Getting started with EBP 

EBP is defined as ‘integrating the best available research evidence with clinical expertise and the patient’s unique values and circumstances’. [1] In practice this means that evidence needs to be considered in the context of the person or patient’s values and preferences, and the insights gained from clinical experience. The circumstances of care will also influence any decision as this may increase or decrease care options. 

When engaging with EBP it is useful to remember:

  • Evidence needs to be tailored to the individual and it does not alone determine what action will be taken. In the absence of evidence care decisions will be based on patient values and clinical experience. A lack of evidence does not mean that no decision can be taken or change to care made.
  • From the patient’s perspective it is important that they understand the potential benefits and risks of any care decision. This helps them to evaluate risks and benefits against what is important to them and so make an informed decision about their own care.
  • Developing a question, searching for and appraising the evidence, and facilitating change based on the evidence takes time. Using guidelines and pre-appraised evidence as shown in the 6s pyramid can help to reduce the time required. 
  • Sharing your findings with other health professionals for example at staff meetings or journal clubs can be a useful way to get feedback on what you have found and how it might be implemented.

Your organisation can also take steps to support EBP by implementing a framework to assist staff apply a consistent approach to implementing change. In the following section we highlight some models that are freely available for your organisation to use.

EBP models 

Models have been developed to assist implementation of EBP in the clinical setting at the practitioner and organisational levels. [2] These provide a structured approach to identifying where change is needed, and outline the steps required to bring about needed changes.

Examples include:

PDSA cycle

The PDSA cycle (Plan, Do, Study, Act) is a well-known model t facilitate the testing of changes in a ‘real world’ setting. The model evolved from the FOCUS-PDCA developed in the early 1990s, an approach that incorporated analysis of the evidence and context of care before embarking on change. [3] The Institute for Healthcare Improvement has more on application of the PDSA model in health.

John Hopkins model

A problem solving model used to guide clinical decision making based on the EBP approach. Intended for organisations and individuals.

Iowa model

A flowchart to assist with clinical decision-making and problem solving. Intended for organisations and individuals.

Adapting guidelines

The Australian NHMRC has guidance on deciding whether to adopt, adapt or start from scratch when it comes to clinical guidelines. Factors that should be considered before adapting or adopting a guideline include:
  • how the evidence was interpreted
  • whether there were conflicts of interest
  • what values and preferences were considered
  • the context in which the recommendations are meant to apply.

The widely used ADAPTE toolkit can also be used to step through the process of adapting guidelines to local practice contexts.

The Canadian National Collaborating Centre for Methods and Tools (NCCMT) has guidance on assessing whether evidence is applicable to the local context (patient, population, setting, system) and whether it is likely to achieve similar results (see NCCMT)

Understanding Risk / benefit 

Deciding whether to make a change or to take up a new approach to care will depend on what there is to gain and what the risks of doing this might be. There are useful resources to help you understand risk/benefit in clinical practice. This will in turn help you to explain this to the person you are caring for and their family based on their circumstances.

Learn more 

The following modules provide insights into CareSearch resources that can be useful to integrate evidence into your everyday palliative care practice.

The Aged care module is about finding resources to help you provide better clinical care for older people in residential aged care who are coming to the end of their life.

The carers module helps you to understand carer needs and to find helpful resources for them.

  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71.
  2. Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9.
  3. Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011 Apr;20 Suppl 1:i13-17. doi: 10.1136/bmjqs.2010.046524

Page created 09 May 2022