Research

• Begin development of evidence-based practice by brainstorming to identify the area of research, such as particular treatments or interventions, groups of patients (pediatric, surgical, transplant recipients) or settings (clinic, office, hospital). Clinical pathways have a narrow focus. Once you chosen the area for intervention, you must determine specific desirable outcomes that you can monitor as part of the evaluation. Then you should review applicable literature and analysis of research studies, include meta-analysis of large pooled studies in which researchers combine and compare findings of numerous smaller studies. You may also utilize expert judgment, such as from a specialist in the field, but opinions should be supported by empirical (measurable) evidence whenever possible.
  
  

Considerations

• Consider all implications when developing evidence-based practice guidelines. Cost-effectiveness is an important consideration because of cost-cutting efforts by many institutions and the reluctance of Medicare/Medicaid and insurance companies to pay for costly care and treatments if alternatives are available. Interventions that require increased staffing or extensive retraining may not be financially feasible. Evaluate all legal implications to ensure that the institution does not face increased liability because of changes in policies or procedures; you must also determine if the changes will impact access to care.
  
  

Implementation

• Develop a clearly written policy that outlines recommendations. In many cases, you may include different alternative approaches. For example, you may develop a protocol for use of specific antibiotics for Staphylococcus infections. Conventional practice is to assign letters to indicate those with the highest recommendations ("A" to "D" ) based on evidence. In some cases, you may use the policy to develop very specific clinical pathways. Evidence-based guidelines should be implemented in steps, usually beginning with a trial in one area so you can monitor outcomes and effectiveness and make revisions as needed. Once fully implemented, ongoing monitoring should include review of records and supporting data (laboratory reports, statistical analysis) and current research to determine if outcomes are acceptable or if you must make changes.