Implementing Evidence into Practice International Clinical Librarian Conference

Implementing Evidence into Practice International Clinical Librarian Conference 1

Introductions Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC Chief Nurse and Publisher Wolters Kluwer Health Lippincott Williams & Wilkins/Ovid Technologies Mark Barragry Senior Director of Strategic Markets and Partnerships Wolters Kluwer Health Ovid Technologies 2

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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 Record Analyze 4 Question Experiment

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 5

Hierarchy of evidence-based information Translated Evidence. Clinical Decision Support Systematic Reviews and Practice Guidelines Original Research and Review Articles 6 (adapted from Haynes, 2007)

Evidence-based healthcare information and practice Evidencebased allied health Evidencebased medicine Evidencebased nursing 7

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 3 rd party payers • Reduces complications and payment denials • Meets the expectation of an informed public 8

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, 2 nd Edition) 9

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) 10

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 11

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 12

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 13

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 14

Ovid products that support EBP • • MEDLINE Evidence-Based Medicine Reviews (EBMR) – Cochrane Reviews Transplant Library British Medical Journal Embase Psyc. INFO Joanna Briggs Institute - PACESetter. S Ovid. MD 15

Ovid. MD “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 – Up. To. Date Professional Topics Literature-driven updating system; more than 440 journals are monitored by editors and authors. – Current Opinion full-text journals Contain peer-reviewed articles on research, techniques and diagnostic methods 16

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 17

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. 30 th. • 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; 2 nd edition • Mc. Clellan, M. Mc. Ginnis, 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. 18

Questions? Thank You!