Jbi Evidence Implementation最新文献

Introduction: Oral mucositis is an inflammatory toxic reaction that can affect up to 100% of patients undergoing radiotherapy for head and neck cancer.

Objective: This study aimed to promote best practices for the assessment, prevention, and management of oral mucositis in patients undergoing radiotherapy for head and neck cancer.

Method: The study adhered to the seven-phase JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. The study was conducted from October 2022 to August 2023 in the radiotherapy department of a university hospital in Brazil. Eight evidence-based criteria were established to assess compliance with recommendations before and after implementation. Data were analyzed using JBI PACES. Barriers, strategies, and resources were identified using the JBI GRiP approach and improvement strategies were implemented. A follow-up audit was conducted to measure changes in compliance.

Results: In the follow-up audit, six of the eight criteria achieved 100% compliance. These included standardized initial and follow-up oral cavity assessments, treatment of oral mucositis based on damage, education about oral mucositis, oral hygiene protocols, and standardized assessment for malnutrition. The criterion related to the involvement of a multidisciplinary team in treating oral mucositis reached 90% compliance, while the criterion for referring malnourished patients to a nutritionist showed 66.7% compliance.

Conclusions: The high level of compliance with the best practice criteria demonstrates the feasibility of using evidence in clinical practice. The project highlights that strategies and resources can be used to overcome barriers, such as the active involvement of a multidisciplinary team, education, and systematizing the evaluation, prevention, and management of oral mucositis.

Spanish abstract: http://links.lww.com/IJEBH/A442.

Introduction and aims: Applying knowledge generated from implementation science can improve the process teams use to move evidence into practice. To facilitate the use of implementation science knowledge in practice, training and resources for healthcare providers and leaders are needed. Our team developed a toolkit for maternal-newborn settings to provide guidance and tools on how to apply implementation science knowledge to their practice change initiatives. The aim of this study was to evaluate the toolkit for acceptability, appropriateness, feasibility, usability, and potential adoption.

Methods: We conducted a convergent mixed-methods study. Healthcare providers and leaders working in Ontario maternal-newborn care read the toolkit and completed a feedback survey and interview. The questionnaire included questions on toolkit content and format and validated measures on acceptability, appropriateness, feasibility, and usability. The interviews explored questionnaire responses and application of the toolkit. Quantitative data were analyzed descriptively. Qualitative data were analyzed using directed content analysis.

Results: Participants (n = 17) rated the toolkit as acceptable, appropriate, feasible, and usable, indicating the toolkit meets the need for practical resources to guide implementation. Most participants indicated their intention to use the toolkit and refer it to others. Several areas for improvement were identified including simplifying language and content and improving the format. Participants highlighted the need to effectively disseminate the toolkit and offer training and support for its successful implementation.

Conclusions: The toolkit has the potential to improve maternal-newborn teams' implementation processes and outcomes; future work is needed to improve the toolkit and evaluate its use and impact in practice.

Spanish abstract: http://links.lww.com/IJEBH/A431.

Introduction: Nurses and midwives play a central role in ensuring the sustainability of evidence-based practices in the clinical setting. However, for this role to be effectively fulfilled, an understanding is needed of how sustainability concepts are applied, together with the continuous evaluation of practice changes over time.

Aim: This study aimed to explore nurses' and midwives' experiences regarding the sustainability of evidence-based inpatient postnatal care in a maternity unit in Kazakhstan.

Design: The study used an interpretive description design and individual in-depth interviews with nine participants. The COREQ checklist was used to report the study.

Results: Four themes emerged from the analysis. Theme 1: Awareness and Accessibility of Evidence-Based Inpatient Postnatal Care Standards. This theme emphasizes the importance of nurses and midwives continuously using the protocol or standards for postnatal care while being aware of and having access to the protocol and standards. Theme 2: Management Support, Relationships, and Professional Satisfaction. This theme focuses on the dynamics within the unit among nurses and midwives and their managers, and the impact of these dynamics on staff autonomy and professional identity. Theme 3: Training and Updates. This theme refers to the regular training conducted in the unit on the protocol for postnatal care. Theme 4: Practicing Evidence-Based Inpatient Postnatal Care. This theme relates to the activities of nurses and midwives while caring for patients.

Conclusion: The study findings suggest that sustainability in the clinical setting is precarious and multifaceted. The four themes related to the experiences of the staff, were a dynamic and integral component of patient care, driving the sustainability of evidence in the clinical setting.

Spanish abstract: http://links.lww.com/IJEBH/A428.

Introduction: Retention of surgical items (RSI) is a "never event" and has serious consequences for patients, providers, and the organization.

Objectives: This project aimed to implement best practices for surgical counts to reduce the incidence of RSI in patients undergoing intra-abdominal surgery.

Methods: This project followed the seven-phase JBI Evidence Implementation Framework. The framework recommends a before-and-after audit and feedback approach. A baseline audit was conducted to determine current compliance with best practices. Strategies were then implemented to address gaps in compliance, and two follow-up audits were conducted to measure changes in compliance. The audits used five evidence-based criteria adapted from JBI Evidence Summaries, with a sample size of 30 patients.

