Getting evidence into practiceEarly Clinical Career Fellowships
Masterclass29th August 2013
Annette Thain [email protected]
Learning Outcomes1. Understand the aim Knowledge into Action is to
support the implementation of evidence in practice 2. Know what sources to use for different types of
evidence3. Identify knowledge management tools and
techniques to support you to get evidence into practice
4. Know where to get help and advice for you and your colleagues
Average time from research initiation to application of findings/treatments is...
17 years
Knowledge into Action review
• help practitioners to apply knowledge to frontline practice.
• embed use of knowledge in healthcare improvement.
• support practitioners and managers to translate knowledge into better health outcomes, i.e. safe, effective, person-centred, efficient care.
What is Knowledge into Action?
evidence based practice
knowledge translationknowledge implementation
implementation science
“The move beyond simple dissemination of knowledge to actual use of knowledge”
Straus, et al (2009)
From Accessing to Applying Knowledge in NHS Scotland
Knowing• 66 libraries• 116 library staff• 12 million + resources
Doing• How much of this gets used
in a meaningful way to improve safe, effective, person-centred care?
http://www.knowledge.scot.nhs.uk
Knowledge as process
Know-what
•Journals
•MEDLINE
•Cochrane reviews
•Reports
Know-where
•Systems
•Processes
•Local context
Know-who
•Service users
•Practitioners
•Teams
Practice
Experience
Research
Know-how:
•Actionable •Relational
•Organisational
Knowledge as process
Actionable knowledge•Checklists
•Pathways
•Mobile apps
Relational use of knowledge
•Communities of Practice
•Social networking
•Social learning
Organisational enablers
•Backing at national and board level
•Tests of change to demonstrate impact
•Knowledge broker
Know-how:
•Actionable •Relational
•Organisational
Discussion
• Discuss examples from your practice of – actionable knowledge ie ways of presenting
knowledge– social/relational use of knowledge ie examples of
communicating and sharing
• Feedback one example of each
Transfer of Knowledge into Quality Patient Care Clinical Knowledge
(Evidence Based Practice):
MEDLINE, Cochrane etc
Improvement Knowledge:
SPSP experience, etc
Know-What
Know-How
Quality
Patient Care
Doing the right thing
Doing it right
Clinical Decisions
Process/System Changes
Adapted from: Glasziou, P et al. Can evidence-basedmedicine and clinical quality improvement learn fromeach other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17
Mnemonic – the practical activities to support the cycle
Question What do you need to know?
Source Where will you look?
Find What words will you use?
Evaluate Is the information ‘good’?
Combine How does it all fit together?
Share How will you share it?
Apply How will you use it?
Question - Keyword
Keyword Synonym
Osteoporosis Bone density, bone loss
Adult male Elderly man, older people
Calcium supplement Adcal D3, Calcit D3, Calcichew-D3
Alternative/additional measures Diet, exercise, lifestyle
John is a 62 year old man who has been diagnosed with osteoporosis. He’s been prescribed a calcium and vitamin D supplement but is interested in other ways protect
himself.
PICO
P Person, population or problem
Adult male, elderly male
I Intervention (proposed)
Diet and lifestyle changes
C Comparison/Current intervention Calcium and vitamin D
O Outcome(s) expected
Improved bone density
Now you try an example……
Know-what
•Journals
•MEDLINE
•Cochrane reviews
•Reports
Know-where
•Systems
•Processes
•Variation
Know-who
•Service user
•Practitioner
•Teams
Practice
Experience
Research
Research
Point of care DynamedNursing Reference CenterGuidelinesEvidence summaries
Other questionsDatabasesJournalsBooks
Reliable information resources :
http://www.knowledge.scot.nhs.uk
The Knowledge NetworkIndex
Systems
Summaries
Synthesis of Synopsis
Synopsis
Synthesis of Single Studies
Studies
Computerised decision support
Guidelines/Protocols/ Evidence Based textbooks
Evidence based journal articles eg Evidence
Based Nursing
Systematic Reviews eg Cochrane Library
Original Journal Articles and Studies eg Medline
Point of Care Resources eg Dynamed
[Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model.
Evidence-Based Nursing, 12,99-101]
Know What – Evidence Triangle
Other Sources - discussion
Know-where
•Local context
•Systems
•Processes
Know-who
•Service users
•Practitioners
•Teams
Practice
Experience
Research
Possible Sources- depends on topic• Grey literature• References• Epidemiology• Drug information• Patient stories• Case studies• Improvement websites
eg IHI
• Books• Elearning• Videos• People• Communities of
practice• MCNs• GOOGLE
Demo of The Knowledge Network to find the know what and know how
Does it answer my question?Do I need to do a full scale critical appraisal?
How does all this fit with your previous knowledge and experience / local setting?
RefWorks/RefShare
Who else needs to know about whatyou’ve found?
How will you let them know about it?
Information/knowledge has little value unless it isused
How will you -Use the new information?Change your practice?Keep up to date?
Barriers and facilitators
Barriers FacilitatorsBarriers• Awareness and
knowledge• Skills• Motivation• Practicalities• Acceptance and
beliefs www.nice.org.uk
Practice based small group learning
Using real clinical problems to stimulate reflection, discussion and learning among groups of peers
• Specially prepared modules produced which “closes the gap between current practice and best practice”
• Knowledge brokers provided support to clinicians in developing a PBSGL module on cervical screening.
• Educational perspective – clinicians and knowledge brokers working together
Sepsis and VTE collaborative
• The Sepsis Collaborative aims to contribute to overall aim of the Scottish Patient Safety Programme of reducing mortality rates by 20% by December 2015
• Knowledge broker involved in a range of activities• Educational perspective – knowledge broker role combined
with tools and resources produced a positive outcome.
An informal method to stimulate and create ‘awakening and engaging of collective intelligence through conversations about questions that matter’. It is a technique to evoke and make visible the collective intelligence of a group.
A community of practice shares a specific interest that becomes a source of identification. This creates a sense of commitment to the community as a whole, not merely connections to a few linking nodes. Eg Dementia MKN
Also known as ‘learning before doing.’ A team asks for help: people are invited to share their experience, insights and knowledge with the team.
A short, facilitated meeting of project team members (and possibly other stakeholders) to evaluate and capture lessons learned.
Task or resource lists as an aide memoire to
improve consistency.
Knowledge banks are repositories which store knowledge and allow people to retrieve and use the knowledge they contain. For example, SSKS, ASSIA
Provide understanding of causal factors, barriers and facilitators that led an event to unfold as it did. Examples on Evidence for Practice tab on SSKS.
Librarians and knowledge managers carry out expert searches of research sources. Use of Health Management Library Services
Use of the Evidence Informed Practice search option on SSKS
Directories of people with contact details and information on skills, practice experience and areas of interest eg members of Dementia MKN
Social media tools eg Blogs, Twitter, Facebook, Book Marking, News Feeds, Community Website tools
PTO for more info
KM Tools and techniques
Help and training
• Online help• Webex sessions for The
Knowledge Network and other services – sign up for monthly newsletter [email protected]
• Webex sessions from providers
• CLEAR service
• Local NHS librarians• Materials for colleagues
• Any problems or questions [email protected]
KnowNetScotland
TKNScotland
Thank you for listening
• Any questions?Learning outcomes1.Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2.Know what sources to use for different types of evidence3.Identify knowledge management tools and techniques to support you to get evidence into practice4.Know where to get help and advice for you and your colleagues