The second step in the EBP process is Acquire, to identify and search for the most appropriate information sources that address the question. Remember, practicing EBM is integrating the best research evidence with clinical expertise and patients' circumstances and values. But with the proliferation of information sources and research studies out there, knowing how to find the best evidence can be daunting. Using an evidence pyramid or hierarchy of evidence can help guide the search process.
The evidence pyramid is a visual representation of the quality and amount of information you might find for any given question. The quality of information increases as you go up the pyramid, but the amount of information decreases. You may not always find a meta-analysis or systematic review on your topic, in which case you would go down and look for the next best level of evidence on the pyramid. Also, the top levels of information are comprised of sources from the lower levels.
There are many evidence pyramids. The pyramid above was designed based on the following sources:
Note that while UpToDate topics are not practice guidelines, many cite practice guidelines and include a link to "Society Guidelines" toward the bottom of the left navigation column.
UpToDate has adopted the GRADE approach to classify the quality of its evidence and recommendations. Read more about the GRADE approach here.
You may not always be able to find filtered information on your topic. As you go up the evidence pyramid, less information will be available. In these cases, you will need to search for primary studies in the following databases. Note that you can also find systematic reviews and some filtered article synopses in these databases. If you find an unfiltered primary study, you will need to do your own critical appraisal of that study to make sure it's valid and reliable.
The definitive resource for nursing and allied health research, providing full text for more than 900 journals. It covers more than 50 nursing specialties and includes quick lessons, evidence-based care sheets, CEU modules and research instruments
Agoritsas T, Vandvik PO, Neumann I, et al. Finding Current Best Evidence. In: Guyatt G, Rennie D, Meade MO, Cook DJ, eds. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed. New York, NY: McGraw-Hill Education; 2015.