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Evidence Based Practice / Medicine

What is EBP/M? 

The most commonly used definition for EBM is that "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." provided by David Sackett et al in the 1996 article, " Evidence-Based Medicine: What it is and what it isn't" for BMJ. (Full text here)

However, there are some specific points to consider when defining Evidence-Based Practice. 

"Evidence-based practice (EBP) refers to the systematic process where-by decisions are made and actions or activities are undertaken using the best evidence available. The aim of evidence-based practice is to remove as far as possible, subjective opinion, unfounded beliefs, or bias from decisions and actions in organisations. Evidence for decisions comes from various sources:

  1. Peer-reviewed research
  2. Work-based trial and error testing
  3. Practitioner experience & expertise
  4. Feedback from practice, practitioners, customers, clients, patients or systems

Evidence based practice also involves the ability to be able to evaluate and judge the validity, reliability and veracity of the evidence and it’s applicability to the situation in question. This means that there are a series of methods and approaches for developing practice, and that evidence-based practitioners undergo continual development and training as practice develops." (Oxford

What Is PICO(T)?

Let us assume you have a topic you wish to research but have yet to begin your searches. Before you begin, you must have a clinical question formulated - this will direct how you phrase your research queries. This approach is known as the PICO model. 

P - Patient and/or Population

  • Who is your patient? Their age, sex, health history and problem at hand are all elements under this first category.

I - Intervention 

  • What is your treatment plan? Tests, potential prescriptions & procedures go here.

C - Comparison 

  • Which alternatives are available? What has come before in the literature?

O - Outcomes

  • What is your goal? Do you need to give a new, correct diagnosis? Stabilize a condition?

T - Time

  • How long did the aspects of the study take? What timeframes must be considered?

PICOT Search

EBM Explained

How I Read A Paper!

The 5 A's

From Ascension WI:

The 5 "A's" will help you to remember the EBP process:

  1. ASK:  Information needs from practice are converted into focused, structured questions.
  2. ACCESS / ACQUIRE:  The focused questions are used as a basis for literature searching in order to identify relevant external  evidence from research.
  3. APPRAISE:  The research evidence is critically appraised for validity.
  4. APPLY: The best available evidence is used alongside clinical expertise and the patient's perspective to plan care.
  5. ASSESS / AUDIT:  Performance is evaluated through a process of self reflection, audit, or peer assessment.

Please note, there are several models for EBP with various named and numbered steps.  This guide will detail the first three steps ASK, ACCESS/ACQUIRE, APPRAISE.  Some models include a 6th step for DISSEMINATE.

* This box and graphic was created by Diane Giebink-Skoglind of ThedaCare. Used by permission.  The graphic is adapted from Melnyk, BM & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best pracatice. (2nd ed.)  Philadephia: Wolters-Kluwer/Lippincott Williams & Wilkins.

EBP Databases & Resources

Cochrane Database of Systematic Reviews