T/F: because EBP tells us what the best course of treatment is for certain pt populations, there is no variation across clinical practice
FALSE: there is always variation in practice!
what is the goal of EBP guidelines?
reduce variation in outcomes
What are EBP guidelines?
statements intended to optimize patient care and outcomes, including a recommendation for practice
What are EBP guidelines based on?
systematic review of evidence, based on previously appraised evidence
why are EBPs important?
there is overwhelming evidence, competing clinical priorities and increasing accountability
What are issues with EBPGs?
rigor of evidence search varies between website, appraisal and level of evidence changes, guidelines may be conflicting and guidelines may be difficult to implement!
What are some of the sites that have EBPGs?
National Guideline Clearinghouse, Community Guide, US Preventative Task Force
What is the gold standard for accessing EBPGs?
NATIONAL GUIDELINE CLEARINGHOUSE
why is NGC the gold standard for accessing EBPGs?
most descriptive, most rigorous guidelines, updated every week!
what is the goal of NGC?
to create a comprehensive database of up-to-date English language EBPGs
What information, aside from clinical information, is contained in EBPGs?
expertise of guideline developers, who funded it, thoroughness of evidence search, strength of evidence, population it was intended fore, date
How do guideline websites differ?
EACH has their own grading system!
What questions do we ask to rapidly critically appraise EBPGs?
- is guideline valid and reliable?
- what are the recommendations in the guideline?
- how useful are the recommendations?
What do we need to consider before we do an EBPG?
- does the proposed guideline have the potential to change health outcomes or cost?
- is there available scientific evidence on which to develop the guideline?
why do we want to create an ebp clinical environment?
- regulatory initiatives and insurance mandates
- Magnet recognition
- triple aim
what is the “triple aim”?
- improving the patient experience of care
- improving the health of populations
- reducing per capita cost of health care
What are the 6 objectives for developing an EBP vision?
- develop a mental framework
- establish a motivating image for change
- create specific goals
- gain admin support
- establish a leadership team
- involve experts and mentors in clinical practice
what are strategies for developing a mental framework?
- develop a written summary of what you want to accomplish
2. brainstorm with colleagues about environment you want
what are strategies for establishing a motivating image for change?
- use creativity to capture attention of clinical staff
2. take advantage of real clinical scenarios to stress need for change
what are strategies for creating specific goals?
- focus on short term goals
2. establish 2-3 goals at one time
what are strategies for gaining administrative support?
- create a presentation that reflects the need for the EBP culture
- seek admin support for the project to be a priority
what are strategies for establishing a leadership team?
- identify key personnel who are passionate about EBP
2. conduct focus groups
what are strategies for involving experts and mentors in clinical practice?
- identify clinical experts & mentors
2. engage clinical expert support
What are barriers to EBP?
- inadequate knowledge/skills
- weak beliefs about EBP value
- poor attitude about EBP
- lack of EBP mentors
- lack of support by leaders
- economic restrictions
