Innovators Early Early Late

Adopters Majority Majority Laggards

13.5% 34% 34% 16%
2.5%

 – 2sd  – sd   + sd

Rogers, E.M. (1995). Diffusion of Innovations (4th Ed.). New York, NY: The Free Press.
 Stay a cycle ahead.
 Scale down the scope of tests.
 Pick willing volunteers.
 Pick changes that don’t require a
lengthy approval process.
 Don’t reinvent the wheel.
 Pick easy changes to try.
 Avoid technical slowdowns.
 Reflect on the results of every change.
 Be prepared to end a test of change.
Nurses are just like any other hospital worker
 Nurses must operate
from a body of knowledge
 Practice must be
evidenced-based
 Nurses must collect
reliable data
 Nurses must base
decisions on sound data
 Transformational leaders
 Staff involvement
 Nurse Champions
 Unilateral Assignments
 Vision and Mission
 Time and Resources
 Internal Expertise
Identified leaders for EBP

Collaboration with outside

experts
Executive level EBP champion

 Educating Frontline staff

Enhancing staff awareness and
understanding
Grooming staff to become leaders
in EBP
 Collecting evidence and
conducting research
Time & fiscal resources
support provided
EBP resources always
accessible
 Ensuring Principled
Implementation
Concise implementation
procedures
Systematic results tracking
and dissemination
 Expert knowledge about EBP
 Expertsin mentoring staff
and facilitating practice
changes
 Experts in outcome
measurement and evaluating
effectiveness of practice
changes
 Steps to Conducting an EBP
Innovation: A Brief Overview
 Assess the Implement
need for Design and
change in practice evaluate
practice change change in
practice

Link problem Integrate and

Synthesize
interventions maintain
best
and outcomes change in
evidence
practice
Selecting a Topic (Clinical Issue)
• The first step in carrying
out an EBP project is to
select a topic.
• The topic needs to fit:
• The organization
• The department
• The unit priorities
 Problem Focused Triggers
Risk management data
Identification of a clinical problem
QI or Financial Data

 Knowledge Focused Triggers

New research or other literature
Philosophies of Care
Organizational standards and
guidelines
 The next step in solving a practice problem
is to determine the “real” clinical issue.
 Part of the process in determining the
“real” clinical issue is to describe the issuePICO
as a clinical question.
 Well-formulated, focused clinical question
drives the subsequent steps of the clinical
problem solving process.
 A well-formulated clinical question has a
specific structure and format called
 Patient population
 Intervention (new evidence-based intervention)
 Comparison intervention (standard, usual care)
 Outcome(s)

• Knowledge
• Practice/Process
• Patient
Sackett et al, 2004
P (Population) In adult patients undergoing joint
replacement surgery,

I (Intervention) what is the effect of integrating a teach back

approach to standardized discharge
education (i.e. Krames education tool)

C (Comparison) versus standard discharge education alone

O (Outcome) on patient satisfaction and knowledge for

discharge?
 A 70-year old woman who has had open heart surgery has been
very ill for the last 3 days, requires mechanical ventilation and a
number of inotropic and vasoactive drugs. Despite turning &
positioning, she has developed a small pressure ulcer at the
posterior occipital region. Several nurses come to you to ask
about how to prevent further pressures ulcers. They heard about
a new type of mattress/bed that the skin care specialist
discussed in a recent class and they would like to try the
mattress on high risk patients.
 Howwould you formulate this practice issue into a
answerable clinical question?

 Population:

 Intervention:

 Comparison:

 Outcome:
In critically ill patients, are low-pressure
mattresses/beds w/positioning more effective than
usual foam mattress/bed w/positioning in
preventing pressure ulcers, (defined as all stages,
discoloration of skin, partial or full thickness skin
loss)?
 Once a policy or clinical practice
issue is selected, relevant
research and related literature
needs to be retrieved:
Conducting the Literature Review

 Sufficient research on a specific topic

 Skill in accessing and critically analyzing research
 Sources of Evidence
• Clinical Practice Guidelines (Best Evidence)
 Centers for Disease Control http://www.cdc.gov
 Clinical Evidence http://www.clinicalevidence.com
 Cochrane Collaboration http://www.cochrane.org
 Evidence-Based Nursing http://ebn.bmjjournals.com
 Institute for Healthcare Improvement http://www.ihi.org
 Joanna Briggs Institute for Evidence-Based
http://www.joannabriggs.edu.au
 National Guideline Clearinghouse http://www.guideline.gov
 National Institute for Clinical Evidence http://www.nice.org.uk
 National Library of Medicine http://www.nlm.nih.gov
Other Sources of Best Evidence

• Cochrane Collaboration
• Professional Organizations
• Benchmark Institutions
• Traditional methods of finding published
literature (e.g., card catalogs, health indexes)
• Other sources include:
 Bibliographies of integrative reviews
 Abstracts published as part of conference proceedings
 Master's theses and doctoral dissertations
 Others having completed an EBP project on the same topic.
 Systematic Reviews & Meta
 Analysis
 Randomized Controlled Trials
 Experimental Studies
 Quasi-experimental Studies
 Non-experimental Studies
 Descriptive Studies
 Comparative Studies
 Case Reports
 Expert Opinion & Textbooks
• Once the research and other levels
of evidence have been obtained and
critiqued, the evidence-based
intervention (innovation) needs to be
developed
• The intervention needs to be written
into some unit or department-based
practice document such as a
practice guideline, procedure,
competency, policy, patient
education, documentation forms,
computer charting screens, menus
• How will it solve the identified problem
• The solution is described so it is clear to
readers exactly what will change
• Ways the proposed solution consistent with
the research base of support
• The population involved
• Those who will implement the project
Elements of an Implementation Plan

Identify the resources

Describe the actual
needed for
time needed for
implementation of
implementation.
proposed solution

List specific plans and Identify specific people,

programs needed for equipment and other
training and staff resources needed and
development the cost of each
 Make-up is driven by topic
 Multidisciplinary
 Based upon expertise, interest and role
responsibility
 Involvement of key stakeholders
Attitude “not me” but “we”

There is a difference between interest & commitment

Interest-do when its convenient; commitment accepts no

excuses-only results

Believes in the new practice based on evidence, and best

outcome for the patient, will not take no for an answer

Are undaunted by insults and rebuff, and above all persist for
the good of the patient
 Nobody can do everything, but
everybody can and must do something!
 Thank You!!!

For any questions,

please contact me at:
l.evangelista@uci.edu