Evidence-based practice (EBP) involves the integration of best research, clinical expertise, and patient values in patient care decisions (Stevens, 2013). The utilization of EBP in the clinical environment results in improved health outcomes, such as quality health care. The integration of EBP into the clinical setting is not an automated process. It is a gradual process that requires a team effort. This paper delves into the steps used in EBP integration, barriers faced in implementation, strategies used to overcome the barriers, and the sources of internal evidence that may provide data that demonstrates improvement in outcomes.
Part 1
The Eight Steps to Integrating Evidence-Based Practice in Clinical Environment
According to Melnyk and Fineout-Overholt (2015), the successful integration of evidence-based practices into the clinical environment requires that clinicians and various healthcare leaders adhere to the following steps:
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Creating structured and formal EBP implementation teams. The successful implementation of EBP in the clinical environment is highly dependent on the composition of the change implementation team. Thus, it is essential that a leadership team made up of informal and formal coordinators is brought together to champion the change at the unit levels. The implementation team may comprise of advanced practice registered nurses (APRNs), masters or doctorally advanced nurses and expert nurses. APRNS are known to be competent at project design and outcome evaluation. At the same time, the rest of the team members would be essential in determining feasibility, clinical applicability, and assessing patient outcomes.
Ignite passion and excitement for the EBP implementation. The various stakeholders in the clinical environment should be enthusiastic about EBP implementation. The enthusiasm can be ignited through different efforts, such as demonstrating the better health outcomes at institutions which have adopted the EBP. Nationally recognized experts and organization experts could attest to the credibility and relevance of the EBP. Staff engagement through a demonstration of the effectiveness of the intended practice changes in producing desired changes may help create synergy with the EBP implementation leaders.
Distribute the evidence. The implementation of EBP is usually faced with various barriers such as knowledge and skills deficit and skepticism from the various stakeholders. Hence, there is a need to provide education to surmount the knowledge and skills deficit and skepticism. The education process should comprise of the change process, the evidence for the change, and the beneficial outcomes achieved by the change. The dissemination may be done through patients’ and practitioners’ experiences, internal and external evidence. The dissemination of the evidence helps to sensitize on the need for change.
Establish clinical tools. The change implementation team should be well informed of the new processes and tools that the clinical staff will require for the successful implementation of the EBP. In preparation, the team should develop various resources corresponding to the needed interventions and changes. These resources may include EBP summaries, guidelines, clinical pathways, etc. Developed resources should be easily accessible and usable. The availability and accessibility of these resources can be enhanced through the integration of alerts and reminders into the different clinical aspects, e.g., the electronic medical records and the medication administration records.
Conduct a pilot test for the EBP implementation. Implementation of EBP change results in a disruption of routine processes. Hence, it is essential to conduct preliminary studies in selected clinical areas before adopting a widespread rollout. The decision for the chosen pilot-test areas may be informed by geographical location, patient acuity, early and late adoption, etc. The preliminary studies may be used to develop a positive attitude towards the change amongst the staff. Pilot studies are essential in providing feedback that may be used to improve the proposed change. They may also inform the decision to abandon a proposed clinical change.
Conserve energy sources for the full implementation of the EBP. Implementing change can create fatigue and stress to the different stakeholders and especially the clinicians. Thus, it is essential to maintain enthusiasm and excitement for the change throughout the full project implementation cycle. The energy resources can be maintained by implementing the change in manageable phases and having new change agents for every implementation phase. The excitement for the change may also be maintained through sharing with the different stakeholders the gradual successes achieved during the various stages of change implementation.
Develop a timeline for the EBP implementation success. The EBP implementation should be allocated adequate and appropriate time. An implementation timeline should be prepared based on the incremental steps of the project. The time required to implement a change is also dependent on the EBP expertise, the magnitude of the project, and the urgency of the change.
Celebrate the successful implementation of EBP. The success achieved at different phases of the change implementation should be celebrated. The various personnel involved in planning and implementing the change should be recognized in meetings and hospital newsletters. Clinicians and administrators are more likely to support future EBP projects when the current ones become successful. The success efforts should also be shared with other professionals and institutions through presentations and publications.
Barriers Faced in Implementing New Practice
The implementation of new clinical practices is rarely a smooth process. Often, it is accompanied by various barriers. Similarly, the implementation of a new clinical practice where patients suffering from chronic obstructive pulmonary disease (COPD), e.g., asthma, should use both maintenance and rescue inhalers in the management of their conditions is bound to face some barriers.
