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Stepping up to Evidence Based Practice - Ideas into Action 5

Debra Ugboma

January 2010

Implementing Evidence Based Practice and Change

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Objectives

Ensure you have appraised the evidence in the context of your own clinical setting

Identify local factors that may affect the outcomes of applying the findings

Revisit some of the barriers to implementing EBP Identify personal and team influences over care and change Discuss the value of action plans and Gantt charts

What do I need for this session:– Your evidence summary– Your ideas for your plan of action– Worksheet 5

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Stepping up to EBP..

Ideas into action

Getting involved in audit

Implementing EBP dissertations

Evidence from others/policy etc.

Questioning care, responding to feedback

Structured EBP projects

Projects into publication!

Active involvement in research

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A PHT Model?

Implementers

(drivers)

Consultant NursesPDNsSpecialist NursesMasters educated clinical staff (facilitators/sponsors)

Learning and

Development

Department (supporters)

Practice Links Clinical CareKnowledge/Expertise

“Permission”

Higher Education Links Scholarship Development

Resources Skills

Development

Clinical ManagersMulti-professional Team

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Context

Have you appraised the findings – and answered your question – in the context of your own clinical environment?

Have you considered all the comments and issues raised from team discussions about the proposed change?

Is this a multi-professional issue? It usually is, and so do not forget to consult others and work collaboratively.

These are important before moving further forward

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Embracing change..

Think about a previous change implemented in your clinical area?

Undertake the activity on worksheet 5 (questions 1-3)

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Who will Lead, Facilitate and Support?

What will each need from the other?

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The Lead…

Clarify role and responsibilities as the lead Identify any educational/information/skill needs for staff – how

will you convey the message and information and develop skills Plan the change – Action plan or Gantt chart Be realistic in your time-scale and what you want people to do Consider how you are going to evaluate the change and feed-

back to staff and into care/practice You must enthuse, drive, keep positive and keep momentum

going Where are you going to get your support from and what form

does this need to take?

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The Facilitator

Clarify role and responsibilities Usually adds “weight” to a project Provide expertise and support planning/implementation May help with information sharing and developing skills and

knowledge Connections and networking Problem solving Enthuse, drive, keep positive and keep momentum going Regular structured “catch ups” with lead

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The Supporter

Clarify role and responsibilities Usually “hands-off” in relation to project (there for the lead and

facilitator rather than clinical team) Resource for Lead and Facilitator Provide a corporate/global perspective May support global or resource issues/initiatives Enthuse, drive, invigorate, keep positive and keep momentum

going Structured “catch ups” with Lead and Facilitator – clinical

supervision/action learning models?

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Top tips.. What works

Small incremental changes Talking Involving staff and “taking them with you” Regular reminders and updates The right tone Doing and role modelling Positive attitude…but… Being realistic Knowing it will not be perfect initially Feedback, encouragement, reward (cakes!)

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Awareness, Agreement, Adoption, Adherence (Pathman,1996 cited in Friedman et al 2009)

Awareness

AgreementAdoption

Adherence

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Final word about audit and evaluation

Evaluation or audit of change is important Not always about tick lists! Choose most appropriate audit and evaluation method. Try to use validated tools or get help with designing audit tools Keep it as simple as possible

Helps to evaluate achievement of EBP Helps to identify further actions Feeds back into EBP cycle

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What if we need money or resources for our EBP project?

If your EBP change is significant, and requires money or resources you will need to discuss this with your line manager in the first instance

You can apply for money through some professional or charitable organisations e.g:– The Florence Nightingale Foundation travel scholarships:

http://www.florence-nightingale-foundation.org.uk/scholarships.htm

– The Foundation of Nursing Studies “putting patients first programme”: http://www.fons.org/ahcp_pffunding.asp

– The Learning and Development Team can help you with some of these aspects as any application needs thought and care

You may need to write a business plan if there are significant financial implications for the Trust (discuss with your Operational Manager)

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Start your plan..

At the end of this session, try drafting your plan for implementing EBP. Try it in an action plan or Gantt chart format?

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It’s a wrap for us and a beginning for you!

These five presentations have hopefully helped to steer you through aspects of the EBP process

Our aim is to set you off on the road to continued and on-going EBP

Please keep in touch about your current and future projects…

For further information contact:Learning and Development TeamDebbie Knight, Deputy Head of Nursing and Midwifery Education

and Practice DevelopmentDebbie.Knight@porthosp.nhs.uk

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Resources

Case studies for change/developing practice: http://www.rcn.org.uk/development/practice/clinical_governance/case_studies#ebp

Fish! Motivational ideas. Fish! A remarkable way to boost morale and improve results. Stephen Lundin, Harry Paul and John Christiensen.

Foundation of Nursing Studies – Networking and Sharing: http://www.fons.org/ns_projects.asp?sub=sub2

Intute – helping you find the best websites for study and research: http://www.intute.ac.uk/cgi-bin/browse-keyword.pl?jacs=nmap&id=31462

PHT Governance and clinical audit: http://pht/Departments/ClinicalAudit/default.aspx

PHT Leadership and Management Courses e.g. Managing and leading for the first time, Practical project management: http://phtlearningzone.org.uk/index.php?page=lm