Practice question

How can I ensure dementia care is based on the best available evidence?

The critically appraised topic (CAT) process helps ensure that clinical practice is informed by an evidence-based approach
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The critically appraised topic (CAT) approach is being used in dementia care to help ensure clinical practice is evidence-based

As with any area of clinical practice, providing safe, effective and high-quality dementia care should be based on the best available research evidence. However, traditional, outdated practice often continues regardless of any new or updated findings, with the justification: This is the way its always been done.

This can result in suboptimal care being delivered to patients. Nurses are often nervous when the term research is mentioned in relation to their clinical practice and perceive it as a burden and somewhat removed from their day-to-day role.

Critically appraised topic approach aims to foster partnerships between clinicians and researchers

In collaboration with Keele University, dementia services at Royal Wolverhampton NHS Trust have adopted a critically appraised topic (CAT) approach to ensuring

...

The critically appraised topic (CAT) approach is being used in dementia care to help ensure clinical practice is evidence-based

Picture shows woman sitting at a desk, looking at a computer screen and making notes
Picture: iStock

As with any area of clinical practice, providing safe, effective and high-quality dementia care should be based on the best available research evidence. However, traditional, outdated practice often continues regardless of any new or updated findings, with the justification: ‘This is the way it’s always been done.’

This can result in suboptimal care being delivered to patients. Nurses are often nervous when the term ‘research’ is mentioned in relation to their clinical practice and perceive it as a burden and somewhat removed from their day-to-day role.

Critically appraised topic approach aims to foster partnerships between clinicians and researchers

In collaboration with Keele University, dementia services at Royal Wolverhampton NHS Trust have adopted a critically appraised topic (CAT) approach to ensuring clinical practice is based on the best available evidence.Picture of critically appraised topic (CAT) logo

Keele allied health professionals (AHPs) CAT group was developed in 2003 based on this methodology (Foster et al 2001, Stevenson et al 2007). The approach also aims to develop clinicians’ critical appraisal skills and foster partnerships between clinicians and researchers.

Keele University (2020) has since established a number of other successful CAT groups, supported by its impact accelerator unit, in the fields of general practice, general practice nursing and multidisciplinary community groups.

How a CAT group works

Members of the CAT group generate locally relevant clinical questions from their everyday practice, which are structured and answerable. Using the PICO framework, the question is developed to allow for a thorough literature search.

The PICO framework

  • Patient, population or problem. What are the characteristics of the patient or population? What is the condition or disease of interest?
  • Intervention or exposure. What do you want to do with this patient?
  • Comparison. What is the alternative to the intervention?
  • Outcome. What are the relevant outcomes?

(Richardson et al 1995)

 

The resulting evidence is appraised by the group using a structured critical appraisal skills programme or CASP (CASP UK 2020) checklist to provide a summary of the best available evidence and subsequent ‘clinical bottom line’.

Implications for practice can then be considered and a new evidence-based approach can be implemented and evaluated where appropriate. If insufficient evidence is available, the CAT process can generate practice-based clinical questions requiring further research.

Opportunity for a shared learning experience

Providing evidence-based dementia care across an acute hospital trust is particularly challenging and involves many diverse disciplines across a variety of specialties. The CAT approach provides a ready-made framework and resources with a proven success record.

The first important step in developing the Royal Wolverhampton NHS Trust dementia care impact CAT group was to identify those individuals with a common interest. In addition to specialists in dementia care, the established group consists of clinicians from a variety of specialties, AHPs, pharmacists, researchers, academics and a medical librarian.

The response has been overwhelmingly positive, with staff recognising the great potential of this collaborative and dynamic approach and the opportunity for a shared learning experience.

Group has identified clinical questions to be explored

Although the group is in its infancy, it has attracted regular attendance and has already identified a number of clinical questions to be explored, which are at various stages of the outlined process and include:

  • In people with dementia and in pain, is regular pain relief more effective than that given ‘when required’ (PRN), for improving pain/pain behaviours?
  • In adults with dementia, is the use of colour-contrasted toilet facilities more effective than a uniform colour in maintaining safety, dignity and independence?

This non-threatening approach to research has generated curiosity around practice resulting in some great ideas about day-to-day issues. Its continued application will ultimately aim to improve the quality of care for patients with dementia using evidence-based practice.


Picture of Julie Willoughby, who is a nurse consultant in dementia services at Royal Wolverhampton NHS Trust, WolverhamptonJulie Willoughby is a nurse consultant in dementia services at Royal Wolverhampton NHS Trust, Wolverhampton

Practice Question is written by members of the Nurses and AHPs Council of the British Geriatrics Society


Find out more

British Geriatrics Society – Nurses and AHPs Council


References

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