Evidence based practice

Evidence based practice

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  EVIDENCE BASED PRACTICE BY NAKKAVARSHITHA
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  DEFINITION It is asystematic approach to clinical problem solving which allows the integration of best available research evidence with clinical expertise and patient values Knowledge experience skills • Patient values and preferences Best available evidence • CLINICAL DECISION
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  Why?????  To Improvequality of care  Promotes critical thinking  Try new methods  To adopt Constantly changing information
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  WHO PRACTITIONER RESEARCHERS FUNDERS POLICY MAKERS COMMUNITY
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  • ASK • ACQUIRE •APPRAISE • APPLY • ASSESS EVIDENCE BASED PRACTICE
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  ASK-FORMULATING ANSWERABLE CLINICAL QUESTION Questions are generally , frequently unstructured and complex  Practice of EBM should begin with a well formulated clinical question  Good clinical question should be clear, directly foused on problem at hand and answerable by searching the medical literature Information needed Answerable question A useful frame work for making clinical question should have 4 or 3 essential components in PICO
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  PICO • P-Patient orproblem in question • I- Intervention or test or exposure of intrest • C-Comparison • O-Outcomes
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   What isthe risk of breast cancer in post menopausal women using HRT when compared to womens with no HRT?  A 4 months old baby with viral bronchiolitis, does the administration of corticosteroids compared with not giving corticosteroids improve clinical score and reduce length of hospital stay?  In patients with acute MI does early treatment with a statin decreases cardiovascular risk? EXAMPLES questions for PICO format
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  ACQUIRE-finding the evidence Findingthe evidence for the framed question by using ,Sources of information ■ Primary sources are original materials on which other research is based, including:  original written works – poems, diaries, court records, interviews, surveys, and original research/fieldwork, and  research published in scholarly/academic journals. ■ Secondary sources are those that describe or analyze primary sources, including: reference materials – dictionaries, encyclopedias, textbooks, and books and articles that interpret, review, or sythesize original research/fieldwork. ■ Tertiary sources are those used to organize and locate secondary and primary sources.  Indexes – provide citations that fully identify a work with information such as author, titles of a book, artile, and/or journal, publisher and publication date, volume and issue number and page numbers.  Abstracts – summarize the primary or secondary sources,  Databases – are online indexes that usually include abstracts for each primary or secondary resource, and may also include a digital copy of the resource.
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  One way toorganize the different types of evidence involved in evidence-based practice research is the levels of evidence pyramid. The pyramid includes a variety of evidence types and levels.
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   Appraise theevidence for its validity and usefulness  Research evidence may be appraised with regard to validity, importance and applicability to the patient.  Tools for appraising research articles Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency. eg: CASP
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  APPLY • Apply thesolution to the identified problem • Consider patients own personal values and cirumstances • Evidence regarding both efficacy and risks should be discussed Is the patient is suitable for the study? Does the benefits outweighs risk? Cost ? Patients values and preferences? ASSESS Evaluation of performance at frequent intervals
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  APPLICATIONS  Minimize theerrors in patient care  Reduce the cost of treatment  Optimize the quality of patient care  Improve self directed learning of practiner  Updates knowledge