Evidenced-Based Health

Care
 Evidenced-Based Health
Care
 Evidenced Based Care - is clinically competent
care based on the best scientific evidence
available.
 Individual nurses have responsibility for
evaluating and promoting the use of patient care
based on the best scientific evidence available.
 Future trends in health care will require the use of
sophisticated evidence-based tools to deliver care
and measure outcomes of care.
 This suggests that nursing must become more
comfortable using a scientific process driven by
evidence-based standards and practice guidelines
while also emphasizing continuing quality
improvement.
 History of Evidence-Based
Care
 Initially, this movement into evidence-
based clinical application began with
medicine.
 The term evidence-based medicine (EBM)
was coined at McMaster Medical School in
Canada during the 1980s.
 D.L. Sackett along with his colleagues
defined evidence-based medicine as the
“conscientious, explicit, and judicious use
of current best evidence in making
decisions about the care of individual
patients”.
 History of Evidence-Based
Care
 Evidence-based medicine integrates the
clinical expertise of individual clinicians
with the best available external clinical
evidence from systematic research into
the accuracy and precision of diagnostic
tests; the clinical examination and other
elements of the therapeutic, rehabilitative
and preventive regimens prescribe for
patients.
 EBC is a newer term and has broadened
the EBM methods to include other clinical
health care providers.
Importance of Evidence-Based
Care
 Generally speaking, nursing, medicine, health
care institutions and health care policy makers
recognize science reports. It is a process
approach to collecting, reviewing, interpreting,
critiquing, and evaluating research and other
relevant literature for direct application to patient
care.
 EBC uses evidence from research; performance
data; and quality improvement studies such as
hospital or nursing report cards, program
evaluations, surveys, national and local
consensus recommendations of experts, and
clinical experience.
Importance of Evidence-Based
Care
 Applying the best available evidence does not
guarantee good decisions, but it is one of the
keys to improving outcomes affecting health.
 Nurses and doctors will always need to search for
the best evidence available to support their
clinical decisions.
 It is evident as we consider the art and science of
nursing that recognizing the importance of EBC
and stimulating an environment within
institutions in which evidence-based models of
care can flourish will result in improved outcomes
of clinical care.
 Attributes of Evidence-Based
Care
 A new culture that can support EBC needs
to evolve in institution. Stetler et al.
identify three specific attributes of
establishing an evidence-based
environment within an institution:
 1. Establishing the culture.
 2. Creating a capacity for change.
 3. Using the organizational infrastructure
to sustain the reinforce change.
 Conducting Evidence Reports
in Nursing
 For the new nurse, understanding
how evidence is judged can be a very
complex task. However, experience
in reviewing and critiquing research
and using research in clinical
activities can be very rewarding.
 Methods for Conducting
Evidence Reports in Nursing
 Select topic or identified problem – The
nurses and doctors on your unit have
reported that falls in evening seem
excessive and want to try to reduce falls
on the unit using principle of evidence-
based care.
 Report the evidence – Evidence is
reviewed and ranked.
 Identify the methods for assigning level of
evidence- Research are reviewed from
evidence.
 Methods for Conducting
Evidence Reports in Nursing
 Report findings, including statistical summary if
appropriate – Statistical information is reviewed
from research articles that report less than 0.05
levels of significance between falls and nighttime
environment in institution; data from the unit
found most falls were a result of patients getting
up to go to bathroom in evening, slipping, not
using the light, and so on.
 Give summary of evidence reviews – As above.
Include specific research articles with levels of
significance of findings, and so on.
 Make recommendations for levels of evidence to
be assigned and potential for clinical application –
Document major reasons for the
recommendations.
Evidence-Based Centers in the
United Stated
 The Agency for Healthcare Research and
Quality has undertaken the development
and funding of 12 evidence-based centers
to carry out development and
dissemination of best practice models
based on available scientific information
and data.
 Development of these special centers has
been a driving force for state-of-the-art
evaluations of current knowledge used in
EBC in the United States.
 Promoting Evidence-Based
Best Practices
 The U.S. health care system is a $1 trillion
industry yet it is difficult to get all clinical
health care providers to carefully consider
the findings of both nursing and medical
research and then deliver quality
outcomes.
 Research can be facilitated within the
institution and then the findings can be
reviewed and implemented. A change in
practice can be facilitated through the
collaboration of nursing and medicine
working closely with quality improvement
teams to deliver quality outcomes.
Situational Analysis
Expanded Program on
Immunization
Vaccine Minimum Age Number Dose Minimum Route Site Reason
at 1st Dose of Doses Interval
Between Doses

