Evidence Based Practice (EBP)

Evidence Based Practice

A widely accepted definition of evidence based practice as proposed by Sackett et al* is:
"the integration of best research evidence with clinical expertise and patient values"

The basic concept of evidence-based practice is the making of clinical decisions based on the integration of clinical expertise acquired through formal education and experience accumulated from daily practice and the patients' own personal and unique concerns, expectations, and values with the most clinically relevant and methodoligically sound research. This integration defines a clinical decision and therefore practice as evidence-based.

The 5 Steps

1. Formulate an answerable question

One of the fundamental skills required for EBP is the asking of well-built clinical questions. By formulating an answerable question you to focus your efforts specifically on what matters. These questions are usually triggered by patient encounters which generate questions about the diagnosis, therapy, prognosis or aetiology.
2. Find the best available evidence

The second step is to find the relevant evidence. This step involves identifying search terms which will be found in your carefully constructed question from step one; selecting resources in which to perform your search such as PubMed and Cochrane Library; and formulating an effective search strategy using a combination of MESH terms and limitations of the results.

3. Appraise the evidence

It is important to be skilled in critical appraisal so that you can further filter out studies that may seem interesting but are weak. Use a simple critical appraisal method that will answer these questions: What question did the study address? Were the methods valid? What are the results? How do the results apply to your practice?

4. Implement the evidence

Individual clinical decisions should then be made by integrating the best available evidence with the clinical expertise and patient values. This can then be integrated into your practice which can then be justified as evidence based.

5. Evaluate the outcome

The final step in the process is to evaluate the effectiveness and efficacy of your decision in direct relation to your patient. Was the application of the new information effective? Should this new information continue to be applied to practice? How could any of the 5 processes involved in the clinical decision making process be improved the next time a question is asked?

Make it simple!

It is more likely that the evidence will be integrated into clinical practice if the process is kept simple. Keep a log of the questions that you wish to answer, answer a few important questions per week, get help with searches, simplify the appraisal or use pre-appraised topics and focus on the interpretation of the evidence.

References

• Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.