Chapter 7: Design and Pilot the Practice Change

INTRODUCTION

When the evidence-based practice (EBP) team decides to move forward, the next step is to design a pilot test of the change. Pilot testing the practice change is a critically important step in implementing EBP (Shapiro & Donaldson, 2008). In the Iowa Model, this step was expanded to provide more specific guidance on the process. The purpose of the pilot is to determine whether the practice change works as intended, whether the implementation plan results in adoption of the change, and whether other patient care areas would benefit from a rollout. Failing to plan a systematic and thorough pilot test can lead to confusion among the EBP users and may make it difficult to interpret the post-change data. Without credible data to show that the EBP had the intended effect, it may be difficult to convince users and stakeholders to maintain the change.

Pilot testing often requires more time and effort than assembling, appraising, and synthesizing the evidence, so adjust the timeline for the project accordingly. Shapiro and Donaldson (2008) provide a useful example of a timeline for making triage changes in emergency departments. Involve the right people in the planning. At this point in the process, new team members may need to be added. If the EBP might incorporate patient or family preferences (e.g., family presence during resuscitation), engage patients and families in the discussion. Select a pilot area that has an enthusiastic manager, known opinion leaders, and change champions. Supportive leadership is vital for the success of the initiative (Sandström et al., 2011). Be mindful of other initiatives that are happening in the pilot area that may compete for resources and time. The strategies described in Chapter 8 provide ideas for developing the implementation plan and promoting adoption of the EBP.

Questions to consider when using the body of evidence to design and pilot the practice change are:

• How is the evidence relevant and meaningful to the population of interest?

• How can the intervention be adapted to fit the cultural norms of the patients and organization?

• How can recommendations be adapted to be consistent with patient preferences (e.g., promoting independence vs. limiting independent mobility to prevent falling)?

• What are the risks and how can they be minimized to benefit patients, clinicians, or the organization?

• Are the costs (human and material) associated with the practice and implementation of the practice change outweighed by the benefits?

• Is the practice change complex? Are there threats to intervention fidelity (ability to carry out intervention as intended)? Is there a need for training and monitoring anticipated outcomes?

• What are the consequences for ineffective use or failure of the practice change? How can these consequences be addressed or minimized?

• Is the practice recommendation consistent with ...