One of the significant barriers likely to be encountered is inadequate knowledge and skills amongst healthcare practitioners (Melnyk & Fineout-Overholt, 2015). Some staff may lack the knowledge, principles, and expertise on the effective use of inhalers. Some of the patients also lack the knowledge and skills of inhaler use (Jenkins, 2019). Some patients may fail to adhere to their management plans. Another barrier is is skepticism and poor attitude towards the practice from the different healthcare practitioners leading to resistance to the change (Melnyk & Fineout-Overholt, 2015). Organizational barriers, such as lack of administrative support, may also be experienced.
Strategies of Increasing EBP Implementation Success and Overcoming Barriers
The successful implementation of EBP changes is highly dependent on the level of engagement that is cultivated with the staff and different stakeholders in the change process. Consequently, to ensure the successful implementation of the new clinical practice, the various staff, e.g., clinicians, physicians, nurses, administrators, etc. will be brought on board. The staff and stakeholders will be involved in overcoming the various implementation barriers.
One of the strategies that will be used in overcoming the barriers will be training the clinical staff on the knowledge and skills relevant to inhaler use. According to Jenkins (2019), the knowledge and adherence barriers in patients may be overcome through educating the patients and conducting scheduled regular asthma reviews. The education sessions in patients will target self-monitoring and proper inhaler use. The reviews will be used to assess the effectiveness of asthma control measures. The barrier of skepticism and poor attitudes amongst the staff will be overcome through engaging influential staff members who will act as positive influencers (Melnyk & Fineout-Overholt, 2015). Organizational barriers, such as lack of support from the senior management, will be overcome by engaging the administration early in the change process and ensuring that their support is secured.
Part 2
Sources of Internal Evidence Used in Providing Data to Demonstrate Improvements
The successful implementation of EBP changes is gauged through the evaluation of outcomes, e.g., patient or financial outcomes. According to Melnyk and Fineout-Overholt (2015), the various sources of internal evidence which can provide data useful in demonstrating improvements in outcomes include:
Quality management departments. Some of the crucial data that may be available from the quality management departments include patient satisfaction, medication errors, near misses, unanticipated events resulting in death or severe injuries etc. The obtained data may be analyzed for trends and correlated to different factors, e.g., care processes and staffing.
Finance departments. Finance departments are custodians of some vital data that may be used to evaluate any improvements in outcomes. Such data is derived from the billing and registration systems and includes the cost of different medications, tests, equipment, lengths of admissions, patient demographics, e.g., age. Such data is used to comprehend the volume of patients cared for and the care processes used. Necessary adjustments can be made from the obtained outcomes.
Human resources departments. HR departments may provide crucial data derived from the employee and payroll systems. Employee systems provide turnover and staff education levels. Some of the data obtained from payroll systems include hours by labor category that may indicate the provider skill mix and hours by pay category, which may be used to determine the staffing.
The clinical systems. Some of the data found in clinical systems include laboratory tests, point-of care-tests, and pharmacy data. The dosages and types of medication data accessible from the pharmacy data are useful in assessing care process compliance and patient outcomes.
Administrative departments, e.g., hospital administration. The hospital administration may avail crucial data such as patient complaints concerning care processes and services offered. Such data may also be elaborative on the complaint, e.g., the type, location, resolution, etc.
Electronic Health Records (EHR). EHRs avail all the data that was documented during clinical care. Such data include patient data, e.g., vital signs and weight, and the clinical interventions that were made during the care process. Such data can be used to evaluate improvements in patient outcomes when a comparison is made with other clinical interventions.
Conclusion
Evidence-based practice is a crucial element in clinical practice. Its integration into the clinical environment results in improved health outcomes, such as the quality of care offered to patients. The realization of the optimal benefits of EBP requires careful implementation and the involvement of the various relevant stakeholders. This paper has discussed the steps that should be followed in EBP integration, the implementation barriers, strategies used to overcome the barriers, and the various sources of internal evidence that may provide data demonstrating improvement in outcomes.
References
Jenkins, C. (2019). <p>Barriers to achieving asthma control in adults: evidence for the role of tiotropium in current management strategies</p>. Therapeutics And Clinical Risk Management , Volume 15 , 423-435. https://doi.org/10.2147/tcrm.s177603
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (3rd ed.). Wolters Kluwer Health.
Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing , 18 (2).
