EVIDENCE BASED

IMPLEMENTATION

Presented by:
Ku Badlisyah Ku Aziz
Lily Fairuz Md. Yasan

1
Content
Content
Content Slide
Slide
What
What you
youhave
havelearned?
learned? 3
What
What isisEvidence
Evidence Based Implementation?
Based Implementation? 4
The
Theimportant
importantofoffinding
findingevidence
evidence of of
advanced in clinical
advanced in 8
practice
clinical practice
The important of finding of effect of 11
The important of finding
intervention/prognosis andofdiagnostic
effect of test/experience
intervention/prognosis and diagnostic test/experience
Explain why changing is hard (practice/management) 14
Explain why changing
Explain evidence is hard physiotherapy
based practice (practice/management)
in the 17
Explainof
context evidence
continuous based practice
quality physiotherapy in the
improvement
context
What youofwant
continuous
to know?quality improvement 20
What you want to know?
References 21

2
What you have learned?
• Definition of evidence based
practice/implementation
• Importance of finding evidence of advanced
in clinical practice
• Importance of finding of effect of
intervention/prognosis and diagnostic
test/experience
• Why changing is hard
• Evidence based practice physiotherapy in the
context of continuous quality improvement

3
What is Evidence Based Implementation?

 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 available
external clinical evidence from
systematic research (Law et al,2002:5)

4
Cont…
 EBP is portrayed as a rational, moral, right and
superior decision-making framework that
prevents clinical errors or the provision of
suboptimal care (Mantzoukas & Watkinson,
2008:131)
 The process of implementing EBP involves the
ability to frame, ask and address clinical
questions, translating best evidence into
practice and leadership strategies to shape a
culture for EBP (Pipe et al, 2008:265)

5
Cont…
• Technically, evidence based medicine refers
only to the “medical” field, whereas evidence
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 continue evaluating their
techniques and practice to see what can be
improved
(Law et al, 2005:5)

6
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. Design a change in practice
5. Implement and evaluate the practice
6. Integrate and maintain the practice change

 This model provides a pragmatic framework for

empowering clinicians at the unit level to engage in EBP
process and is helpful in creating an organizational
atmosphere where EBP initiatives can thrive
(Pipe et al,2008:265-266)

7
Importance of finding evidence of
advance in clinical practice
 For patients
Offer the safest and most effective
interventions
Produce best possible clinical outcomes for
patients
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)

8
Cont…
• Physiotherapists and the profession
– Preparedness to act on the basis of objective
evidence about good practice regardless of
how unpalatable the evidence might be
– Gain respect and trust of patients and public
at large
– Have the patients’ best interest at heart and
have high ethical standards
– Provide transition of autonomy
(Herbert et al,2005:6)

9
Cont…
 For funders of physio service
Public are confident that healthcare does
good, and not harm.
Ensuring value for money and health
benefits in situations where health resources
are always scarce

(Herbert et al,2005:7)

10
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)

11
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 the
accuracy of diagnostic test

(Herbert et al, 2005: pp17)

12
Experience
 Personal and professional judgments ,
experiences and preferences of practitioner
and patients are considered to be
quintessential components of evidence in
EBP
 Privileged as the ones capable of acquiring
unique understandings and satisfying
individual needs in a holistic manner
(Mantzoukas et al,2008:132)

13
EXPLAIN WHY CHANGING 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)

14
Barriers to implementing the steps of
EBP
• Patients’ demand for treatment despite lacks of evidence for
effective treatments
• Lack of time and workload pressure
• Lack of skills
• Insufficient staff resources
• Doctor would not cooperate with physiotherapy
implementations
• Felt that they did not have enough authority to change practice
• 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)

15
Barriers to implementing a 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)

16
Explain EBP physiotherapy in context of
continuous quality improvement
• Making EB physiotherapy happen should
have benefits for patients, as they receive
more effective care, which should in turn
lead to better health outcomes
• However, EB physiotherapy is only one
dimensions of quality improvement and
should not be implemented in a way that is
isolated from an overall organizational
quality improvement system
(Herbert et al,2005:216)

17
Cont…
• Good organizations strive to continually
improve their process of care (continuous
quality improvement) and physiotherapists
should engage in this process
• Organization should empower staff to
identify the potential for improvement and
instigate change. They should also have a
culture of striving for improvement and
places high importance on staff learning
(Herbert et al,2005:216)

18
Cont…
• Continual improvement requires leaders
who can support and nurture individuals
and who believe that individuals wants to
do better, to learn and to develop
• Physiotherapist can set up their own
continuous improvement cycles through
the measurement of their practice (audit,
outcome evaluation) and by reflective
practice and peer review
(Herbert et al,2005:216)

19
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

20
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, SLACK incorporated, USA

 Mantzoukas, S & Watkinson, S (2008) Redescribing reflective

practice and evidence-based practice discourses. International
Journal of Nursing Practice 14:129-134

 Pipe, T.B., Cisar, N.S, Caruso, E & Wellik, K.E (2008)

Leadership strategies: Inspiring evidence-based practice at the
individual, unit and orgabizational level, J Nurs Qual 23(2):265-
271

21