There are three decision points within the Iowa Model delineated by a diamond. The first decision point asks the question, “Is this topic a priority for the organization?” If the answer is “no,” then the model prompts the clinician to consider other triggers and returns them back to the problem — and knowledge-focused triggers for consideration of a different topic (feedback loop). The second decision point on the model asks, “Is there a sufficient research base?” Determining if there is enough research to guide clinical practice is a critical step in the EBP process; implementing a practice change on limited or poorly conducted studies will not produce the intended outcome and can be potentially dangerous. When evaluating the evidence the following criteria are useful to consider: (a) consistency of findings across research studies; (b) the level and quality of the research; (c) clinical relevance of the findings to practice; (d) similarity of sample characteristics; (e) feasibility of implementing the findings; and (f) the risk-to-benefit ratio[1]. If after a thorough literature review and synthesis, high-quality research evidence is not available, the project team may either recommend use of lower level evidence (e.g., case reports, expert opinion) or conducting a research study in order to generate the knowledge needed to base practice decisions[4]. When evidence is deemed sufficient, the practice change is piloted to determine feasibility and effectiveness of the change in the actual clinical setting. Pre- and post-pilot data will determine the appropriateness of adopting the change into practice. If the desired outcomes are not achieved in the pilot study, adopting the change is not appropriate (third decision point) and the EBP team should refocus on ongoing quality monitoring and consider a new problem- or knowledge-focused trigger (feedback loop). If the pilot data show positive outcomes the practice change is implemented into practice. Integrating a practice change is facilitated by leadership support, staff education and continuous monitoring of outcomes[4]. Implementing a practice change can be a challenge. Effective, sustained implementation requires multiple reinforcing and interactive strategies. The final stage of the Iowa Model that is likely the most significant entails disseminating the EBP change results internal and external to the organization through presentations and publications. Results dissemination is important for professional learning and ensures the growth of an EBP culture, expands our knowledge, precludes duplication of work and encourages positive EBP changes in other organizations[4]. The Iowa Model outlines a pragmatic approach to changing practice by melding quality improvement with timely translational science. The ultimate goal is always improvement in patient outcomes. Through the use of the Iowa Model, clinicians can effectively manage EBP projects and gain confidence in the fact that the best available evidence has been translated into practice at the bedside. For further assistance please contact: Houston Methodist Hospital: Shannan Hamlin Houston Methodist San Jacinto: Kathy Arthurs Houston Methodist Sugar Land: Betty Gonzales or Tricia Lewis Houston Methodist West: Kahla LaPlante or Laura Espinosa Houston Methodist Willowbrook: Robin Howe References 1. Titler MG, Kleiber C, Steelman VJ, Rakel BA, Budreau G, Everett LQ, Buckwalter KC, Tripp-Reimer T, Goode CJ: The Iowa Model of Evidence-Based Practice to promote quality care. Critical care nursing clinics of North America 2001, 13(4):497-509. 2. Gawlinski A, Rutledge D: Selecting a model for evidence-based practice changes: A practical approach. AACN advanced critical care 2008, 19(3):291-300. 3. Dearholt SL: The johns hopkins nursing evidence-based practice model and process overview. In: Johns Hpkins Nursing Evidence-Based Practice: Model and Guidelines. Edited by Dearholt SL, Dang D, 2nd edn. Indianapolis: Sigma Theta Tau International; 2012: 33-53. 4. Ciliska D, DiCenso A, Melnyk BM, Fineout-Overholt E, Stetler CB, Cullen L, Larrabee JH, Schultz AA, Rycroft-Malone J, Newhouse RP et al: Models to guide implementation of evidence-based practice. In: Evidence-Based Practice in Nursing & Healthcare a Guide to Best Practice. Edited by Melnyk BM, FineoutOverholt E, 2nd edn. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins; 2011: 241-275.
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