Results: Although there was moderate to high compliance (50% to 100%) for four of the five criteria in the baseline audit, compliance was low for "surgical pause" (Criterion 4; 16.7%). A key barrier was that surgeons failed to conduct wound exploration before wound closure, despite reinforcement by nurses. Including surgeons as key stakeholders in the revised "surgical pause" protocol significantly improved compliance, which rose to 66.7% in follow-up audit 1 and 86.7% in follow-up audit 2.

Conclusions: Following project implementation, compliance with best practices increased. However, human factor issues remain a challenge in mitigating the occurrence of RSI. Poor inter-professional collaboration and misalignment of values and attitudes toward improvement interventions could hamper efforts to reduce RSI events.

Spanish abstract: http://links.lww.com/IJEBH/A430.

Background: Vaccine communication is critical to improve pregnancy and childhood vaccination uptake. However, communication about vaccination in pregnancy between health care providers and patients is suboptimal. The Sharing Knowledge About Immunization (SKAI) is an Australian multicomponent intervention aimed at improving vaccine communication to increase vaccine uptake in pregnancy and childhood. However, it is unclear whether and how effective the intervention would be in the Canadian context.

Objectives: The objectives of this study were to (1) determine what components of SKAI addressed vaccine communication and barriers identified by providers and parents in Canada, and (2) if necessary, identify additional intervention components that could improve vaccine communication during pregnancy in Canada.

Methods: This multi-method study used the Behaviour Change Wheel and the Theory and Techniques Tool to (1) identify behavior change techniques (BCTs) in the SKAI intervention; (2) map the identified BCTs to the barriers and enablers of vaccination in pregnancy communication, as reported by providers and parents in Canada, using the Theoretical Domains Framework; and (3) if the BCTs identified did not address reported barriers, develop a shortlist of possible BCTs to target barriers reported in Canada but not identified in SKAI.

Results: A total of 22/93 BCTs were identified in the SKAI intervention materials for providers and 8/93 BCTs in the materials for patients. The majority of BCTs from both the providers' and the patients' materials targeted the barrier domains, Knowledge and Environmental Context and Resources, focusing on providing information. The domains with the fewest BCTs identified were Intention and Behavior Regulation. BCTs that targeted barriers in Skills, Belief About Capabilities, and Behavior Regulation for providers and Reinforcement, Social Influences, and Emotions for parents and not identified in SKAI were shortlisted (n = 26) for the Canadian intervention.

Conclusion: A tailored Canadian intervention aimed at improving vaccine communication during pregnancy should move beyond simply providing information, and should include BCTs that target Skills, Belief About Capabilities, and Behavior Regulation for providers. For parents, BCTs should target Reinforcement, Social Influences, and Emotions. Including BCTs that target these barriers that are unique to the Canadian context will increase the likelihood of changing patients' and providers' communication behavior and improving vaccine acceptance during pregnancy.

Spanish abstract: http://links.lww.com/IJEBH/A427.

Background: The Pediatric Intermediate Care Unit (Ped-IMC) provides specialized monitoring and care for children at high risk of clinical deterioration. The Pediatric Early Warning Score (PEWS) assesses key factors, such as vital signs and concerns from parents and nursing staff. The score helps to predict clinical deterioration, trigger a rapid interprofessional response, reduce morbidity and mortality, and enhance staff safety.

Objective: This project aimed to promote the prompt identification of clinical deterioration and boost interprofessional response in a Ped-IMC through the implementation of best practices.

Methods: This project used the JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practices. A follow-up audit was conducted 6 months after implementation to measure change. The audits investigated cardiopulmonary events and unplanned transfers to the pediatric intensive care unit (PICU). A staff survey measured sense of safety, and the Assessment of Interprofessional Team Collaboration Scale (AITCS) was used to measure job satisfaction and interprofessional collaboration.

Results: After implementation, no cardiopulmonary events occurred (compared to one before implementation), and unplanned PICU transfers decreased from 17 (5%) to 14 (4%). Half of the medical and nursing staff (n = 30) completed the survey: interprofessional collaboration scores were stable, and job satisfaction increased from 88% to 97%. Health care providers reported feeling more listened to, with scores improving from 84% to 90%, while their sense of safety remained stable. Compliance with audit criteria increased from 0% to 100% for criteria 1 to 4, and from 0% to 24% for criterion 5.

Conclusion: Implementing PEWS was feasible and effective in enhancing patient safety. While results showed promising improvements in safety culture, reduced adverse events, and increased staff satisfaction, continued monitoring and long-term evaluations are necessary to ensure that PEWS remains a reliable tool in clinical practice.

Spanish abstract: http://links.lww.com/IJEBH/A423.

Introduction: Aggression is a frequent occurrence in psychiatric settings and results from complex multifactorial phenomena. Verbal or physical aggression has a significant impact on the quality of care, with negative repercussions on patients, professionals, and health care institutions.

Objectives: This project aimed to prevent and manage hetero-aggression in a university hospital psychiatric department in Switzerland through the promotion of evidence-based practices.

