Tips for Building an Evidence-Based Practice
—By Ed Coombs, Dräger
One of the recent trends we have seen among our customers is a move toward an evidence-based practice, which involves using evidence from well designed, peer-reviewed research to optimize decision making. The purpose of evidence-based practice is to:
- Improve patient safety and quality
- Consider cost savings
- Increase professional satisfaction
There are various levels of evidence to consider. The quality of each level is based on the source – ranging from high quality, systemic reviews (including meta-analysis and randomized controlled trials) down to expert opinion, which is regarded as the lowest level of evidence.
To develop an evidence-based practice, you need to consider two basic types of questions: background and foreground.
#1: Consider background questions
Background questions concern general knowledge and generally have two parts: A question root (who, what, when, where, how, why) and a disorder (test, treatment, or other aspect of health care). Often these questions can best be answered by using a textbook or consulting clinical databases, such as the U.S. National Library of Medicine’s PubMed or Cumulative Index to Nursing and Allied Healthcare Literature (CINAHL).
#2: Consider foreground questions, using PICO
Foreground questions, which are about specific knowledge, can affect clinical decisions and may include a broad range of biologic, psychological, and sociologic issues.
These questions generally require a search of the primary medical literature and are best answered using the PICO methodology. PICO is an anagram that guides the development of a clinical question and leads to high quality information and answers. When a project is defined in this manner, it helps keep the team on track and limits expansions that can make the project falter or fail.
P | Patient, Population, or Problem | How would I describe a group of patients similar to mine? Example: In adult patients with acute COPD exacerbation |
I | Intervention, Prognostic Factor, or Exposure | Which main intervention, prognostic factor, or exposure am I considering? Does BiPAP |
C | Comparison or Intervention (if appropriate) | What is the main alternative to compare with the intervention? When compared to CPAP |
O | Outcome you would like to measure or achieve | What can I hope to accomplish, measure, improve, or affect? Reduce need for intubation? |
#3: Minimize the impact of change
Answers derived by using the PICO format usually call changes to the practice – and our experience is that changes are usually accompanied by obstacles, such as insufficient time to implement, inadequate staff training, skills, or resources, and hesitance to change from the status quo.
There are several actions you can take to successfully introduce changes and innovative approaches in clinical practice:
- Locate the most current review article on a topic: it will provide a comprehensive bibliography related to study design and associated outcomes.
- Develop a multi-disciplinary team and identify champions in each discipline.
- Conduct a test pilot of the practice change to better control the implementation and track its effectiveness.
By following these steps, the acceptance of building an evidence-based practice and becoming more effective will be within your reach.
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