific data from a variety of clinical sources collected
over a period of several years. It allows for the development of reliable
statistical predictors of specific events.
 What Can Outside Reference
Sources (Vendors) Bring to the
Table?
The tools for evidence-based practice have shifted from simple methods
like paper and pencil to advanced technology integrated into clinical
information systems.

1. Changes in Evidence-Based Practice Over Time

IN the 1980s: Hospitals developed their own clinical practice guidelines.
By the 2000s: Hospitals began relying on external vendors (like Zynx, Wolters Kluwer, and
Micromedex) to provide evidence-based guidelines.
These vendors review research and offer best practices, but healthcare organizations
decide what to implement.
2. Use of Technology
Technology now allows quicker incorporation of evidence into patient care.
3. EHR vendors support evidence-based practice in three main ways:
1. In-house Clinical Decision Support (CDS):
Alerts, reminders, order sets, and templates to help with clinical tasks.
Requires regular updates.
2.Third-Party CDS Content:
Vendors integrate content from external providers.
3. Knowledge Sharing:
Vendors create platforms where users can share rules, workflows, and tips.
They may also offer benchmarking tools to compare performance and analytics.

Integration of EBP Technology in the

Clinical Areas
Barriers to research implementation were identified three decades ago. Melnyk (2013) states
“although progress has been made over the years, the same barriers to EBP identified decades ago
(e.g., time, lack of knowledge and skills, peer resistance, lack of access to resources, and EBP
mentors) continue to exist is healthcare systems. Most recently… new findings indicate that resistance
from leaders and managers along with environments steeped in tradition were top barriers to
provision of evidence based care” (Melnyk, 2013, p. 127).
 Information Access
There are over 150,000 medical articles published each month (Matter, 2006). Table
40.5 provides several examples, along with their Web addresses, of sources for EBP
available today. Most are free, however, some sites do have a subscription fee.

Data, Information, Knowledge, Wisdom, Healthcare

Business Intelligence
Data
the raw materials from which information is
generated and information is the relevant, usable
commodity needed by the end user. (Worthley 2000)
Five Tenets of Successful Healthcare Business
Intelligence (Montalvo, 2013, p. 23)

Data Quality
Sponsorship and Leadership
Technology and Architecture
Value
Culture Change
 Five Dimensions of Data

1. Completeness: accessibility, accuracy, availability, omission, presence, quality,

validity, rate of recording.
2. Correctness: is an element present in the EHR true? This dimension includes
accuracy, corrections made, errors reported, validity tested.
3. Concordance: is there agreement between the elements in the EHR, or between the
EHR and other data sources? Other considerations are agreement, consistency,
reliability, variation.
4. Plausibility: does an element in the EHR make sense in light of other knowledge about
what that element is measuring? Are the data accurate, believable, trustworthy, and
valid.
5. Currency: is an element in the EHR a relevant representation of the patient state at a
given point in time? This is a dimension of timeliness
 12 Characteristics of Successful Clinical
Decision Support Systems (Castillo &
Kelemen (2013)
1. Incorporate into existing systems
2. Integrate into the current workflow
3. Provide specificity
4. Incorporate user involvement
5. Provide education and training
6. Provide sufficient system support
7. Provide automated system prompts
8. Provide straightforward alerts
9. Have simple clinical decision support system displays
10. Prompt acknowledgment
11. Require minimal clinical decision support system data entry
12. Have continuous clinical decision support system evaluation and monitoring
 Implementing Clinical Rules to Automate
Steps in Delivering Evidence-Based Care
that to be Successful there Must be
(Brokel, Shaw, and Nicholson (2006)

1. The use of uniform coded terminologies,

2. A culture to transform care with the use of evidence-
based practices
3. Processes in place to guide the organization and staff.
4. Inter-disciplinary involvement which is required to be
successful
Regulatory and Accreditation
Agency Impacts
 Optimizing Existing Systems and Applications

Three barriers have been identified

1. Excessive use of alerts and reminders
2. Outdated or inaccurate information in the system
3. Inappropriate levels of the alerts.

Florence Nightingale (1859) wrote “Let whoever is in charge

keep this simple question in her head. Not how can I always
do the right thing myself, but how can I provide for this right
thing to always be done?”
 Conclusion

The integration of evidence-based practice and nursing informatics

plays a vital role in enhancing healthcare quality and patient
outcomes. By combining clinical expertise with informatics tools,
healthcare professionals can deliver safer, more effective, and
patient-centered care. This approach underscores the significance
of leveraging technology to support evidence-based decision-
making and optimize care processes in the modern healthcare
landscape.
 Thank You!
As future nurses, remember every challenge you
face today builds the strength, compassion, and skill
you’ll need to care for others tomorrow. Stay
committed, stay passionate, and trust in your
journey.

Members:
PESCADERO, JULIANA MAXINNE D.
PILAS, CHIPPY C.
RONTAL, APRIL ROSE C.
SEMIL, IRENE R.
TAUB, QUEEN JOANNAH MAE S.
TENEL, JELYN MARIE P.
UNDANG, FLEA C.
VENENOSO, JANETTE V.

Reference:
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