Bacillus Birth or anytime 1 0.05 mL -- Intradermal Right deltoid BCG given at

Calmette-Guérin region of the earliest possible
age protects the
after birth possibility of TB
arm meningitis and
other TB
infections in
which infants

are prone
Diptheria-Pertussis-Tetanus
6 weeks 3 0.5 mL 4 weeks Intramuscular Upper outer An early start
Vaccine portion of the with DPT
reduces the
chance of
thigh

severe pertussis
Oral Polio Vaccine 6 weeks 3 2-3 drops 4 weeks Oral Mouth The extent of
protection
against polio is
increased the
earlier the OPV
is given.
Keeps the
Philippines

polio-free
Hepatitis B Vaccine
At Birth 3 0.5 mL 6 weeks Intramuscular Upper outer An early start
interval from portion of the of Hepatitis B
1st dose to vaccine
2nd dose, reduces the
thigh chance of
being infected
8 weeks and becoming
a carrier
interval from
2nd dose to
third dose.

9 months 1 0.5 mL -- Subcutaneous Upper outer At least 85% of

portion of the measles can be
Measles Vaccine prevented by
immunization at
arms this age[
Vaccine Minim Number Dose Minimum Route Site Reason
um Age of Doses Interval
at 1st Between
Dose Doses

Hepatitis B At
Vaccine 3 0.5 mL 6 weeks Intramu Upper An early
Birth interval scular outer start of
from portion Hepatiti
1st dose of the sB
to 2nd thigh vaccine
dose, reduces
8 weeks the
interval chance
from of being
2nd dose infected
to third and
dose. becomin
ga
carrier
 Rota Virus Vaccine
 Rotavirus is a virus that causes
severe diarrhea, mostly in babies and
young children. It is often
accompanied by vomiting and fever.
 Rotavirus vaccine is the best way to
protect children against rotavirus
disease.
 Rotavirus vaccine is an oral
(swallowed) vaccine; it is not given
by injection.
 Rota Virus Vaccine
 They are recommended at these ages:
First Dose: 2 months of age
Second Dose: 4 months of age
Third Dose: 6 months of age
• The first dose should be given between 6 and 12
weeks of age. The vaccine has not been studied
when started among children outside that age
range.
 Children should have gotten all 3 doses by 32

weeks of age.
 Rota Virus Vaccine
 A vaccine, like any medicine, could
possibly cause serious problems,
such as severe allergic reactions. The
risk of rotavirus vaccine causing
serious harm, or death, is extremely
small. Getting rotavirus vaccine is
much safer than getting the disease.
 Problem Analysis
 Inappropriate storage, handling and
transport of vaccines.
 Expiration of Vaccines.
 Proposal
 To ensure the optimal potency of vaccines, careful attention
is needed in handling practices at the country level. These
include storage and transport of vaccines from the primary
vaccine store down to the end-user at the health facility,
and further down at the outreach sites.
 A "first expiry and first out" (FEFO) vaccine system is
practiced to assure that all vaccines are utilized before its
expiry date. Proper arrangement of vaccines and/or labeling
of expiry dates are done to identify those close to expiring.
Vaccine temperature is monitored twice a day (early in the
morning and in the afternoon) in all health facilities and
plotted to monitor break in the cold chain. Each level of
health facilities has cold chain equipment for use in the
storage vaccines which included cold room, freezer,
refrigerator, transport box, vaccine carriers, thermometers,
cold chain monitors, ice packs, temperature monitoring
chart and safety collector boxes.