Discuss important evidence

If, after reviewing the evidence, you feel that substantial changes are warranted, it is important to share your ideas with the rest of the colleagues in your practice, and potentially with owners.

There are a number of ways that can be used to promote evidence to your colleagues within the practice. A number of strategies, as outlined by Scott and Glasziou (2012), may be employed to do this:

Promotion of evidence to colleagues via:

Electronic communication

Using e-mail or other electronic means of communication will allow your colleagues to read through some of the material you have found, or have produced, before discussions begin in person.

In relation to cardiopulmonary resuscitation (CPR) in small animals, research shows that, in relation to chest compressions and ventilation rates, the optimum rates veterinarians should use have been updated  (100-120 compressions/min and 10/min ventilation rate). These RECOVER guidelines are freely available, and can be circulated around to individuals in your practice.

 Journal clubs

Highlight the evidence you found as part of a journal club session within your practice.

You might want to spend a journal club session discussing how the RECOVER guidelines were constructed using the papers published in the Journal of Veterinary Emergency and Critical Care.

People in a meetingPractice meetings

These are an opportunity to raise awareness of new evidence and to discuss how your colleagues approach cases. If these meetings don’t currently exist, use this as an opportunity to start regular meetings  to discuss cases and approaches.

You could discuss how individuals within the practice currently approach CPR in small animal patients, and whether the team feels there are any changes that could be made in relation to the recommendations in the RECOVER guidelines.

Rounds

Discuss the evidence in relation to a case which you are currently working on.

Use a recent case where CPR was indicated, and discuss how the case fits into the suggested workflow in the RECOVER guidelines.

Resources that highlight any new evidence sources

Highlight resources that could give your colleagues insight into the evidence and help them make clinical decisions.

You might choose to highlight relevant documents associated with the RECOVER guidelines and point out other secondary resources that might be of use in relation to dealing with emergency cases (e.g. BestBETs for Vets, Knowledge Summaries, Banfield CATs, EBVMA CATs, and more listed in ACQUIRE.

It is possible that your colleagues may not agree with the changes that you are suggesting. Many barriers (e.g. time pressures) have been highlighted in the literature in relation to reasons why evidence cannot be applied into practice (Legare 2009). Don’t let this stop you from making a change individually to the patients that are in your care. It may be that after a period of time, you will be able to use some of the techniques in the ASSESS stage of the EBVM cycle to help further promote the changes you are advocating.

Promotion of the new evidence to clients:

Owner compliance

Owners may be wary of new treatments or different approaches, particularly if they are familiar with treatments that have previously been described, so it will be of benefit to spend time discussing the new evidence with clients. Discussing evidence with clients will potentially improve patient adherence to treatment regimens and management strategies.

Mrs. Lee has been using a glucosamine supplement for the last two years in an attempt to reduce the clinical signs of osteoarthritis in her dog. You know that there is a Best Evidence Topic (BestBET) and a ‘What is the Evidence?’ publication in the Journal of the American Veterinary Medical Association outlining that this supplement may not be effective. Mrs. Lee has been using the product for some time, and is convinced that there are some benefits gained by using it. Talking with Mrs. Lee about the benefits of other therapies for reducing the clinical signs of osteoarthritis which have been recognised in research studies will be important for her. Developing a structured treatment regime in conjunction with Mrs. Lee that uses other therapies such as carprofen (or other NSAIDs) without glucosamine will be important. It is crucial that together you identify re-assessment points and schedule check-ups proactively so that Mrs. Lee can provide you with feedback about the new regime and how it is performing in relation to how comfortable her dog is.