Building a team to effectively implement a sustainable EBP should be supported by

What is it?

Evidence-based practice (EBP) is an approach to care that integrates the best available research evidence with clinical expertise and patient values.1

It involves translating evidence into practice, also known as knowledge translation, and ensuring that ‘stakeholders (health practitioners, patients, family and carers) are aware of and use research evidence to inform their health and healthcare decision-making’.2

Why is it important?

Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimise functional decline in older people.

• Four in 10 adult patients receive care that is not based on current evidence or guidelines, including ineffective, unnecessary or potentially harmful treatments.2
• Despite the availability of evidence-based guidelines, there are significant gaps in implementing evidence into routine clinical practice.3
• Translating evidence into practice can not only improve outcomes and quality of life for older people, it can also improve productivity and reduce healthcare costs.1

How can you implement evidence-based initiatives to improve outcomes for older people?

Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website.

The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.

The ‘how to’ guide: turning knowledge into practice in the care of older people identifies a five-stage process to implementing change, which can be applied to translate evidence into practice.

Identify a practice that could be improved

• Select an area of interest in your clinical practice that could be improved – for example falls, medication errors or malnutrition.
• Identify current best practice guidelines and evidence-based interventions associated with improved outcomes.
• With your team, select an appropriate intervention and outcome measures that will influence your practice.
• Collaborate with quality teams and researchers with expertise in the area you are focussing on.

Barriers, enablers and issues

• Identify the barriers to implementing change. This includes anything that might obstruct or slow down the adoption of a new clinical intervention, such as feasibility, existing care processes or existing team culture.
• Explore the enablers to implementing change. This includes anything that might assist or encourage take up of a new evidence-based practice, such as positive staff attitudes, funding or alignment with accreditation standards.
• Consider issues for any data collection for measuring the effectiveness of your intervention.
• Plan for sustainability to ensure the change can be maintained.

The intervention

• Tailor the intervention to fit within the appropriate policies, standards and guidelines.
• Engage and communicate with relevant stakeholders including staff, patients, family and carers to promote and facilitate adoption of the new intervention.
• Consider implementing a plan-do-study-act cycle from the ‘how to’ guide in which interventions are introduced and tested in the real work setting, in a sequence of repeating, smaller quality cycles.

What did and didn’t work

• Monitor patient outcomes following the adoption of a new intervention.
• Measure the impacts of translating evidence in your current practice.
• Outline an evaluation to measure outcomes and demonstrate any improvement.

Maintaining the intervention

• Adapt and integrate the new intervention within the current systems taking into account funding and resources.
• Ensure all new staff receive ongoing training.
• Maintain ongoing communication, engagement and partnerships with relevant stakeholders and the broader network.

1. Sackett D et al. 2000, ‘Evidence-Based Medicine: How to Practice and Teach’ EBM, 2nd edition. Churchill Livingstone, Edinburgh, p1.

2. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ & Squires JE 2012, ‘Knowledge translation of research findings’, Implement Sci, 7(50):50.

3. Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA & Braithwaite J 2012, ‘CareTrack: assessing the appropriateness of health care delivery in Australia’, Med J Aust, 197(2):100-5.

Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making. Oncology nurses are perfectly positioned to be adopters and promoters of EBP, resulting in practice change for improved quality and safety.

The impact of EBP on nursing and patient outcomes is clearly evident. Many organizations have developed competency-based, nurse-led EBP programs that are redesigning care delivery to increase the effectiveness and efficiency of interventions while reducing costs and safety risks. For EBP integration to be successful and sustainable, a culture of EBP readiness must exist through ongoing leadership support, EBP resource availability, and adoption of an EBP implementation framework.

In recent years, nurse scientists have developed several EBP models to help demystify the process of translating research into clinical practice. Although the models include varying levels of detail, they share the following basic phases of the EBP process.

• Ask: Identify a clinical problem.
• Attain: Review relevant literature.
• Appraise: Critically appraise evidence.
• Apply: Evaluate the need for practice change and potential implementation.
• Assess: Evaluate outcomes.

Organizations must adopt the EBP model that best fits their context of care, aligns with improvement goals, addresses priority clinical problems, and guides a systematic and evaluative approach to collaborative practice change.

Common EBP Models

The Iowa Model for Evidence-Based Practice to Promote Quality Care has been revised to better address sustainability of EBP, interprofessional change implementation, and patient-centric care for clinicians at all levels of practice, guiding them through a team-based, multiphase process. The path initiates with a clinical “trigger” that identifies a clinical problem and includes decision points with evaluative feedback loops when recommending and implementing practice change. The model phases are interprofessional team formation; evidence review, critique, and synthesis; change implementation through piloting; ongoing evaluation; and outcomes dissemination.

The Advancing Research and Clinical Practice Through Close Collaboration Model is for building resources and training mentors who play a central role in facilitating and sustaining EBP at the point-of-care and throughout the organization. The model has seven steps: cultivating a spirit of inquiry; asking a PICOT-formatted clinical question; collecting, critically appraising, and integrating the best evidence with clinical expertise and patient preferences; and evaluating and disseminating practice change outcomes.

The Johns Hopkins Nursing Evidence-Based Practice Model is clinician-focused, allowing rapid and appropriate application of current research and best practices. It simplifies the EBP process and cultivates a culture of care based on evidence. It has three overall steps: practice question, evidence, and translation. Its directive tools are intended for practicing clinicians working individually or in a group to address clinical inquiries.

The Promoting Action on Research Implementation in Health Services (PARIHS) Framework has been revised into the integrated or i-PARIHS framework. The framework refers to evidence-based change as practice innovation. It contends the core elements of successful implementation of practice innovation is dependent on the type of evidence available, context of the care setting, and how the process is facilitated. The framework emphasizes the importance of taking into consideration the perspectives of all recipients of the intended change.

Although these are just a few models for translating evidence into practice, each outlines and promotes the need for a systematic approach to evidence-based change. Each addresses the sustainability of EBP through organizational culture change, stakeholder engagement, comprehensive literature review and appraisal, barrier identification, impact evaluation, and outcomes dissemination. Regardless of the preferred model, the EBP process should tell the story of how a problem was recognized, addressed, and improved, and that story should be shared.

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