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International Clinical Librarian Conference

Implementing Evidence into Practice

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Introductions

Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Chief Nurse and PublisherWolters Kluwer Health

Lippincott Williams & Wilkins/Ovid Technologies

Mark BarragrySenior Director of Strategic Markets and Partnerships

Wolters Kluwer HealthOvid Technologies

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In the beginning…

• The Cochrane Model– Archie Cochrane,

epidemiologist from Britain

– Care should not be done just because it’s always been done that way

– Evidence-based care will:• ensure quality care• improve patient

outcomes• improves cost

efficiencies

Question

Experiment

Analyze

Record

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Defining evidence-based practice (EBP)

• Evidence-based practice or evidence-based decision-making is based on:

– External evidence – systematic reviews, randomized control trials, best practice, and clinical practice guidelines that support a change in clinical practice

– Internal evidence – health care institution based quality improvement projects, outcome management initiatives, and clinical expertise

– Patient preferences and values – what does the patient really want

Evidence-based care improves quality of life

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Hierarchy of evidence-based information (adapted from

Haynes, 2007)

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Evidence-based healthcare information and practice

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Why healthcare providers use evidence-based practice

• Leads to highest quality care and patient outcomes

• Reduces health care costs

• Reduces geographic variations in the delivery of care

• Increases healthcare provider empowerment and role satisfaction

• Reduces healthcare provider turnover rate

• Increases reimbursement from 3rd party payers

• Reduces complications and payment denials

• Meets the expectation of an informed public

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7 steps of EBP

0: Cultivate a spirit of inquiry

1: Ask the question in the PICOT format

2: Search for and collect the most relevant and best evidence

3: Critically appraise the evidence

4: Integrate the best evidence with the healthcare provider’s experience/ expertise and patient preference

5: Evaluate outcomes of the practice decision

6: Disseminate the outcomes of the EBP decision

(Melynk,B., Fineout-Overholt,E. Evidence-based practice in nursing & healthcare. 2010, 2nd Edition)

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Key initiatives

• Cochrane Collaboration (http://www.cochrane.org)- systematic reviews focused on medicine and overall healthcare

• Joanna Briggs Institute – systematic reviews and best practice recommendations focused on nursing and overall healthcare

• Campbell Collaboration – systematic reviews focused on social sciences

• Guidelines International Network (G-I-N) – International Guideline Library – 94 organizations

• World Health Organization (WHO) – focused on public health guidelines

• Germany - German Agency for Quality Medicine

• United Kingdom - National Institute for Health and Clinical Evidence (NICE) – guidelines focused on interventional procedures, clinical practice and technology appraisals

• Netherlands - Dutch Institute for Healthcare Improvement (CBO)

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Barriers to implementing EBP in health care institutions

• Lack of EBP skills or knowledge

• Misperceptions or negative attitudes about research and EBP

• Lack of belief that EBP improves outcomes

• Too much information in journals – information overload

• Lack of time and resources to search for and appraise evidence

• Overwhelming patient loads

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Barriers to implementing EBP in health care institutions

• Organization constraints and lack of administrative support

• Lack of EBP mentors

• Demands from patients for a certain type of treatment

• Peer pressure to continue to practice steeped in tradition

• Resistance to change

• Lack of consequences for not implementing EBP

• Lack of autonomy over practices and incentives

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How can institutions support EBP?

• Leaders need to support and encourage a culture of EBP

• Medical librarians need to teach researchers and healthcare providers how to search

• Healthcare providers and researchers need the time to critically appraise studies and implement findings

• Researchers need to be taught how to write clear reports that can be translated into practice

• EBP mentors need to be readily available and accessible

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How can institutions support EBP?

• Provide proper tools and resources – access to evidence-based journals and databases

• Provide an adequate number of computers throughout the institution and make sure they have intranet and internet capability

• Clinical systems need to incorporate EBP information• Clinical practice policies and procedures need to be based

on evidence• Initiate journal clubs• Support EBP rounds

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Ovid products that support EBP

• MEDLINE• Evidence-Based Medicine Reviews (EBMR) – Cochrane

Reviews• Transplant Library• British Medical Journal • Embase• PsycINFO• Joanna Briggs Institute - PACESetterS• OvidMD

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OvidMD “Putting Research into Practice”

The first clinical tool from Ovid for physicians and other clinicians to find quick answers to clinical questions backed by comprehensive, evidence-based research from trusted sources.

A clinical lens based on evidence-based content:– Evidence-Based Guidelines

A synthesis of best available evidence written by physicians for physicians that recommends a course of action

– UpToDate Professional Topics Literature-driven updating system; more than 440 journals are monitored by editors and authors.

– Current Opinion full-text journalsContain peer-reviewed articles on research, techniques and diagnostic methods

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In summary…

• Healthcare practice based on evidence:– Improves healthcare practice– Improves patient outcomes– Lowers healthcare costs

• Librarians are in a key role to facilitate evidence-based practice by:– Leveraging their expertise to teach and assist healthcare providers

with search and obtaining the best search results– Assisting in appraising the evidence for validity, reliability, and

applicability– Leading educational opportunities to educate healthcare providers on

the importance of evidence-based practice– Facilitating a journal club to discuss the latest clinical practice

guidelines around specific conditions and diseases– Being the “Evidence Mentor” for the institution

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References

• Eddy, D. Evidence-based medicine: A unified approach; Health Affairs, 24, no.1 (2005)

• Guyatt, G. Evidence-based medicine has come a long way; BMJ, 2004, Oct. 30th.

• Hemingway, P. What is a systematic review? Hayward Group Ltd; April 2008.

• Liang, L. The gap between evidence and practice; Health Affairs, 26, no.2 (2007)

• Melnyk, B. Fineout-Overholt, E. Evidence-based practice in nursing & healthcare. LWW, Philadelphia, June 2010; 2nd edition

• McClellan, M. McGinnis, M., Nabel, E., et.al. Evidence-based medicine and the changing nature of healthcare: Meeting summary; IOM Roundtable on evidence-based medicine; National Academies Press; 2008.

Questions?

Thank You!