Evidence-based practice (EBP) is a term that has been widely used by healthcare professionals for the past two decades. The basic philosophy underpinning EBP is that decision making in patient care should be based on the best available evidence, integrating individual clinical expertise and in consultation with the patient.1

So how far have we 'walked the talk'?

In order to effectively implement the evidence, healthcare professionals should have the knowledge and skills to find and assess the quality of the evidence. Universities and healthcare organizations have made significant efforts to educate and equip health professionals with knowledge and skills about EBP and its implementation in clinical practice by including it as an integral part of the undergraduate programs and offering postgraduate EBP courses. Knowledge alone is not a driver for EBP; availability of the relevant resources at the point of care has the potential to fundamentally influence decisions that have an impact on patient safety and quality of care. To this end numerous decision-support resources have been developed such as the Cochrane Clinical Answers, Joanna Briggs Institute Best Practice Information Sheets, ACP PIER, Up to Date, First Consult, Dyna Med and Clinical Evidence, which provides practical evidence for healthcare decision making. These resources provide access to synthesized evidence-based information instead of lengthy systematic reviews or meta-analyses. In addition, journals dedicated to EBP such as the International Journal of Evidence-Based Healthcare have also been developed to provide clinicians with evidence in a concise and digestible form and key messages they can apply to their clinical practice.

It appears that multifactorial efforts have been made to encourage EBP; however, the question remains 'has it resulted in the implementation of EBP at the point of patient care?'. In a recent study undertaken on community nurses, the majority of the respondents had a positive attitude towards EBP and stated that their practice was evidence based. Ninety-five percent of the respondents indicated that EBP was fundamental to their nursing practice and 85% indicated that EBP improved patient care. However, one third of the participants indicated that although EBP was worthwhile it placed another demand on an already overloaded profession and access to resources were limited. Only one third of the respondents had used the Cochrane library or the Joanna Briggs Institute-Best Practice Information Sheets. Seminars and workshops were considered a useful resource for EBP by approximately 70% of the respondents.

It is widely acknowledged that between 10 and 40% of patients do not receive care based on best evidence, or even worse, they often receive treatment that is unnecessary or harmful. For EBP to be successfully adopted and sustained, it must be embraced not only by the individual care providers and the microsystem but also by the system leaders, as well as the federal, state and local policy makers and other regulatory bodies.

Implementing EBP requires strategies that address the complex healthcare systems, senior leadership and individual clinicians to change healthcare cultures and provide a safe environment for patients. Hence, the development of Implementation science which is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice. Implementation science seeks to understand the behaviour of healthcare professionals and other stakeholders in the sustainable uptake, adoption and implementation of evidence-based interventions.2,3

Most healthcare organizations have a made a strong commitment to patient safety and to providing high-quality evidence-based care to their patients. to bridge the discovery-to-delivery gap, initiatives such as tailoring EBP to the practice environment or clinical specialty, an audit and feedback process illustrating the impact of EBP on patient outcomes or clinical practices is becoming increasingly used. Some healthcare institutions provide clinicians with tablet computers, or cellular phones to access the evidence-based resources. However, maintaining these initiatives is resource intensive and a complex process. There is a need for the application of conceptual frameworks for the development of the blueprint for hospital reforms if implementation of EBP is to be sustained.

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