Evidence-Based Practice

A five-minute introduction

What is Evidence-Based Practice?

• Definition: Applying the best available research results (evidence) when making decisions about health care. Health care professionals who perform evidence-based practice use research evidence along with clinical expertise and patient preferences. Systematic reviews (summaries of health care research results) provide information that aids in the process of evidence-based practice.

An Example:

A health care provider recommends acetaminophen to treat arthritis pain in a patient who has recently had stomach bleeding. The health care provider makes this recommendation because research shows that acetaminophen is associated with less risk for stomach bleeds than other common pain relievers. The health care provider's recommendation is an example of evidence-based practice.

The Process of Evidence-Based Practice

ASSESS the patient 1. Start with the patient—a clinical problem or question comes from patient care

ASK the question 2. Build a solid, clinical question from the case

ACQUIRE the evidence 3. Pick the right resource(s) and conduct a search

APPRAISE the evidence 4. Rate the evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

APPLY: talk with the patient 5. Return to the patient -- integrate the evidence with your clinical expertise, patient preferences & apply it to practice

Self-evaluation 6. Evaluate your performance with this patient

Anatomy of a good clinical question: PICO

P = Patient or Problem What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.

I = Intervention What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient? Co-existing problems?

C = Comparison What is the main alternative to compare with the intervention? Your clinical question does not always need a specific comparison.

O = Outcomes What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events?Improve function or test scores?

What Does this mean?

You find proof of good health care and use it with your clinical expertise as well as the patient’s preferences.

A few years ago, nurses were waking up patients in

the middle of the night because of the order to take vital signs every four hours. Through evidence-based practice, the nurses found that practice wasn’t necessary. Now patients can get better rest.

Thank you!

Mary Shah, MLS

Medical Librarian, Nursing Liaison

Horblit Health Sciences Library

5 North

mary.shah@wcthealthnetwork.org

Phone: 203-739-7035, Fax: 203-739-7568