Implementation Strategy for Evidence-Based Practice

Ubbink, Dirk T.

Thursday, July 14, 2011: 8:50 AM

Dirk T. Ubbink, MD, PhD¹
Anouk M. Knops, MSc¹
Robert Simons, RN²
Hester Vermeulen, RN, PhD¹
(1)Department of Quality Assurance & Process Innovation, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands
(2)Department of Paediatrics, Academic Medical Center at the University of Amsterdam, Amsterdam, Netherlands

Learning Objective 1: The learner will be able to take home a structural implementation strategy to implement and sustain EBP at various (managerial) levels.

Learning Objective 2: The learner will be able to appreciate what nurses and doctors in five major clinical specialties think and know about EBP.

Background Evidence-based practice (EBP) is a means to improve healthcare quality. However, not all healthcare professionals and managers actually apply EBP in daily practice. We investigated EBP attitude, knowledge, barriers and facilitators in a large teaching hospital and merged these with findings in other centers to define a tailor-made clinical EBP implementation strategy.

Methods We surveyed available literature as well as the nurses and doctors from the departments of Internal Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, and Neurology, using the McColl and Barriers questionnaires.

Results Response rates among the 537 nurses and 435 doctors were 74% and 70%, respectively. EBP was welcomed and was thought to improve patient care (means 79 and 74 on a 10-cm VAS, respectively). Regarding EBP knowledge, 6/8 common EBP-terms could be explained by 54% of doctors, but by only 15% of nurses. Most doctors (66%) and nurses (77%) mentioned lack of time. Doctors had difficulties with contradicting results (75%) and flawed methodology (69%), while nurses frequently mentioned unawareness of (75%), or difficulty to read and interpret (70%), research papers. Facilitating factors were availability and accessibility of high-level evidence, EBP training facilities and communication of evidence for clinical decision-making. Both groups desired more managerial support as to EBP motivation and opportunities. The literature also signaled time restraints, knowledge gaps, and poor availability of evidence. Hence, an EBP implementation strategy should comprise at least the availability and accessibility of high-level evidence, EBP training facilities, communication of evidence for clinical decision-making, and more managerial support as to EBP motivation and opportunities.

Conclusions Healthcare professionals have embraced the EBP paradigm as an important means to improve quality of clinical patient care, but its application is still cumbersome. We were able to develop a structural implementation strategy, supported by professional and managerial role-models, to implement and sustain EBP.

See more of: Developing the Culture of Evidence-Based Practice
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters