How organizational infrastructure hinders the implementation of EBP.
How organizational infrastructure hinders the implementation of EBP
Define evidence-based practice, research utilization, best practice, clinical practice guideline, systematic review, translational research, implementation science, reinfusion, organizational context, academic detailing/educational outreach, opinion leaders, and performance gap assessment.
Identify how organizational infrastructure can help or hinder the implementation of evidence-based practices.
How can a documentation system serve as a “trigger” to assess important risk factors, patient conditions, and outcomes of care?
Evidence–based practice (EBP) is an approach to care that integrates the best available research evidence with clinical expertise and patient values.1
It involves translating evidence into practice, also known as knowledge translation, and ensuring that ‘stakeholders (health practitioners, patients, family and carers) are aware of and use research evidence to inform their health and healthcare decision-making’.2
Why is it important?
Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimise functional decline in older people.
- Four in 10 adult patients receive care that is not based on current evidence or guidelines, including ineffective, unnecessary or potentially harmful treatments.2
- Despite the availability of evidence-based guidelines, there are significant gaps in implementing evidence into routine clinical practice.3
- Translating evidence into practice can not only improve outcomes and quality of life for older people, it can also improve productivity and reduce healthcare costs.1
How can you implement evidence-based initiatives to improve outcomes for older people?
Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website.
The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.
The ‘how to’ guide: turning knowledge into practice in the care of older people identifies a five-stage process to implementing change, which can be applied to translate evidence into practice.
Identify a practice that could be improved
- Select an area of interest in your clinical practice that could be improved – for example falls, medication errors or malnutrition.
- Identify current best practice guidelines and evidence-based interventions associated with improved outcomes.
- With your team, select an appropriate intervention and outcome measures that will influence your practice.
- Collaborate with quality teams and researchers with expertise in the area you are focussing on.
Barriers, enablers and issues
- Identify the barriers to implementing change. This includes anything that might obstruct or slow down the adoption of a new clinical intervention, such as feasibility, existing care processes or existing team culture.
- Explore the enablers to implementing change. This includes anything that might assist or encourage take up of a new evidence-based practice, such as positive staff attitudes, funding or alignment with accreditation standards.
- Consider issues for any data collection for measuring the effectiveness of your intervention.
- Plan for sustainability to ensure the change can be maintained.
- Tailor the intervention to fit within the appropriate policies, standards and guidelines.
- Engage and communicate with relevant stakeholders including staff, patients, family and carers to promote and facilitate adoption of the new intervention.
- Consider implementing a plan-do-study-act cycle from the ‘how to’ guide in which interventions are introduced and tested in the real work setting, in a sequence of repeating, smaller quality cycles.
What did and didn’t work
- Monitor patient outcomes following the adoption of a new intervention.
- Measure the impacts of translating evidence in your current practice.
- Outline an evaluation to measure outcomes and demonstrate any improvement.
Maintaining the intervention
- Adapt and integrate the new intervention within the current systems taking into account funding and resources.
- Ensure all new staff receive ongoing training.
- Maintain ongoing communication, engagement and partnerships with relevant stakeholders and the broader network.
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