Post on 10-Feb-2017
transcript
BY JORDAN KESSLER RN, BSN
Implementing Evidence Based Practice at BJU
EVIDENCE-BASED PRACTICE
What is Evidence Based Practice? (EBP)
Best Evidence Research
Clinical Expertise
Patient Values &
Preferences
EBP
Evidence based practice has 5 simple steps,
known as the 5 A’s
Provide an algorithm to guide the EBP process
Step-by-step process
Use as a guide when there is not up-to-date evidence based protocol/procedures for them to use
Types of EBP Models
47 different types of EBP models exist today in literature
Of those 47 models, they can be characterized into 4 main categories
Knowledge Transformation Processes Strategic/ Organizational Change Theory to Promote
Uptake and Adoption of New Knowledge Knowledge Exchange Synthesis for Application and Inquiry
Examples: Stetler Model, Iowa Model, PARiHS Model, & Colorado Model
Here is an example ofThe Colorado Patient- Centered
Interprofessional Evidence-Based Practice Model
Organizational Support
Leadership Mentorship Facilitation
All of these components are
important to sustaining an
evidence-based culture
Teamwork P
ositive W
ork
Environment
Autonom
y
Best practice
Professional D
evelopment
Training & Education
Quality & Safety
Excellent Nursing Care
Commitment 2
Service
Culturally Sensitive
Evidence-based Practic
e
Respect
BJU Current Model
Current Practices at BJU
Journal Club
Hourly rounding
Up2DateEducation
Practices are
evidence
informed
Presentation of Case Studies
Curriculum Training
Barriers to implementing EBP
Not enough time to read, review, research or implement new ideas
Overwhelming patient work loadNurse unaware of hospital resources, such as
usage of Up2date & journal clubThe amount of research can sometimes be
too overwhelming
Survey Conducted at BJU
Sample survey at BJU
Survey Questions
What level nurse are you?
Years of nursing experience ________ years
What type of nursing degree
Have you heard of Evidence based practice (EBP)?
Have you implemented EBP for clinical decision making in the past year?How many times per month have you accessed the following online database systems (Up2date) to search medical information?What is your motivation to access online database systems?
Are you willing to participate in evidence based projects or activities in the coming years?
Survey Results42 surveys completed
72% of nurses with a bachelors degree, 64% Level III nurse
79% of nurses know what evidence based practice is
MORE THAN ½ of the nurses have implemented evidence based practice for clinical decision making in the past year
21%
16%
17%11%
11%
25%
Why do you use Up2date?
a. Improve clinical practice
b. Research
c. Patient discharge instructions
d. Unsure of patient di-agnosis
e. Promotion exam
f. Self-learning
98% of the nurses use Up2Date 90% of nurses are interested in getting involved
18%
19%
14%18%
31%
Future interest
a. Journal Club
b. Evidence based practice committee
c. Research team
d. Revising procedures to be aligned with EBP
e. Education
How can BJU change its current EBP and continue to provide quality
patient care?
Choose an EBP Model
Nursing Change Theory
SUCCESS!
Nursing Change Theory
Kotter 8 Step Model, created in 1996, based on a 8 step process
“According to John Kotter, 70 percent of all major change efforts in organizations fail because
organizations do not take the holistic approach required to effect that change”
8 step model increases changeImproves operating process and effectivenessChange is difficult both for the organization and for staffThis models offers a road map for implementing change
Create
urgency
Form a pow
erful coalition
Create a vision for
change
Com
municate the vision
Empow
er action
Create quick w
ins
Build on the change
Make it stick!
Kotter 8 Step Model
Quality & Safety
Excellent Nursing Care
Commitment 2 Service
Culturally Sensitive
Evidence-based
Practice
Respect
Kotter Change Model + EBP
Using the Kotter Change Model you can follow the EBP steps Construct a patient question or clinical case
P- Patient/population/Problem I-Intervention/Exposure C-Comparison O-Outcome
Research the literature Look for valid applications Apply the evidence to your practice Evaluate
How to continue to improve EBP at BJU
TrakCare Implementation of standardized nursing terminology
Exit Writer
Improvement in discharge instructions
Journal Club
Continuation and creation of Evidence Based Practice
Committee
Promotion Exam
Incorporate evidence based practice questions into exam for
Level III/IV
2016 Future
THANK YOU!
References
Goode,C., Fink,R., Krugman,M., Oman, K., Traditi,L. (2011). The colorado patient-centered interprofessional evidence-based practice model: a framework for transformation. Worldviews on Evidence-Based Nursing. Retrieved from https://www.researchgate.net/publication/49660700_The_Colorado_Patient-Centered_Interprofessional_Evidence-Based_Practice_Model_A_Framework_for_Transformation
Gawlinksi, A. Rutledge,D. (2008). Selecting a model for evidence-based practice changes: a practical approach. AACN Advanced Critical Care, 19(3), 291-300. Retrieved from http://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf
Kotter International (2016). The 8 step process to leading change. Kotter International. Retrieved from http://www.kotterinternational.com/the-8-step-process-for-leading-change/
Melnyk,B., Fineout-Overholt,E., Stillwell,S., Wiliamson,K. (2009). Igniting a spirit of inquiry: an essential foundation for evidence-based practice. AJN, 109 (11), 49-52. Retrieved from http://evidencebasednurse.weebly.com/
Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
http://qsen.org/evidence-based-practice/ (example print out)