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8C: Applying Evidence

How do we put evidence into practice? At an organisational level, research has identified a number of strategies which have been effective in achieving the transfer of evidence into practice, including:

  • ‘Champions’ to become key resource personnel and provide support
  • Educational materials
  • Hands-on skills development workshops
  • Clinical decision making support systems and tools
  • Reminder systems.

This section provides an example of implementing evidence based practice at the level of the individual clinician, incorporating the three aspects of evidence based practice (as described in 8A: What is EBP?) when planning care:

  • best available research evidence
  • clinical expertise and context
  • client preferences.

Example scenario

The following scenario describes the process of applying evidence and starts with a clinical problem.

Clinical problem

A 75 year old client has a leg ulcer just above the ankle.

IMAGE - M8 01 Ulcer located on ankle

She has a medical history of osteoarthritis, varicose veins, hypertension, chronic obstructive airways disease and is a smoker. The leg ulcer has been present for 13 months and she has suffered with many leg ulcers in the past.

Implementing evidence based practice

How would you commence evidence based practice for this client? Essentially, you would follow these steps:

Step Details
1. Search the best available evidence Find evidence based guidelines available based on recent evidence such as RCN, The management of patients with venous leg ulcers. 2006; RNAO, Assessment and Management of Venous Leg Ulcers. 2004; and Robson et al. Guidelines for venous ulcers. Wound Rep Regen. 2006. 14: 649-62.

The guidelines report strong evidence to recommend:

  • All patients with a leg ulcer should be screened for arterial disease by health professionals with training in this area
  • Graduated multilayer high compression bandage systems (applied by a trained practitioner) should be the first line of treatment for uncomplicated venous leg ulcers
  • Four layer elastic compression bandage systems may provide a shorter time to healing than multilayer non-elastic compression bandage systems.

After healing, the use of compression hosiery helps prevent recurrence (as outlined in 3C: Prevention).

2. Consider the available clinical expertise and context
    You contact a local wound care specialist to screen for arterial disease and find that the client has a normal Ankle Brachial Pressure Index (ABPI) However, the client’s medical history of hypertension and smoking suggests that caution is needed when prescribing an appropriate type of compression therapy.
3. Consider the client’s preferences
    The client has limited financial resources and prefers the more economical short stretch compression bandage system to the more expensive 4 layer elastic compression bandage system.
4. Make a final decision
    Considering all these factors, you decide to treat the ulcer with a multilayer short stretch compression system. The ulcer is assessed weekly and makes good progress, healing after 20 weeks. The client then commences wearing Class 2 hosiery to prevent recurrence.
    IMAGE - M8 02 Ulcer healing
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