Ava Clarissa C.

Veron BSNIV Block 6 Evidence-Based Practice Evidence-Based Practice (EBP) is a thoughtful integration of the best available evidence coupled with clinical expertise. As such it enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and past research, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings. The goal of EBP is the integration of: (a) clinical expertise (b) best current evidence (c) client/patient perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve.

Steps in the Process of Evidence-Based Practice Step 1: Framing the Clinical Question Ex. "Are patients with aphasia who received SLP services shortly after their stroke more or less likely to achieve functional communication abilities than stroke patients who received such treatments later?". Step 2: Finding the Evidence Systematic Reviews They are useful in helping clinicians make treatment decisions in that, when done properly, they have pulled together and in a systematic way characterized the available evidence on a clinical question. Individual Studies

Step 3: Assessing the Evidence The first is relevance of the review to your specific clinical question The second factor to consider is who wrote and published the review

Step 4: Making the Decision

Finally, the time will come to combine clinical expertise, the patient's perspective, and the available scientific evidence in making a specific clinical decision with a specific patient. In some instances, evidence-based clinical guidelines will already have been developed on topics related to your particular question. There are at least three important factors to keep in mind when considering whether and to what extent to follow the guidance contained in such documents. The first is relevance of the guideline to your specific clinical question. If the brain-injured patient whose care prompted your question is a member of a cultural or linguistic minority, for example, how useful are brain-injury guidelines that exclude or make no specific mention of culturally or linguistically diverse populations? If you are treating an autistic teenager, of what relevance are guidelines developed primarily on the basis of evidence from younger children? Once again, the expertise and experience of the individual clinician is an absolutely essential part of evidence-based practice. The second consideration is the extent to which clinical practice guidelines are truly evidenced-based. Many guidelines are produced via an expert consensus process or other non-systematic approaches. While expert consensus can certainly be a valuable source of information, the conclusions are particularly vulnerable to the biases held by the "experts", and history is full of examples of such conclusions being simply wrong. If a guideline is truly evidence-based, the methodology by which evidence was identified and evaluated should be transparent. Unfortunately, transparency in itself is not a guarantee of quality. It can be a challenge for clinicians to determine what is and is not a high quality evidence-based practice guideline. Systems for evaluating practice guidelines have been developed and can be useful tools to help determine whether a guideline should be applied. The third factor to consider is who wrote and published the guideline. While many guidelines are produced by academic institutions and interdisciplinary collaborations, others are produced by advocacy groups or payors. It is important to consider who produced the guidelines and to what extent they would likely be affected by positive or negative recommendations. However, guidleines eminating from a "trusted" source are no more guaranteed to be of high quality than are guidelines coming from a less objective source guaranteed to be flawed. Application of the AGREE or other objective criteria should be the final determinant of the guideline's quality.