Getting evidence into practice Early Clinical Career Fellowships

Getting evidence into practice Early Clinical Career Fellowships Masterclass 29 th August 2013 Annette Thain Annette. thain@nes. scot. nhs. uk

Learning Outcomes 1. Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2. Know what sources to use for different types of evidence 3. Identify knowledge management tools and techniques to support you to get evidence into practice 4. Know where to get help and advice for you and your colleagues

Average time from research initiation to application of findings/treatments is. . . 17 years

Knowledge into Action review • help practitioners to apply knowledge to frontline practice. • embed use of knowledge in healthcare improvement. • support practitioners and managers to translate knowledge into better health outcomes, i. e. safe, effective, personcentred, efficient care.

What is Knowledge into Action? know ledg e tra nsla tion “The move beyond simple dissemination knowledge implementation of knowledge to actual use of knowledge” e c i t c a r Straus, et al (2009) p d e s a b e c n e evid implementation science

From Accessing to Applying Knowledge in NHS Scotland Knowing • 66 libraries • 116 library staff • 12 million + resources Doing • How much of this gets used in a meaningful way to improve safe, effective, person-centred care? http: //www. knowledge. scot. nhs. uk

Knowledge as process Practice Know-where • Systems • Processes Know-how: Know-what Research • Journals • MEDLINE • Actionable • Relational • Organisational • Cochrane reviews • Reports Experience • Local context Know-who • Service users • Practitioners • Teams

Knowledge as process Relational use of knowledge • Communities of Practice Know-how: Actionable knowledge • Checklists • Pathways • Mobile apps • Actionable • Relational • Organisational • Social networking • Social learning Organisational enablers • Backing at national and board level • Tests of change to demonstrate impact • Knowledge broker

Discussion • Discuss examples from your practice of – actionable knowledge ie ways of presenting knowledge – social/relational use of knowledge ie examples of communicating and sharing • Feedback one example of each

Transfer of Knowledge into Quality Patient Care Clinical Knowledge (Evidence Based Practice): Doing the right thing MEDLINE, Cochrane etc Clinical Decisions Know-What Improvement Knowledge: Doing it right SPSP experience, etc Process/System Changes Quality Patient Care Adapted from: Glasziou, P et al. Can evidence-based medicine and clinical quality improvement learn from each other? 2011. BMJ Qual Saf 20 (suppl 1): i 13 -i 17 Know-How

Mnemonic – the practical activities to support the cycle Question What do you need to know? Source Where will you look? Find What words will you use? Evaluate Is the information ‘good’? Combine How does it all fit together? Share How will you share it? Apply How will you use it?

Question - Keyword John is a 62 year old man who has been diagnosed with osteoporosis. He’s been prescribed a calcium and vitamin D supplement but is interested in other ways protect himself. Keyword Synonym Osteoporosis Bone density, bone loss Adult male Elderly man, older people Calcium supplement Adcal D 3, Calcit D 3, Calcichew-D 3 Alternative/additional Diet, exercise, lifestyle measures

PICO P Person, population Adult male, elderly or problem male I Intervention (proposed) C Comparison/Current Calcium and vitamin D intervention O Outcome(s) expected Diet and lifestyle changes Improved bone density Now you try an example……

Practice Know-where • Systems • Processes • Variation Know-what Research • Journals • MEDLINE Know-who • Cochrane reviews • Reports Experience • Service user • Practitioner • Teams

Research Reliable information resources : Point of care Dynamed Nursing Reference Center Guidelines Evidence summaries Other questions Databases Journals Books http: //www. knowledge. scot. nhs. uk

The Knowledge Network Index

Know What – Evidence Triangle Computerised decision support Systems Guidelines/Protocols/ Evidence Based textbooks Summaries Synthesis of Synopsis Synthesis of Single Studies Point of Care Resources eg Dynamed Evidence based journal articles eg Evidence Based Nursing Systematic Reviews eg Cochrane Library Original Journal Articles and Studies eg Medline [Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5 S model into a 6 S model. ] Evidence-Based Nursing, 12, 99 -101

Other Sources - discussion Practice Know-where • Local context • Systems • Processes Research Know-who Experience • Service users • Practitioners • Teams

Possible Sources- depends on topic • • Grey literature References Epidemiology Drug information Patient stories Case studies Improvement websites eg IHI • • Books Elearning Videos People Communities of practice MCNs GOOGLE

Demo of The Knowledge Network to find the know what and know how

Does it answer my question? Do I need to do a full scale critical appraisal?

How does all this fit with your previous knowledge and experience / local setting?

Ref. Works/Ref. Share

Who else needs to know about what you’ve found? How will you let them know about it?

Information/knowledge has little value unless it is used How will you Use the new information? Change your practice? Keep up to date?

Barriers and facilitators Barriers Facilitators Barriers Educational materials • Awareness Patient and Opinion mediated leaders knowledgestrategies • Skills How can I overcome the Clinical • Motivation barriers? Educational audit and meetings feedback • Practicalities Education • Acceptance and Reminder outreach systems visits www. nice. org. uk beliefs

Practice based small group learning Using real clinical problems to stimulate reflection, discussion and learning among groups of peers • Specially prepared modules produced which “closes the gap between current practice and best practice” • Knowledge brokers provided support to clinicians in developing a PBSGL module on cervical screening. • Educational perspective – clinicians and knowledge brokers working together

Sepsis and VTE collaborative • The Sepsis Collaborative aims to contribute to overall aim of the Scottish Patient Safety Programme of reducing mortality rates by 20% by December 2015 • Knowledge broker involved in a range of activities • Educational perspective – knowledge broker role combined with tools and resources produced a positive outcome.

KM Tools and techniques Provide understanding of causal factors, barriers and facilitators that led an event to unfold as it did. Examples on Evidence for Practice tab on SSKS. Social media tools eg Blogs, Twitter, Facebook, Book Marking, News Feeds, Community Website tools A community of practice shares a specific interest that becomes a source of identification. This creates a sense of commitment to the community as a whole, not merely connections to a few linking nodes. Eg Dementia MKN Directories of people with contact details and information on skills, practice experience and areas of interest eg members of Dementia MKN Case Studies People Finders Social Media Task or resource lists as an aide memoire to improve consistency. Communities of Practice An informal method to stimulate and create ‘awakening and engaging of collective intelligence through conversations about questions that matter’. It is a technique to evoke and make visible the collective intelligence of a group. Also known as ‘learning before doing. ’ A team asks for help: people are invited to share their experience, insights and knowledge with the team. Knowledge Cafes Checklists Knowledge Management Tools and Techniques Knowledge Banks and Databases Rapid Evidence Search Peer Assist Review After Action Reviews A short, facilitated meeting of project team members (and possibly other stakeholders) to evaluate and capture lessons learned. Expert Evidence Search Knowledge banks are repositories which store knowledge and allow people to retrieve and use the knowledge they contain. For example, SSKS, ASSIA Use of the Evidence Informed Practice search option on SSKS Librarians and knowledge managers carry out expert searches of research sources. Use of Health Management Library Services PTO for more info

Help and training • Online help • Webex sessions for The Knowledge Network and other services – sign up for monthly newsletter knowledge@nes. scot. nhs. uk • Webex sessions from providers • CLEAR service • Local NHS librarians • Materials for colleagues knowledge@nes. scot. nhs. uk • Any problems or questions knowledge@nes. scot. nhs. uk TKNScotland Know. Net Scotland

Thank you for listening • Any questions? Learning outcomes 1. Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2. Know what sources to use for different types of evidence 3. Identify knowledge management tools and techniques to support you to get evidence into practice 4. Know where to get help and advice for you and your colleagues