How to Integrate Evidence-Based Practice into the Clinical Environment

Part 1 

Steps to Integrating Evidence-Based Practice 

Evidence-based practice is an essential part of improving quality care provision in a health facility. It is an approach to solving problems in the healthcare facility by incorporating the best evidence activities as well as the physician's expertise. The use of evidence-based practices improves patient outcomes, safety, as well as reducing healthcare costs ( Melnyk & Fineout-Overholt, 2011). In the healthcare industry, the evidence-based practice can be in the form of adopting the use of technology to reduce medical errors in healthcare. Medical errors are directly responsible for numerous avoidable deaths, affecting patient safety. In this regard, a health facility can implement an evidence-based process, such as integrating technology to reduce medical errors. 

The process of integrating evidence-based practice into the clinical environment entails several steps. The first step is to ask the clinical question to help identify the clinical problem within healthcare. This is done through developing a PICOT question that defines the population of interest, intervention, comparison group, an expected outcome as well as the timeframe ( Melnyk & Fineout-Overholt, 2011) . The use of various studies answers different types of clinical questions. For example, a systematic review is used when the clinical question is about treatment, while a cross-sectional study is used when the clinical question is about the diagnosis. Making inquiries through the PICOT format allows one to identify the appropriate problem. It is recommended to select a panel that will help in identifying the problem and ensure clinical validity 

The second step is to search the literature that allows in answering the defined clinical question in the first step. The literature review helps in solving the clinical question by expediting the location of relevant articles in research databases such as Medline ( Newhouse et al., 2007) . The literature review allows in identifying all the available evidence to integrate into the evidence-based practice. The resources can be explored through websites, journal articles, and other official sources. 

After conducting the literature review, the next step is evidence appraisal, which entails critically reviewing it for validity and applicability. This is a rigorous process of evaluating the studies that involve examining how much high-quality evidence and its applicability in healthcare. The strength of clinical evidence can be determined by designating randomized control trials, meta-analysis, or systematic reviews ( Melnyk & Fineout-Overholt, 2011) . The validity can also be rated by a team consisting of medical doctors, nurses, and physiotherapists, who evaluate the relevance of evidence for follow-up of the process and outcome indicators 

The fourth step of the evidence-based process is to select the final clinical activity and determine the grade for guiding recommendations. This entails reviewing the identified businesses for validity and grading them. The panel can specify the categories of each evidence by gauging the advantages of each proposal. The step ends with making a final selection of the clinical activities before they are graded 

After grading the evidence recommendations, the fifth step entails integrating this evidence into clinical practice based on patient preferences. This step involves coming up with decisions regarding which proposal to implement in the evidence-based approaches ( Newhouse et al., 2007) . The panel needs a structured plan for determining the best guidance for implementation into healthcare. In this step, the clinical activities are clustered into critical interventions and processes 

The sixth step of the EBP process is to develop an action plan that entails implementing the findings with the patient care decisions. Multiple implementation strategies can be used to ensure the successful adoption of EBP by all staff. The implementation stage starts by providing the needed recourses and time before launching as well as identifying the barriers to practice change ( Melnyk & Fineout-Overholt, 2011) . The leader of the team can then work to create an action plan with a timeline on when to implement the evidence-based practice. 

The next step is to evaluate the outcomes to measure whether it made a difference in the health facility. The evaluation focuses on whether the evidence-based practice answered the clinical question as well as determining the expected outcomes from the implementation strategies. This entails evaluating the performance throughout the process and reviewing patient outcomes to learn where to improve whenever necessary ( Newhouse et al., 2007) . The evaluation of issues may have to include the quality improvement process of identifying gaps in procedures and process 

The last step is to disseminate the results using patient satisfaction data, which involves communicating the results to stakeholders. There is a need to distribute evidence to colleagues within the organization on the outcomes of the evidence-based practice ( Melnyk & Fineout-Overholt, 2011) . Dissemination can be done by using the podium and poster presentation at professional conferences. It focuses on sharing the results with others and working to improve the quality of available evidence. 

Barriers to implementing technology in healthcare 

Several barriers come with implementing evidence-based practices such as technology use in reducing medical errors. One obstacle is the lack of knowledge and education that nurses have towards the EBP process. The success of EBP process implementation depends on whether nurses and staff have enough experience regarding the change program and how to operate it effectively ( Newhouse et al., 2007) . This can be a barrier to implementing evidence-based practices and can be ground for poor performance. 

Secondly, a barrier to effective EBP implementation can be a lack of support from the administration to practical application. In many cases, the success of any change process depends on the support that a hospital administration offers in terms of resources and overall guidance ( Melnyk & Fineout-Overholt, 2011) . For example, the administration should provide the necessary training that will help reduce resistance to evidence-based practice. 

