It is not enough to have the knowledge only it is equally important to use it in the clinical

practice to improve the outcomes

Importance of EBP implementation
EBP implementation is important in
1- Improving quality of patient care
consistency of patient care
2- improving patient outcomes
3- reducing the cost
Many models are available for easy EBP implementation-
1- John Hopkin’s Model
2- IOWA Model
3- Stetler model

Facilitators and Barriers to the Implementation of EBP

Facilitators-
 organizational culture which demonstrates active support for EBP
 provision of EBP education for clinicians and managers
 availability of EBP mentors
 availability of clinical library services
 presence within the organization of EBP champions who will support clinical teams
Barriers-
 absence of organizational support for EBP
 knowledge deficits relating to EBP
 absence of EBP mentors
 negative or apathetic attitude toward EBP
 inadequate access to ICT and/or clinical library services

Process of EBP Implementation

Step1 Ask a clinical question relevant to the patient group, ward or unit. the patient group, ward.
Step2 Acquire the best evidence from reliable sources.
Step3 Critically appraise and synthesise the evidence.
DECISION: Does the evidence imply a change in practice? If YES, continue.

Before implementing the evidence the following questions should be asked-

Is the procedure feasible?
What resources are required ?
What are the alternatives ?
Are the patients similar with the found evidence?
What are the benefits and harms ?
What are the preferences of population?

Step-4 Apply
The Process of application of EBP includes the following steps
1- Forecasting the EBP plan
Develop a mental framework
Write a summary what will be done and how it will be done
Cleating the goals
Getting administrative clearance
Formulating a team
 Develop a written summary of what you want to accomplish.
 Brainstorm with colleagues regarding the environment you want to create.
Establish a motivating image for change
Create specific goals
Focus on short-term, attainable goals.
Establish only two to three goals at a time.
Gain administrative support
Contact administrators responsible for clinical practice.
Create a presentation that reflects the need
Establish a leadership team
Identify key personnel with a passion for EBP.
Conduct small focus group meetings.
2- promote engagement
Assess and Eliminate Barriers for EBP-
Engaging the staff and stakeholders
Prioritize clinical issues
Evaluate the infrastructure
Develop Experts in the Evidence-Based Practice Process
2- EBP integration
Build excitement for EBP -Demonstrate the link between proposed EBP changes and desired
patient outcomes.
Creating excitement for EBP
Creating implementation teams
Disseminating the evidence
Develop tools
Do the Pilot the evidence-based change
Evaluating the pilot
Creating a timeline.
Applying the EBP

EBP Implementation
 Assess the specific area of clinical practice to get a baseline measure of current status
 Prepare the scope of practice change to be implemented: Imagine the changed practice
after the time
 Prepare a simple audit plan to measure progress, assess patient outcomes and monitor
compliance
 Plan the duration of a test phase.
 As part of the test phase, calculate the costs involved in the proposed change in practice.
 Agree how the practice change will be communicated to all involved in implementation.
 Provide education to healthcare professionals on the rationale for the change in practice
and how it will be achieved.
 On completion of the test phase, view the results of your audit.
 DECISION: Do audit results imply a change in practice? If YES, continue.
  Distribute audit results to ward or unit colleagues.
 Amend policies and procedures to account for the practice change.
 Distribute email bulletins, flyers, etc., to publicise the practice change.

Step-5
After EBP is implemented the last step in the EBP cycle is assessing outcomes, disseminating
results and making further changes based on problem faced, peer reviews or availability of new
evidence
to practice as necessary or as prompted by new evidence.
Outcome can be measured by assessing the quality of life, improvement of care, improvement in
health or reduction in complications.
Outcome measures may be psychosocial (quality of life, improved patient perception of
care, reduction in depressive and anxiety symptoms), physiologic (improved health,
reduced complications), or functional improvement
Before assessing the EBP the following questions should be asked-
Was the EBP effective?
Should it be included in everyday practice?
Should this new information and/or clinical practice procedure continue to be included in
day to day applications?

EBP assessment can be done by following methods

1. Monitoring outcomes: The purpose of monitoring progress is to determine whether

individuals are improving. One of the best ways to measure improvement is progress
monitoring, a type of formative assessment in which learning is evaluated on a regular basis.
2. monitoring fidelity of implementation: The purpose of monitoring fidelity is to ensure
that the EBP is being implemented as intended, which will increase the likelihood of
improved young child or student outcomes.
3. ongoing feedback
4. action research processes
5. peer assessment
6. audit,
7. self reflection.  

formal evaluation activities or through the and

The fifth step of the process, outcome evaluation, attempts to interpret the results and evaluate
the outcomes of the applied evidence (intervention). .  Evaluation of the process and the results
may occur through, or even