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QAH HospitalPortsmouth Hospitals NHS Trust 04/19/23

Stepping up to Evidence Based Practice - Ideas into Action 4

Debra Ugboma

January 2010

Interpreting the Evidence and Developing a Plan

QAH HospitalPortsmouth Hospitals NHS Trust

Objectives

Provide pointers for reading and organising your literature Identify some resources for helping you critique the

literature Consider factors and influences in preparing for change Have a go at appraisal using a structured critiquing tool.

What do I need for this session:– Worksheet 4– A paper you have identified from your literature search– A critique/appraisal tool (access during the session)


I have my literature.. What now?

Review and read the information you have found Start with the abstracts which will help indicate if you need

to access the complete paper Don’t waste time reading things that are not relevant Access Journals electronically where-ever you can Read with consideration of the hierarchy of evidence, and

with your question, firmly in mind. Do you have any systematic reviews or meta-analyses?

Keep these to one side.


Reading and Appraising…

Unless or until you are confident in critiquing the findings of literature/evidence...

Read papers first of all, then appraise more fully (with an appropriate tool)…

As you become more experienced you will be able to appraise at first (well maybe second) reading!


Sorting out the language…

Do you know your NNT from your p value?

What’s a QUALY?

What is the difference between a systematic review and a meta-analysis?

Try this useful website which helps to explain some of the terminology: http://www.whatisseries.co.uk/whatis/


Reading and appraising..

Keep any systematic reviews and meta-analyses in a secure place – these are often valuable in answering your question, and helping you find further evidence.

Organise the rest of the literature; consider the “traffic light system”:

– Green = very useful, highly relevant, the article answers the question more or less directly

– Amber = may/will be useful, has some relevance, some aspects help answer the question

– Red = does not appear useful, not relevant to the topic, does not help to answer the question


Look at the evidence?


Appraising the evidence

Is it already appraised? i.e. is it linked to a new policy/national guidance, someone’s EBP project etc.

Find an appraisal tool . The CASP website is a good starting point: http://www.phru.nhs.uk/Pages/PHD/resources.htm ..

Or try the research/EBP text books

Trisha Greenhalgh – “How to read a paper” is also good (book or series of articles) for medical research and statistics

Enlist someone to help you? Share the workload


Using the appraisal tool..

Choose the right tool for the job e.g. qualitative research studies, cohort studies, reviews etc. CASP has tools for all of these.

Aveyard and Sharp (2009) also has a useful chapter on appraising the evidence and some good resources (chapter 6)

You may need to use different tools for different of papers.

Use the tool as a template

To allow for comparison, try using the headings of the tool in a table format and review each paper in turn, keeping short notes.


Appraising Clinical Guidelines

The RCN has a very helpful series of web-pages: http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guideline_development/appraisal_and_adaptation


Having a go at appraisal…

Undertake the activity on worksheet 4 (remember you will need to repeat this process with your key papers).


Answering the question..

Can you answer your question?

Does the evidence support your idea for action or proposed change?

Is there more searching to do or are you happy to progress?

Write a summary or short fact sheet – this will help you present the information to colleagues and get ready for implementation?


Getting ready for change…

Who do you need to talk with, and discuss the potential change?

Who could lead the change? Who could facilitate the change? Who could support the change?

Is the Team ready for change?

YesHow do you

know?

NoWhat do you needto do to prepare

them?


Leading and Facilitation


Context and culture


Getting ready for change..

What does the evidence say you should do? Discuss with larger team and gain their ideas Give opportunity for discussion and debate How big a change is this for you? Involve other members of multi-professional team Provide a background information/fact sheet Undertake a SWOT analysis to help identify potential

opportunities and threats Who might lead this?


Planning for change..

Begin to identify what needs to be done! Discuss proposed change at team meetings/after ward

handovers Identify your Lead/Driver(s) Identify your Facillitator and Supporter What resources are required? Do you need to prepare anything e.g. documentation, signage Do you need to audit first?


A note about toolkits..

Many Government or national policy initiatives often come along with a “Toolkit” to help with implementation e.g. Protected mealtimes, Essence of Care.

With new policy or key national changes in particular, remember to look for one of these as they can make life a lot easier!


Resources

Aveyard, H. and Sharp, P., 2009. A beginners guide to evidence based practice in health and social care, Maidenhead: Open University Press (chapter 6)

CASP Website for critiquing tools: http://www.phru.nhs.uk/Pages/PHD/resources.htm

Essence of care toolkit: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4127915.pdf

Greenhalgh, T., 1997, How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses), Br Medical Journal, Sep 13 315(7109):672-675

Greenhalgh, T., 1997, How to read a paper: Papers that go beyond numbers, Br Medical Journal, Sep 20 315(7110):740-743

Parahoo, K., 2006, Nursing Research: Principles processes and issues, Basingstoke: Palgrave Macmillan.

RCN – Developing Clinical Guidelines http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guideline_development/appraisal_and_adaptation

What is Series: http://www.whatisseries.co.uk/whatis/

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