Asking a Searchable, Answerable Question Evidence-Based Practice in Clinical Practice.

Asking a Searchable, Answerable Question

Evidence-Based Practice in Clinical Practice

Crossing the Quality Chasm

5 Core Competencies (Summit on Healthcare

Profession Education) Employ evidence-based practice Provide patient-centered care Apply quality improvement Work in interdisciplinary teams Utilize informatics

Research…

Asks, “Does it support what we are doing?”

Generates new theory, support, evidence

Evidence-Based Practice

Asks, “What is the research telling us?”

Asks, “What is known about a certain subject?”

Helps us make decisions about the type of care being provided

5 Steps

PICO

P – Patient or Population I – Intervention or Interest C – Comparison Intervention or Group O – Outcome

Note: You can use this method without a Comparison

Levels of Evidence

Level 1 From a systematic review or meta-

analysis of randomized control trial (RCT) or EB clinical practice guidelines based on systematic reviews of RCT

Level 2 From at least one well designed RCT

Levels of Evidence

Level 3 From at least one well designed

controlled trial without randomization

Level 4 From a well-designed case control and

cohort studies

Level 5 From a systematic review of descriptive

and qualitative studies

Levels of Evidence

Level 6 From a single descriptive or qualitative

study

Level 7 From the opinion of authorities and/or

reports of expert committees

Evidence

Books Less reliable (become outdated quickly) Landmark books are okay

Scenario – Asian ManA 40 year-old Asian man is admitted to the GI unit after

three days of severe nausea and vomiting. His medical and social histories are benign; the only drug he is taking is acetaminophen, 1 gram T.I.D., for a backache, reportedly attributed to a vigorous workout 3 days ago. The patient was found to have a hepatitis B infection, for which he will receive appropriate treatment.

The patient's wife tells you she has heard that Tylenol can cause liver problems, and she wonders if, given his diagnosis, her husband should ever take this drug in the future.

Scenario – Infant Temps

You notice that infants with cardiac disease seem to experience more respiratory effort and discomfort when temperatures are taken rectally versus axillary.

You believe that axillary temperatures are just as accurate as rectal temperatures if done correctly.

Scenario – Carrots

Parents have begun to ask you if their kids will become obese by eating baby carrots.

They watched a TV program about a boy, a body builder, who refused to eat carrots because he believed they were too high in sugar.

Scenario – Ligament Displacement

You notice an increasing trend in children diagnosed with annular ligament displacement. Because you are concerned with their safety, you discuss the situation with the healthcare team at the clinic and discover that this is not an abuse issue.

You therefore wonder what has led to the increase in cases and are suspicious of an activity at the local fall carnival where parents pull their children through a pumpkin “tunnel.”

Scenario – Children & Healthcare

You care for a group of children newly diagnosed with cancer. You notice certain characteristics about this group that seem to influence how they interact with their healthcare team and engage their healthcare plan.

You wonder if there is evidence that may assist you, and other members of the healthcare team, understand these children more fully.

Forming a Therapy Question

Scenario:P

Middle aged Asian male with hepatitis – what is the effect of…

I acetaminophen compared to…

C Ibuprofen

O on liver function

Forming a Diagnosis or Diagnostic Test Question

Scenario: Are (I) Axillary temps, compared to (C) Rectal temps, more accurate in diagnosing (O) fever in (P) Infants with cardiac disease?

What is the topic of focus?

Forming a Prevention Question

Scenario: In (P) Adolescent teens, does the eating of (I) carrots or baby carrots compared to (C) broccoli (or other low-glycemic

vegetable) increase the risk of (O) high blood sugar?

Forming a Prognosis Question

Scenario: In toddlers who have (P) annular

ligament, does (I) intervention influence (O) displacement?

Forming a Scenario: Meaning

Scenario: How do school aged children (P) with newly diagnosed cancer (I) Perceive hospitals, nurses, etc. (O)

What is the interest?

Content Validity Formulate a well built question Determine the type of study design that

would best answer the question Using PICO, search keywords or subjects Combine and further limit searches by

English/human/gender/age Apply inclusion/exclusion criteria

References

Fineout-Overholt, E., Baldwin, C. M., & Greenberg, E. A. (2004). Using evidence-based practice for clinical decision making in the holistic nursing process. Retrieved March 21, 2006, from http://www.ahna.org/Portals/4/docs/Research/Evidence%20Based%20Practice.pdf

Melnyk, B. & Fineout-Overholt, E. (2004). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.

National Guideline Clearinghouse. (2006). Retrieved March 21, 2006, from http://www.guideline.gov/