Implementing Iowa EBP and Kotter and Cohen's Change Models in Clinical Practice

INTRODUCTION
• Evidence-based practice (EBP) is a
problem solving strategy to clinical
decision-making in healthcare
institutions
• It integrates high quality scientific
evidence with experiential evidence
• There are various EBP models that have
been developed to help to conceptualize
transferring evidence into practice
• One EBP model and change model is
Iowa EBP model
• The aim of the current presentation is
– To describe the Iowa EBP and Kotter and
Cohen’s models
– To describe how these two models can be
used to implement an EBP change in
clinical practice

IOWA EBP MODEL
• Iowa model of EBP is based on an approach of
problem solving
• it is a decision support schema comprised of
three key decision points
– Determining the knowledge-focused trigger or
problem priority for the organization
– Establishing the readiness of the evidence
– Determining the outcomes of a pilot
implementation to change practice to
determine if change is warranted (Hope &
Rittenmeyer, 2012).
• It is made up of certain steps namely topic
selection, formation of team, retrieval of
evidence, grading the evidence, Critical
appraisal and evidence synthesis, proposing
EBP recommendations , development of the
EBP, implementation and dissemination of
changes in practice, and change evaluation
(LoBiondo-Wood, Haber, & Titler, 2018).

KOTTER AND COHEN S’
CHANGE MODEL
• Kotter and Cohen’s change model has the
following stages.
• Creating a sense of urgency
• Forming a team
• Creating a vision and strategy
• Sharing the vision
• Removing hindrances to successful change
• Discovering interim successes
• Forging persistence
• Encouraging the new culture (Melnyk &
Fineout-Overholt, 2015)

IMPLEMENTATION OF
IOWA MODEL
• Problem focused triggers
– Process improvement data
– risk management data
– External or internal benchmarking data
– Financial data
– Clinical problem identification
• Knowledge-focused triggers
– Current, new research
– Organizational standards and guidelines
– Care philosophies
– Questions from institutional standards
committee
PICO Question
Problem: high rates of urinary tract infections associated with use of catheters
Intervention: use of new silicone catheters
Comparison: Common latex catheters
Outcome: Reduced rates of urinary tract infections linked to catheter use
Does use of silicone catheters in comparison to common latex catheters within one
month reduce the rate of occurrence of urinary tract infections associated with
catheter use?