EBP Model ePoster

Johns Hopkins Evidence-Based Practice Model and Guidelines

Appendix H

Synthesis & Best Evidence Recommendations Tool

Purpose: This tool guides the EBP team through the process of synthesizing the pertinent findings from the Best Evidence or Individual Evidence Summary (Appendix G1 or G2) to create an overall picture of the body of the evidence related to the EBP question. The team analyzes the data in each category of support for decision-making, as well as any additional organizational approaches that bring further insights.

Section I: Findings from the Individual Evidence Summary

Support for Decision-Making

Synthesized Findings with Article Number(s) (This is not a simple restating of information from each individual evidence summary,see

instructions)

_____

_____

_____

Strong

Number of sources =

Moderate

Number of sources =

Limited

Number of sources =

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

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Section II: Best Evidence Recommendations

The recommendations below are based on:

Pre-appraised evidence identified in a best evidence search → Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach

Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design) → Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in the table below. See instructions for more details.

Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre- appraised evidence that does not fully address the EBP question) → Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I

Characteristics of the Recommendation(s) Best Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent, and/or based mostly on evidence that provides limited support for decision-making)

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Johns Hopkins Evidence-Based Practice Model and Guidelines

Instructions for the Synthesis, & Best-Evidence Recommendation Tool

Section I: Findings from the Individual Evidence Summary Only complete Section I if the team

completed an exhaustive evidence search and the Individual Evidence Summary Tool (Appendix G2).

Support for Decision-Making

Synthesized Findings With Article Number(s) (This is not a simple restating of information from each individual evidence summary—see

instructions)

_____

_____

_____

Strong

Number of sources =

This table captures key findings that answer the EBP question from an exhaustive evidence search. As a team, review the evidence that provides strong support for decision-making in the Individual Evidence Summary Tool (Appendix G2). Look for salient themes, patterns, important takeaways, consistencies, and inconsistencies.

After discussing the strong evidence and coming to a consensus as a team, record succinct statements in this box that synthesize the information, enhance the team’s knowledge, and

generate new insight, perspective, and understanding to answer the EBP question.

Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool. Record the article number(s) used to generate each synthesis statement to make the source of findings easy to identify.

Moderate

Number of sources =

Repeat the process above for evidence that provides moderate support for decision-making.

Limited

Number of sources =

Repeat the process above for evidence that provides limited support for decision-making.

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

This is an optional section to reflect any additional insights the team has from further organization and analysis of the data. It may include patterns, themes, subgroups, or additional sorting. To determine if this step is necessary, the team should ask themselves, “How can the evidence be organized to explore subtleties or details in order to produce a more comprehensive understanding of the big picture?” See Chapter 9 for more information.

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Section II: Best Evidence Recommendations The recommendations below are based on: Select boxes below that reflect the type(s) of evidence used to generate the bestevidence recommendations.

Pre-appraised evidence identified in a best evidence search → Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach Using the certainty or confidence schema used by the authors of the pre-appraised evidence, put each recommendation into the corresponding box.

Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design) → Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in the table below. See instructions for more details. Record any changes to the recommendations from the pre-appraised evidence in the corresponding box. When determining if a recommendation should be updated, consider the following:

o Does the new evidence provide results that are based on robust methods that the team considers compelling?

o How does the certainty of any new or altered recommendations compare to the certainty of the recommendation from the pre-appraised evidence?

Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre- appraised evidence that does not fully address the EBP question) → Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I Review the information from Section I. Consider the quantity and quality of information for each recommendation. Based on the descriptions below, record the best-evidence recommendation in the box that corresponds to the characteristics of the evidence used to support it. Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP question. The team bases these recommendations on the evidence and does not yet consider their specific setting. Translating the recommendations into action steps within the team’s organization occurs in the next step (Translation and Implementation Tools, Appendices I and J).

Characteristics of the Recommendation(s) Best Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Record recommendations that the team feels confident in endorsing here. Keep in mind, these can be recommendations FOR or AGAINST an intervention. Sentences can start with phrases such as:

• “The evidence endorses...” • “The evidence recommends...”

Or end with

• “...is recommended” • “...is indicated” • “...is beneficial” • “...is useful”

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Record recommendations that the team is fairly confident in endorsing here. Sentences can start with phrases such as:

• “The evidence suggests...” Or end with

• “…is reasonable” • “…can be useful” • “…can be effective” • “…can be beneficial”

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Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Record recommendations that the team has little confidence in endorsing here. Sentences can start with phrases such as:

• “Evidence is mixed regarding…” • “Evidence is conflicting regarding…” • “There is little evidence to support…”

Or end with:

• “… may or may not be useful” Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent, and/or based mostly on evidence that provides limited support for decision-making)

Record recommendations that the team has no confidence inendorsing here. Sentences can start with:

• “There is no evidence to support…” • “Evidence is very limited on…” • “Recommendations cannot be made on…”

Or end with:

• “….is not supported by evidence”

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1. instructions):
2. Number of:
3. Number of_1:
4. Further Synthesis Based on Additional Organization and Analysis (OPTIONAL):
5. sources =:
6. sources =_1:
7. sources =_2:
8. High certainty recommendations (Robust,well-documented, consistent & persuasive,based mostly on evidence that provides strongsupport for decision-making):
9. Reasonable certainty recommendations(Good, mostly compelling, consistentevidence, based mostly on evidence thatprovides moderate to strong support fordecision-making):
10. Reasonable to low certaintyrecommendations (Good but conflictingevidence Inconsistent results, based mostlyon evidence that provides moderate supportfor decision making):
11. Low certainty recommendations (Little to noevidence Information is minimal, inconsistent,and/or based mostly on evidence thatprovides limited support for decision-making):
12. sources =_3:
13. sources =_4:
14. sources =_5:
15. Check Box1: Off
16. Check Box3: Off
17. Check Box2: Off
18. Check Box01: Off
19. Check Box02: Off
20. Check Box03: Off