Evidence Based Implementation
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Transcript of Evidence Based Implementation
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8/8/2019 Evidence Based Implementation
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Presented by:Ku Badlisyah Ku Aziz
Lily Fairuz Md. Yasan
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Content
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Content Slide
What you have learned?
What is Evidence Based Implementation?
The important of finding evidence of advanced in
clinical practice
The important of finding of effect of
intervention/prognosis and diagnostic test/experience
Explain why changing is hard (practice/management)
Explain evidence based practice physiotherapy in the
context of continuous quality improvement
What you want to know?
Content Slide
What you have learned? 3
What is Evidence Based Implementation? 4
The important of finding evidence of advanced in clinical
practice
8
The important of finding of effect of
intervention/prognosis and diagnostic test/experience
11
Explain why changing is hard (practice/management) 14
Explain evidence based practice physiotherapy in the
context of continuous quality improvement
17
What you want to know? 20
References 21
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What you have learned?
Definition of evidence basedpractice/implementation
Importance of finding evidence ofadvanced in clinical practice
Importance of finding of effect ofintervention/prognosis and diagnostictest/experience
Why changing is hard
Evidence based practice physiotherapy inthe context of continuous qualityimprovement
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What is Evidence Based
Implementa
tion? Evidence-based medicine is the
conscientious, explicit and judicious use
of current best evidence in making
decisions about the care of individual
patients. The practice of evidence based
medicine means integrating individual
clinical expertise with the best availableexternal clinical evidence from
systematic research (Law et al,2002:5)
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Cont
EBP is portrayed as a rational, moral, rightand superior decision-making framework thatprevents clinical errors or the provision of
suboptimal care (Mantzoukas & Watkinson,2008:131)
The process of implementing EBP involvesthe ability to frame, ask and address clinical
questions, translating best evidence intopractice and leadership strategies to shape aculture for EBP (Pipe et al, 2008:265)
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Cont
Technically, evidence based medicinerefers only to the medical field, whereasevidence based practice/implementation
encompasses more aspects of healthcare,including rehabilitation
Is based on self directed learning model,whereby practitioners must not only
continue learning but also continueevaluating their techniques and practice tosee what can be improved
(Law et al, 2005:5)
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Evidence based practice model
Has 6 steps:1. Assess the need for change in practice
2. Link the problem with interventions and outcomes
3. Synthesize the best evidence
4.D
esign a change in practice5. Implement and evaluate the practice
6. Integrate and maintain the practice change
This model provides a pragmatic framework forempowering clinicians at the unit level to engage in
EBP process and is helpful in creating anorganizational atmosphere where EBP initiativescan thrive
(Pipe et al,2008:265-266)
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Importance of finding evidence of
adva
nce in clinica
l pra
ctice For patients
y Offer the safest and most effective
interventions
y Produce best possible clinical outcomes for
patients
y Provide high quality clinical research for
patients if patients are to make informed
contributions to decisions about the
management of their conditions
(Herbert et al,2005:6)
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Cont
Physiotherapists and the profession Preparedness to act on the basis of
objective evidence about good practice
regardless of how unpalatable the evidencemight be
Gain respect and trust of patients and publicat large
Have the patients best interest at heart andhave high ethical standards
Provide transition of autonomy
(Herbert et al,2005:6)
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Cont
For funders of physio service
y Public are confident that healthcare does
good, and not harm.
y Ensuring value for money and health
benefits in situations where health resources
are always scarce
(Herbert et al,2005:7)
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The important of finding evidence of effects of
intervention / prognosis and diagnostic test or
experience.
Intervention
To interpret whether the intervention is
effective.
To satisfy patient with the effective
intervention applied based on research.
(Herbert et al, 2005:20)
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Diagnosis
To know the probability of misclassification
so we can know how much certainty to
attach to diagnosis based on a test findings.
To obtain relatively unbiased estimates of theaccuracy of diagnostic test
(Herbert et al, 2005: pp17)
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Experience
Personal and professional judgments ,experiences and preferences of practitioner
and patients are considered to bequintessential components of evidence inEBP
Privileged as the ones capable of acquiring
unique understandings and satisfyingindividual needs in a holistic manner
(Mantzoukas et al,2008:132)
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EXPLAIN WHYCHANGING IS
HARD
Change is always difficult, in every area
of human life
Knowledge alone is often not sufficient
for behavior change. when it comes to
physiotherapists behavior there might
be a number of factors that determine
practice patterns(Herbert et al,2005:208)
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Barriers to implementing the
steps of EBP Patients demand for treatment despite lacks of evidencefor effective treatments
Lack of time and workload pressure
Lack of skills
Insufficient staff resources
Doctor would not cooperate with physiotherapyimplementations
Felt that they did not have enough authority to changepractice
Poor access to library facilities and difficulties in meeting
with peers Problems with culture working against EB physiotherapy
where senior staff were resistance to change
(Herbert et al,2005:208-209)
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Barriers to implementinga change in
specific practice behavior
Lack of knowledge or skills of
physiotherapist in both the diagnosis
and treatment processes
Problems with getting cooperation of the
referring physicians
Issues about higher expectations of
patients Lack of time, skills and culture problems
(Herbert et al,2005:209)
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Explain EBP physiotherapy in context of
continuous quality improvement
Making EB physiotherapy happen shouldhave benefits for patients, as they receivemore effective care, which should in turn
lead to better health outcomes However, EB physiotherapy is only one
dimensions of quality improvement andshould not be implemented in a way that isisolated from an overall organizationalquality improvement system
(Herbert et al,2005:216)
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Cont
Good organizations strive to continuallyimprove their process of care (continuousquality improvement) and physiotherapists
should engage in this process Organization should empower staff to
identify the potential for improvement andinstigate change. They should also have aculture of striving for improvement andplaces high importance on staff learning
(Herbert et al,2005:216)
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Cont
Continual improvement requires leaderswho can support and nurture individualsand who believe that individuals wants to
do better, to learn and to develop Physiotherapist can set up their own
continuous improvement cycles throughthe measurement of their practice (audit,outcome evaluation) and by reflectivepractice and peer review
(Herbert et al,2005:216)
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What you want to know?
How to apply EBP in clinical practice
How to promote change in clinical
practice
Steps to apply EBP in clinical setting
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REFERENCES Herbert,K., Jamtvedt, G., Mead,J. & Hagen, K.B (2005)
Practical Evidence Based Physiotherapy, Elsevier,Philadelphia
Law et al (2002) Evidence based rehabilitation: A guide
to practice, SLAC
K incorporated, USA
Mantzoukas, S & Watkinson, S (2008) Redescribingreflective practice and evidence-based practicediscourses. International Journal of Nursing Practice14:129-134
Pipe, T.B., Cisar, N.S, Caruso, E & Wellik, K.E (2008)Leadership strategies: Inspiring evidence-based practiceat the individual, unit and orgabizational level, J NursQual23(2):265-271
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