Once you have identified the best available evidence that is relevant to the problem or issue of your patient or population your thoughts might turn to how to implement the change.
Adoption of changes will require support from the patient or population and relevant members of your organisation.
Your search for evidence began with an issue or problem in relation to a patient. After identifying and appraising relevant evidence you will need to summarise your findings and consider whether change is warranted. The best evidence may confirm your practice is appropriate. The evidence may show you something new to implement or show something new that would not be appropriate to implement in your care context. That is the decision to make.
Where there is only one review to consider then your appraisal checklist might serve as your summary. If you have multiple reviews to consider then an overall summary reflecting all of the findings will be needed. Consider: Does the evidence answer your question? Is the evidence of good quality and is it relevant to your patient? If so, what changes are proposed to address the original issue or problem?
Consider how you will introduce this change. Evidence-based
care requires integration of evidence within the local context of care as
well as with patient preferences and values, their health condition and context, and your professional expertise. Bringing about change can be challenging when attempting to combine each of these elements.
Before implementing changes, a plan can be helpful. There is no prescribed plan for EBP application. Use the steps outlined below to develop your own plan tailored to your needs and context.
The evidence-to-practice pipeline describes steps for EBP implementation.  In summary the steps correspond to activities to:
If you then want to introduce changes more widely such as across a department then Wensing and Grol  tell us that a systematic approach is essential, and this requires preparation and planning. Their implementation of change model provides more detail on what is required across the following steps:
Visit Clinical Information Access Portal (CIAP) EBP Learning module - Apply the Evidence
Visit Apply the Evidence
Having found relevant evidence that offers an option for addressing a patient issue or problem you may want to share this information with them so that a decision can be reached in collaboration. In palliative care shared decision-making is likely to involve both the patient and family as well as members of the health care team. It can be a way for patients to exert some control over their situation in challenging circumstances. Whether and how much patients want to be involved will vary across a continuum and over time. 
Visit the NSW Agency for Clinical Innovation's Consumer Enablement Guide
Consumer Enablement Guide
Shared decision-making might be viewed as 'a mechanism for applying evidence with an individual patient through personalising the clinical decision.'  It is not simply informing the person. To be a part of decision-making the patient needs to understand the potential risks and benefits of any change. How they understand the information provided will be affected by their emotions and personal values. Hoffman suggests five simple questions that can be used by clinicians to guide the process: 
Decision-aids are one way of helping patients to understand risks and benefits, For patients you will need to consider proposed changes in line with their circumstances and how their values might affect the balance of risks and benefits of any proposed care options. 
Understanding the risk versus benefit for any proposed changes in care can help patients to make decisions about whether it is acceptable to them. This will also help you to know and discuss your patient’s values and preferences and any concerns or questions they may have. The Australian Commission on Safety and Quality in Health Care have eLearning and decision support tools to help with this.
Visit Australian Commission on Safety and Quality in Health Care for Decision support tools for consumers
Decision support tools for consumers
Australian Commission on Safety and Quality in Health Care eLearning - Helping patients make informed decisions
Helping patients make informed decisions
change requires a range of strategies to assist all stakeholders to understand
and support the proposal. Consideration of the likely facilitators and barriers
to change will help you to design a strategy that is more likely to be
barriers to implementing change include:
Page created 09 May 2022