Methods: The project used JBI's Evidence Implementation Framework, which is grounded in an audit and feedback process. A baseline audit was conducted to measure current practices for preventing and managing aggression and compare these to eight best practice recommendations. Interventions to improve compliance with best practices were implemented, and a follow-up audit was conducted to measure the changes achieved.

Results: Despite a high prevalence of staff exposure to aggression, the baseline audit showed that violence risk assessments were not systematically documented. The follow-up audit revealed improvements, with the use of a validated screening tool to identify violence risk and increased prevention interventions. However, these measures had a relatively low impact on the exposure to violence of health care professionals. Patient involvement in the violence risk assessment also remained low.

Conclusions: The JBI approach used in this project led to significant improvements in professional practices related to violence risk assessment and reduced the gaps between recommendations and clinical practices. Clinical practice analysis sessions are a successful means of promoting understanding of prevention interventions.

Spanish abstract: http://links.lww.com/IJEBH/A410.

Introduction: Protocols for assessing sedation levels are important strategies in intensive care units (ICUs). Such protocols promote multidisciplinary knowledge, proper sedation monitoring, choice of appropriate sedatives, and the use of non-pharmacological interventions.

Objective: This project aimed to improve sedation level assessments in patients under mechanical ventilation in the adult ICU of a private hospital in São Paulo, Brazil.

Method: The project used the JBI Evidence Implementation Framework, together with JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) method. The JBI approach is grounded in an audit and feedback strategy, together with a structured approach to addressing barriers to best practices. A baseline audit was conducted to evaluate current practices against five best practice criteria. A follow-up audit was then carried out to evaluate changes in compliance with the evidence-based strategies.

Results: Forty-four patient records were analyzed during the baseline and follow-up audits. The main barriers found among nurses were low compliance with sedation level assessments, no daily sedation targets, inadequate knowledge of sedation assessment using the RASS, and low engagement in training sessions. Strategies were implemented to address these barriers, including the development of a protocol and nursing team training. The follow-up audit showed improvement in three criteria (3, 4, and 5). However, compliance with Criterion 1 decreased from 100% to 71%, potentially resulting from changes in patient record registration. Criterion 2 remained at 47%, indicating that further improvements were necessary.

Conclusion: This project improved sedation assessment practices in ICU patients under mechanical ventilation, with a 60% increase in compliance with best practices.

Spanish abstract: http://links.lww.com/IJEBH/A403.

Introduction: The increasing number of older adults visiting emergency departments (EDs) near the end of life highlights the need for palliative and end-of-life care in this setting, despite the ED's focus on acute care.

Aim: This study implemented evidence-based end-of-life care for terminally ill adult patients in the ED in a medical center in Shanghai, China.

Methods: This project followed JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practice recommendations. Barriers to evidence-based practices were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine changes in compliance.

Results: The results showed significant improvement in adherence to best practice recommendations. For Criterion 1 (staff training), compliance rose from 77.5% to 100% and knowledge scores increased from 9.68 ± 1.945 to 12.30 ± 2.239 (p < 0.001). For Criterion 2 (patients screened and/or assessed for palliative care needs), compliance increased from 50% to 100%. For Criterion 3 (ED protocol for end-of-life care), compliance rose from 0% to 100%. For Criterion 4 (palliative or end-of-life patients transitioned to the appropriate service), compliance increased from 0% to 30%. For Criterion 5 (strategies promoting a suitable environment), compliance increased from 70% to 90%.

Conclusions: This project resulted in positive changes, including the establishment of a formal end-of-life care protocol. Nursing team support and the range of end-of-life care interventions also improved. However, collaboration and referrals between hospitals and hospices remain challenging. Further audits are needed to assess improvements in care for end-of-life patients.

Spanish abstract: http://links.lww.com/IJEBH/A395.

Introduction and objectives: Effective management of post-operative pain improves the condition of patients and reduces their hospital stay. This, in turn, has an impact on caregivers, professionals, and institutions and, as such, is considered a primary indicator of quality. The aim of this project was to improve the assessment and management of post-surgical pain in thoracic surgery patients.

Methods: This implementation project was conducted in a thoracic surgery unit of a tertiary hospital in Spain. The project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted with 44 patients, and barriers to best practice were identified. Strategies were then implemented to improve the assessment and management of post-operative pain. Three follow-up audits were performed using nine audit criteria with 34, 40, and 46 patients, respectively.

Results: The baseline audit revealed poor compliance with best practices. After implementing strategies to address areas of non-compliance, health education for patients and caregivers improved up to 80%, while the measurement of pain upon admission and post-surgery rose to 91%. However, patients undergoing pre-operative assessment to guide their post-operative pain management at hospital discharge remained below 50%.

Conclusions: Using a methodology to implement best practices, together with clinical audits, improved compliance with the use of validated scales to assess and manage pain. A multidisciplinary approach improves the quality of care received by patients and contributes to their recovery.

Spanish abstract: http://links.lww.com/IJEBH/A240.