From Paper To Practice: Incorporating Evidence into your Pharmacy Practice

In 100% of hospitals and related healthcare settings, pharmacists are actively involved in providing care to individual patients that is based on evidence, such as the use of quality drug information resources, published clinical studies or guidelines, and expert consensus advice. (Previously Objective 3.1)

The purpose of the tool kit for objective 3.1 is to illustrate how evidence is applied in clinical practice when pharmacotherapeutic decisions are being made. The tool kit includes an introduction to basic concepts of evidence-based medicine and provides sterling examples of the use and application of evidence in day-to-day practice. Appropriate decision-making involves incorporating and balancing scientific data, safety, accountability, cost, and patients’ wishes. As such, the tool kit provides the context for evidence-based practice in clinical decision-making in the healthcare system today.

CSHP members from across Canada contributed to the tool kit for objective 3.1.

There are 4 sections to this tool kit. Each well-organized, user-friendly section includes the following elements:

  • Brief description of the section
  • Glossary of terms, abbreviations, and symbols
  • Reasons why the section is important for pharmacists
  • Methods of developing, implementing, or using the information
  • Evaluation and performance measures
  • Appendices, references, and evidence-based links relating to the topic areas

How to Apply Basic Principles of Evidence-Based Practice

This section is divided into 2 parts:

Part 1: How to Do a Basic Search for Evidence

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Part 1 describes efficient and easy-to-follow steps for performing a basic literature search in the MEDLINE® database. It uses a sample clinical question to demonstrate how to find the most current and most relevant study results for an issue of interest.

Part 2: How to Critically Appraise Evidence

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Part 2 shows how to critically appraise the scientific literature. This appraisal entails using a systematic approach to assess the usefulness and validity of the research findings. It contains the following elements:

  • workshop presentations on understanding clinical study designs, levels of evidence, and step-by-step processes involved in appraising various types of clinical literature, with specific examples to guide the reader in evaluating randomized trials, systematic reviews, and guidelines; and
  • worksheets and electronic links to references, critical appraisal guidelines, drug information sites, a blog written by a pharmacist for pharmacists, and open-access evidence-based medicine sites.

How to Run Clinical Sharing Sessions for Pharmacists

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This section describes the concept of clinical sharing sessions, provides guidelines on how to organize and conduct such sessions, and offers suggestions on how to evaluate their impact as a tool for applying evidence to clinical practice. A variety of interesting cases illustrate the utility of the clinical sharing session in daily practice for clinical pharmacists.

How to Translate Best Practice Guidelines to Specific Practice Settings

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This section describes the steps involved in knowledge translation (KT) and explains why it is important for pharmacists to be actively engaged in the KT process. Examples are taken from pharmacists’ involvement in well-recognized, high-profile provincial and national projects to show the wide-ranging impact of KT in healthcare.

How to Promote Best Practice and Safety through the Use of Order Sets

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This section describes the key role that pharmacists play in the development of order sets and provides instruction in how to use best evidence to improve patients’ clinical outcomes, as well as safety and efficiency within the healthcare system. Examples of policies, procedures, and sample orders are provided.

Why the Objective Matters

With their knowledge about pharmacotherapeutics and their experience in clinical practice, pharmacists are considered “drug experts”. In addition to these skill sets, the ability to appraise current evidence and synthesize data from a complex array of scientific literature is also essential for making the best decisions. Evidence-based medicine is taught in pharmacy curricula today, but for many pharmacists this skill is learned and polished on the job. The tool kits describe the basic steps of applying evidence to clinical practice, with examples taken from actual practice settings.

A national survey of 127 healthcare institutions carried out by the CSHP 2015 Steering Committee in autumn 2009 showed that 46 (36.2%) had fully implemented objective 3.1 throughout their facilities, and 67 (52.8%) had partially implemented it. The goal is to have this objective fully implemented by 100% of all Canadian hospitals and related healthcare settings by the year 2015. (Complete results of the CSHP 2015 facilities survey can be found at CSHP Survey of Facilities.)

Today, pharmacists who have the skills to apply evidence to patient care are playing an integral role in influencing appropriate decision-making in various settings in healthcare, including direct patient care, guideline development, education, patient safety, regulation, quality improvement, and public policy. These pharmacists set a high standard in evidence-based decision-making, both for their peers and for other members of their healthcare teams.

Link to Crosswalk and Supporting Literature

The CSHP 2015 Crosswalk is a document listing the CSHP 2015 goals and objectives in a tabular format, with links to philosophically aligned Canadian health initiatives. Also included are links to supporting literature, such as primary research papers and guidelines. (The CSHP 2015 Crosswalk can be found at: CSHP 2015 Crosswalk)