Question

What strategies can staff nurses use to collect and share evidence that could impact health policy decision?

Answer 1

Ans) Six steps to EBP:
1. Ask the clinical question.
2. Collect the best evidence.
3. Critique the evidence
4. Integrate the evidence.
5. Evaluate the practice decision or change.
6. Share the outcomes of EBP changes with others.

Strategies
1. Present solid evidence:

- Hospital leaders need to present believable evidence that is relevant to the clinician's practice. When they [see] one or two pieces of information that are relevant and make a difference, they start to trust the system more." The evidence should be provided by a respected colleague from the group being addressed and tailored to the particular challenges facing that audience. "Direct, accurate peer group-related practice and outcome data speak loudly.

2. Adopt a compassionate approach:

- Providing scientific evidence alone is not enough to change physicians' behavior; hospital leaders need to adopt a compassionate approach that respects physicians' skills and beliefs. "Unless [physicians] are compassionately presented with evidence contrary to their customs, they are very resistant to change. Instead of singling out physicians for practicing "bad" medicine, leaders should have a conversation with physicians to understand their perspective and reasoning for their current practices, benchmarked against relative peers. In this approach, "People feel part of the system rather than being evaluated by 'Big Brother' for being a bad apple.

Encouraging physicians to practice evidence-based medicine should also focus on patient safety. "In general clinicians don't respond when the approach is framed as 'a cost issue.' They respond much better to data addressing safety or quality issues, and safer, higher quality practices have been repeatedly shown to improve costs, especially in the evolving reimbursement environment."

3. Include links to information in EHR systems:

- The hospital's electronic health records should include links to the most current evidence or practice standards so physicians can easily access evidence-based medicine. "The way to make practice better is to present evidence at the point of care while patients are being treated. "This is the best way to provide ongoing, current continuing medical education for your caregivers."

4. Use clinical decision support:

- Automated clinical decision support is another tool that can help physicians practice evidence-based medicine. This support would produce relevant alerts or reminders when physicians enter choices about a patient's treatment in the EHR. Companies like Zynx Health compile and "grade" evidence so that the clinical decision support provided is based on the best evidence available. "If you get clinicians comfortable with alerts or reminders coming from a base of evidence that they trust, they change behavior," he says. "The major danger here is to barrage clinicians with alerts or reminders of little relevance in which case they may all be ignored because of 'alert fatigue.'"