Apply: Applying evidence to practice

2. Applying evidence to practice

It has been shown that implementation of evidence into practice is one of the most challenging things to do when compared with finding the evidence and appraising it (Bergus et al., 2004).

There are a number of reasons why it is difficult to apply evidence to practice, but it ultimately comes down to the availability of essential resources (Sackett and Straus, 1996) and the motivation of the individual clinician to make the changes (Kiefe et al., 2001).

Clinicians are trained to assimilate information gathered through taking a clinical history, performing a clinical examination on an animal or group of animals, interpreting diagnostic tests, monitoring previous responses to treatments and understanding client circumstances and expectations (Holmes and Cockcroft, 2004). Integrating evidence works on the same principles that veterinarians use every day, with the evidence becoming a component of the decision-making, alongside the circumstances of the owner and animal in front of you. Through integrating evidence, clinicians continually adapt and update their practice over time.

Example: Is it necessary to measure coagulation parameters before liver biopsy, or not?

In the past, it was recommended that clotting times were evaluated prior to performing a liver biopsy in the horse. There is a risk of haemorrhage associated with the procedure, and in ensuring horses had normal coagulation parameters, this risk was perceived to be lower.

However, measuring clotting times was an added expense and delayed the liver biopsy procedure, sometimes putting clients off performing this important diagnostic step. In 2008 evidence emerged that the risk of haemorrhage was both lower than previously thought, and unrelated to coagulation abnormalities (Johns and Sweeney, 2008). This evidence was rapidly incorporated into practice and now clients are only offered pre-biopsy clotting profiles where there is overt evidence of a clotting disorder (bleeding diatheses).