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Implementing Evidence Based Practice in ICU

1) Implementing evidence-based practice (EBP) in the ICU requires a paradigm shift in healthcare through integrating the best research evidence with clinical expertise and patient values. 2) EBP follows a process of asking questions, acquiring evidence, appraising evidence, applying evidence to practice, and assessing outcomes. Key factors include the evidence itself, nurses' skills and attitudes, and organizational support and resources. 3) Strategies for successful implementation focus on education, leadership, establishing an EBP culture, designating change agents, and allocating resources like time and staff for ongoing audit and evaluation. While challenging, implementing EBP leads to improved quality and cost-effective care.

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Sherlline Carillo-Casucian
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135 views26 pages

Implementing Evidence Based Practice in ICU

1) Implementing evidence-based practice (EBP) in the ICU requires a paradigm shift in healthcare through integrating the best research evidence with clinical expertise and patient values. 2) EBP follows a process of asking questions, acquiring evidence, appraising evidence, applying evidence to practice, and assessing outcomes. Key factors include the evidence itself, nurses' skills and attitudes, and organizational support and resources. 3) Strategies for successful implementation focus on education, leadership, establishing an EBP culture, designating change agents, and allocating resources like time and staff for ongoing audit and evaluation. While challenging, implementing EBP leads to improved quality and cost-effective care.

Uploaded by

Sherlline Carillo-Casucian
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Implementing Evidence B

ased Practice in ICU

DongOak Debbie Kim, RN, PhD,


Associate Professor, Daejeon
University, Korea
2010. 10. 05 7th. WFCCN, Manila
Basic concept Paradigm shift in
of 21st. C health care services
& edu.
Evidence
Based
Quality
Cost-effective
Improvement of
Nursing
Nursing services
Definition of EBP

 Integration of the best research evid


ence with clinical expertise and pati
ent values (Sackett , 1996)
Definition of EBP
 A process of shared decision making
between practitioner, patient & others
significant to them based on research
evidence, the pt’s experiences & pref
erences, clinical expertise or know-h
ow, & other available robust sources
of information. (Rycroft-Malone et al,
2004; Sackett et al, 2000)
EBP Model
(Satterfield, J.M., et al., 2009)

Environment &
Organizational
context
Decision Making
Components of EBP
 The most relevant evidence to answer a c
linical question
 Clinical expertise
 Patient’s preferences & values
But!!! Implementation be considered in the
context of available resources, organizati
onal policies, & priorities
Cf. Research utilization: The use of knowled
ge typically based on a single study, doe
s not take into account clinical expertise
or pt’s preference/values
Steps of EBP :
Identifying/ Appraising/ Synthesizing

1. Ask : utilize PICO format


2. Acquire : search evidence
3. Appraise : critical appraisal for the validi
ty, relevance, applicability of evidence
4. Apply : Integration of the results of syst
ematic reviews with clinical expertise &
pt’s preferences/values
5. Assess : evaluation for the effectiveness
of results/application
Steps of EBP

Clinical Searching evidences


questions

Application to Practice Critical appraisal


(Demonstration)

Evaluating the Changing &


effectiveness of results disseminating
PICO

 Formulation of the clinical issue into


a searchable and answerable questi
on
– P : Patient population, Problem
– I : Intervention or Interest
– C : Comparison with other treatment, if
applicable
– O : Outcome
Hierarchy of Evidence

Strong

Weak

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


Health Sciences Library
Influencing factors to imple
ment EBP

 Evidence dimension
 Nurse dimension
 Organizational dimension
Process of Implementing E
BP
Change in an
Organization

To
succeed
in implementing EBP
 strong evidence itself can’t lead EBP
 establish strategies considered influencing
factors; evidence, nurse, organization
require multidimensional complex action
Strategies for evidence
 the evidence
– has high priority & consensus among experts
– is strong enough & congruent with pt’s needs
& organizational policies
 the guidelines
– have to be developed multidisciplinary
– are clearly described
– have specific recommendations & user conve
nience.
Strategies for nurse
1. Education & training
 To improve knowledge, skill, attitude & s
elf-confidence about EBP
 Content : 5 EBN competencies (Strauss
et al., 2005)
 describing clinical questions
 searching evidences
 critical appraisal
 integrating the evidences in clinical decision
making,
 evaluating the outcomes.
 Methods
 workshop : interactive education is effective
 Staff nurse internship
Strategies for nurse
2. Mentoring
 Support to learn new knowledge & skill
 Counsel & Support for the process of re
ading research results & translating them
to practice
 During implementing
 Support the fear & skepticism to change
 Solve misconceptions (eg. EBN needs lots o
f time)
 Overcome the resistance against practice ch
ange
Strategies for nurse

3. Encourage to participate in various


projects related to EBP
– Conference…
Strategies for Organizationa
l dimension
Establishing
EBN Culture

Audit & Leadership


Evaluation
Organizational
strategies

Preparing Change
Resources Agent
Establishing EBN Culture
 Organizational mission & vision supporting
EBN
 Evidence-based decision making on every
policy & procedure, & nurse executive’s ad
ministrative decision
 Create clinical inquiry culture
 Operate journal club
 Encourage presentation & publication of re
search
 Sacred cow searching competition
Leadership
 Strong and supportive leadership
 Leader’s participation in whole process of d
eveloping & implementing EBN strategies
 Encourage nurses to share and practice th
e vision
 Support the change agents & responsible p
erson for project
 Develop the EBN model of nursing departm
ent
Leadership -cont’d
-
 Integrate EBN guideline/protocol with
organizational policy & procedure
 Connect EBN to Quality Improvement
activities
 Identify barriers to implementing EBN
& set up the strategies reducing them
 Develop the ownership in whole level
of organization
 …etc.
Change agent, champion
 Roles :
– Facilitate for apply EBN
– Influence to build up EBN culture in unit
– Mentoring to nurses
– Educational outreach visit
 Selection : nursing department, unit
 Developing competencies for change age
nts, opinion leaders, & core groups
Resources

 Administrator has to allocate approp


riate resources for EBN : human res
ources, time, finance, facilities
 Establish EBN communication syste
m
Audit & Evaluation
 Audit
– Utilized as instrument for implement gui
deline recommendations to practice
– Focusing on measuring compliance of
the guideline
– providing productive feedback
– Include the process, outcomes, and ev
aluation plan for continuance of chang
e
Conclusion

 As activating and anchoring the EBP


successfully in icu is the complex pro
cess required organizational changes,
various strategies in terms of evidenc
e, nurse, and organizational dimensio
n are required.
To conduct EBN change is c
hallengeable, but highly com
pensated work.

“Never, never, never, never,


never, never quit”
- Winston Churchill -

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