» Evidence hierarchies provide a meaningful way to rank research studies based on scientific
rigor and the levels of evidence: CPGs, meta-analyses, systematic reviews, RCTs, cohort
studies, case control studies, descriptive studies, qualitative studies, expert opinions, and
case studies.
» A variety of professional organizations and clinical entities have developed rating systems
that provide a systematic way to rate risks, benefits, quality, and strengths of the evidence. An
international collaboration proposes to use the GRADE system as a single standard.
» CPGs provide recommendations for practice based on a thorough review of evidence con-
ducted by expert panel members. Because CPGs might have bias, the AGREE II instrument
assists nurses in evaluating guidelines.
» Nurses must consider other factors aside from evidence that influence clinical decision making.Apply What You Have Learned
The EBP committee has been meeting regularly to analyze evidence and is now able to make
recommendations for best practice. Of course, if you were on an actual EBP committee, there
would be much more evidence about hand hygiene that you would need to consider. We have
provided only a sample of evidence for you throughout this exercise. When making a policy
decision in clinical practice, you would need to consider all of the evidence. In this exercise,
first examine each study to determine whether the study is valid by considering the questions
presented in Box 15-1. Then, use the rating system described in Figure 15-1 to assign each
piece of evidence a ranking. Make a decision about the evidence, and write a nursing policy
that you think will increase compliance with hand hygiene. Be sure to consider the feasibility
(organizational and individual barriers) of your policy. A template is included within this text’s
digital resources that serves as an example of a format that can be used to standardize the way
policies are written in a healthcare facility. Use this template to record your policy.REFERENCES
Agency for Healthcare Research and Quality. (n.d.). EPC evidence-based reports. Re-
trieved from http://www.ahrq.gov/research/findings/evidence-based-reports/index
.html
Agency for Healthcare Research and Quality. (2002). Systems to rate the strength of
scientific evidence (Evidence Report/Technology Assessment No 47. AHRQ Pub. No.
02-E016). Retrieved from http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
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