This presentation is to provide an overview and sources of evidence-based practice for Healthcare providers who are working in pediatric critical care

1. Geetanjli Kalyan
Clinical Instructor
National Institute of Nursing Education
PGIMER, Chandigarh
EVIDENCE BASED PRACTICE
IN
PEDIATRIC CRITICAL CARE
3/10/2017

2. Research-Practice Gap
Much of what is known from research has not
been applied in practice.
This is known as

3. EBP is…
Needed to help bridge the research-practice gap by:
Strengthening the evidence base in order to know
 what works and what doesn’t work in providing patients with the best outcomes.
Standardizing evidence across fields
Housing evidence in online databases providing reviews of the evidence
base. (PGIMER has started Remotex service, uptodate)
Translating and consolidating state of the science into clinical
recommendations.
(Stevens, 2004)

4. Evidence-Based Practice
Integration of best research evidence, clinical expertise, and
patient values in making decisions about the care of individual
patients (Institute of Medicine, 2001).

5. A. Levels of Evidence
I : Systematic reviews, meta-analysis, EB clinical practice
guidelines based on RCTs
II : One well designed RCT
III : Control Trials without randomization
IV : Well-designed case control or cohort
studies
V : Systematic reviews of descriptive or
qualitative studies
VI : Single descriptive or qualitative study
VII : Opinions of authorities, reports of
experts

6. Meta-analysis is not the final decision

7. DARE

10. American College of physcian

11. JAMA
One website developed to help clinicians practice EBM in
the PICU and other specialties

13. UpToDate

14. Other Sources To practice
guidelines/Evidence
 Acta pediatrica
 Cochrane
 National Institute for Health and Care Excellence (NICE)
 NICE guidelines
 WHO
 Guidelines of organization : AAP, IAP, NNF, ESPEN
 Journal with high impact factor : Nature Journal, NEJM, AAP
 TRIP Search Engine
 SUMSearch2 (University of Kansas)
 ProQuest Nursing & Allied Health Source
 ClinicalTrials.gov
 University of medicine and health sciene (UMHS)

15. High impact factor/cochrane reviews

18. B. Clinical Expertise
Knowledge gained from practice over
time
Inductive reasoning

19. C. Patient Values, Circumstances
Unique preferences
Concerns
Expectations
Financial resources
Social supports

20. SIX STEPS OF EVIDENCE-BASED PRACTICE
Ask the burning clinical question (PICOT format)
Search for and collect the most relevant and best evidence
Critically appraise the evidence
Integrate all evidence with one’s clinical expertise, patient preferences and values in
making a practice decision or change and apply on patient
Evaluate the practice decision or change
Disseminate
Melnyk & Fineout-Overholt 2005

21. Research utilization vs EBP vs Quality
improvement
Research utilization: Using info from a single study (Chlorhexidine
vs gel/alcohol)
EBP - takes into account expertise of the practitioner and patient
preferences / values (ability of nurses/cost/patients likes/)
Quality improvement : utilizes a system to monitor and evaluate
the quality and appropriateness of care (outcomes) based on EBP
and research

22. In pediatric critical care

23. Challenges to implement EBP in PCC by
nurses
It is likely that as few as 20 % of effective interventions actually
reach patients
time constraints, a knowledge deficit, and organizational culture.
Poor leadership
Jean-Paul Collet, etal Engaging Pediatric Intensive Care Unit (PICU) clinical staff to lead practice improvement: the PICU
Participatory Action Research Project (PICU-PAR) https://doi.org/10.1186/1748-5908-9-6
All nurses are not sensitize to EBP and many don’t know from
where to find the answer of problems encountered in day to day
practice
Changing behavior of HCP is the most difficult

24. Challenges to implement EBP in PICU by
nurses …. Contd…
Most clinical interventions have a modest effect yielding a 25
% or lower relative risk reduction.
Uninformed colleagues sometimes misinterpret EBM and
accuse it of being “cookbook medicine” and potentially
harmful to the patient.
developers of guidelines and protocols rarely graded the
level of evidence underlying each recommendation.

25. Oral care
Bed sore
Saturation targets
VAP
Enlist the major problem

26. Primary Validating criteria for the addressing the prevention,
management treatment guideline

27. Oral care

28. Risk factors for VAP in Indian Children

29. NPPCM in infant and young children

30. Use of antenatal steroids

33. Benefits for pediatric critical care nurses
Fewer Errors –
Type 1 – Acceptance of a practice that is incorrect. Example:
Administration of a wrong dose, using the wrong procedure, teaching patients
using the wrong information.
Type 2 – Rejection of a practice that is correct. Example: Failing to
screen patients for fall or pressure ulcer risks; failing to wash hands before and
after patient contact; failing to provide patients with smoking cessation
information.
(Aherns, 2005)

34. Better Care
Less variation in care among caregivers where knowledge for
improvement is already available.
More predictable health outcomes.
Less waste and inefficiency yielding fewer delays in diagnosis and
treatment and fewer complications.
Greater professional satisfaction from working as part of a team and
experiencing effective practice.
Benefits for pediatric critical care nurses

35. JOIN IHI and learn QI science

36. 10 steps of changing behaviour to
implement EBP

38. Effective literature search and internal
motivation is the key to omplement EBP
in any area of practice
So
Let us begin it from PICU