Resistance is another significant barrier to evidence-based practices in healthcare. This is because the success of an EBP lies in full support from all staff. Changing the culture of an organization can be challenging and will always invite resistance from employees and staff. One person alone is not enough to change a practice, which necessitates the need to create a culture that supports an evidence-based approach to care. 

Lack of time is another barrier to implementing evidence-based practice in the health facility due to busy clinicians prioritizing time. Time management is a barrier to implementing EBP for nurses who may seem extra burdened with extra responsibilities ( Melnyk & Fineout-Overholt, 2011) . At the same time, the lack of motivation is another barrier to implementing evidence-based practices. Nurses need to have a personal drive that will motivate them to accept the change proposal within healthcare. Some nurses who are not inspired to adopt the evidence-based practice affect its implementation and success in the healthcare 

Overcoming barriers to applying an evidence-based practice  

There are several ways to overcome the obstacles to evidence-based practices in healthcare. The first strategy is getting support from the healthcare organization and its administration, who can help remove these barriers. Having administrative support from beginning to end is a critical factor in facilitating EBP implementation ( Melnyk & Fineout-Overholt, 2011) . This support can come in the form of developing an organizational culture that supports EBP as well as providing the necessary resources to facilitate its implementation 

Secondly, a healthcare facility can help in overcoming these barriers by creating structures and processes that increase access to databases that promote EBP. These structures should be part of dealing with the resistance to evidence-based practices by ensuring smooth integration into the hospital facility. Administration support through mentorship and supervision programs, training opportunities, as well as practice development activities to meet the barriers to its implementation ( Newhouse et al., 2007) . For example, providing employee training can be used to overcome the obstacles to applying evidence-based practices. Education is a significant factor to overcome barriers 

Another strategy is to engage appropriate stakeholders in EBP implementation, as it helps in building trust towards the project. Stakeholders can also help in identifying outcome measures to guide in planning a better implementation strategy. Nurse Managers play an essential role in promoting evidence-based practices in clinical units within a health facility ( Melnyk & Fineout-Overholt, 2011) . They should be involved in the change process by seeking their opinions on the issue and engaging them in teaching others. 

In essence, the hospital administrators need to remove these barriers by supporting a spirit of inquiry. This entails creating and developing processes that can help staff to access the databases. Involving nurses in the implementation process is crucial can help in reducing any form of resistance while facilitating their effectiveness. The strategy is to create a culture to incorporate EBP into the organization. In this regard, the organization can foster a culture of accountability that values quality improvement. This is the first step in reducing any chances of employee resistance to the change proposal 

Quality improvement outcomes 

Outcome management in healthcare refers to the process of using hospital data in making decisions that can benefit patient safety. In healthcare, there are several sources of internal evidence that the administration can use in improving healthcare outcomes. The six sources can be categorized into quality management, administration, human resource departments, finance, clinical systems, and Electronic Medical Records. 

The administration information entails patient complains, which can be used in quality improvements. The complaints provide an opportunity to learn from the patient’s perspective and reflects an actual or perceived deficiency in care provision. In essence, patient complaints can be used to drive quality improvement as a source of insight into safety-related problems. Patients can identify issues in healthcare delivery and help in quality improvement. Secondly, an internal source of information can be gotten from the financial department, which comprises information from readmission rates charges for tests as well as patient days within the hospital. For example, the outcome can be measured by comparing the number of readmission of patients in a health facility to determine the quality of care provision 

Thirdly, the human resource information entails staff turnover and education levels, staffing rations, contract labor use. Quality outcomes in healthcare can be improved by focusing on staff turnover since high turnover can illustrate a poor working environment. The turnover can also impact hospitals in terms of the costs involved in recruitment and training. The quality management department is another source of internal information which comprises of patient satisfaction and incident reports. This information can be used in providing quality improvement by determining where to improve in the health facility and ensure the provision of quality care to parents. 

Another source of internal evidence is through the use of clinical systems information, which entails data from diagnostic tests and pharmacy information. This information can be used for quality improvement outcomes. Unsatisfactory test results and pharmacy data can provide the knowledge to help in quality improvement ( Newhouse et al., 2007) . Lastly, an internal evidence source can be through the EMR information and patient data captured through electronic methods. The measurement involves monitoring patient records and treatment using electronic medical records, which allows for tracking the outcomes. Information in the EMR can help the organization to make decisions on how to improve the provision of quality care. 

References

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011).  Evidence-based practice in nursing & healthcare: A guide to best practice . Lippincott Williams & Wilkins. 

Newhouse, R. P., Dearholt, S. L., Poe, S. S., Pugh, L. C., & White, K. M. (2007).  Johns Hopkins nursing evidence-based practice model and guidelines . Indianapolis, IN Sigma Theta Tau International Honor Society of Nursing.