3. EBP is…
Needed to help bridge the research-practice gap by:
Strengthening the evidence base in order to know
what works and what doesn’t work in providing patients with the best outcomes.
Standardizing evidence across fields
Housing evidence in online databases providing reviews of the evidence
base. (PGIMER has started Remotex service, uptodate)
Translating and consolidating state of the science into clinical
recommendations.
(Stevens, 2004)
4. Evidence-Based Practice
Integration of best research evidence, clinical expertise, and
patient values in making decisions about the care of individual
patients (Institute of Medicine, 2001).
5. A. Levels of Evidence
I : Systematic reviews, meta-analysis, EB clinical practice
guidelines based on RCTs
II : One well designed RCT
III : Control Trials without randomization
IV : Well-designed case control or cohort
studies
V : Systematic reviews of descriptive or
qualitative studies
VI : Single descriptive or qualitative study
VII : Opinions of authorities, reports of
experts
14. Other Sources To practice
guidelines/Evidence
Acta pediatrica
Cochrane
National Institute for Health and Care Excellence (NICE)
NICE guidelines
WHO
Guidelines of organization : AAP, IAP, NNF, ESPEN
Journal with high impact factor : Nature Journal, NEJM, AAP
TRIP Search Engine
SUMSearch2 (University of Kansas)
ProQuest Nursing & Allied Health Source
ClinicalTrials.gov
University of medicine and health sciene (UMHS)
20. SIX STEPS OF EVIDENCE-BASED PRACTICE
Ask the burning clinical question (PICOT format)
Search for and collect the most relevant and best evidence
Critically appraise the evidence
Integrate all evidence with one’s clinical expertise, patient preferences and values in
making a practice decision or change and apply on patient
Evaluate the practice decision or change
Disseminate
Melnyk & Fineout-Overholt 2005
21. Research utilization vs EBP vs Quality
improvement
Research utilization: Using info from a single study (Chlorhexidine
vs gel/alcohol)
EBP - takes into account expertise of the practitioner and patient
preferences / values (ability of nurses/cost/patients likes/)
Quality improvement : utilizes a system to monitor and evaluate
the quality and appropriateness of care (outcomes) based on EBP
and research
23. Challenges to implement EBP in PCC by
nurses
It is likely that as few as 20 % of effective interventions actually
reach patients
time constraints, a knowledge deficit, and organizational culture.
Poor leadership
Jean-Paul Collet, etal Engaging Pediatric Intensive Care Unit (PICU) clinical staff to lead practice improvement: the PICU
Participatory Action Research Project (PICU-PAR) https://doi.org/10.1186/1748-5908-9-6
All nurses are not sensitize to EBP and many don’t know from
where to find the answer of problems encountered in day to day
practice
Changing behavior of HCP is the most difficult
24. Challenges to implement EBP in PICU by
nurses …. Contd…
Most clinical interventions have a modest effect yielding a 25
% or lower relative risk reduction.
Uninformed colleagues sometimes misinterpret EBM and
accuse it of being “cookbook medicine” and potentially
harmful to the patient.
developers of guidelines and protocols rarely graded the
level of evidence underlying each recommendation.
33. Benefits for pediatric critical care nurses
Fewer Errors –
Type 1 – Acceptance of a practice that is incorrect. Example:
Administration of a wrong dose, using the wrong procedure, teaching patients
using the wrong information.
Type 2 – Rejection of a practice that is correct. Example: Failing to
screen patients for fall or pressure ulcer risks; failing to wash hands before and
after patient contact; failing to provide patients with smoking cessation
information.
(Aherns, 2005)
34. Better Care
Less variation in care among caregivers where knowledge for
improvement is already available.
More predictable health outcomes.
Less waste and inefficiency yielding fewer delays in diagnosis and
treatment and fewer complications.
Greater professional satisfaction from working as part of a team and
experiencing effective practice.
Benefits for pediatric critical care nurses