Jbi Evidence Implementation最新文献

Background: Sustaining improvements from large-scale quality initiatives in hospital settings remains a persistent challenge. When such improvements fade, patient safety risks may re-emerge. Despite their importance, long-term post-implementation evaluations of large-scale hospital initiatives are scarce.

Aim: This study aimed to identify long-term insights into the sustainability of a large-scale hospital initiative designed to improve timely drug administration.

Methods: A mixed methods case study was conducted on an Australian hospital-wide initiative implemented in 2014-2015. Quantitative data included rates of unintentional drug omissions before, during, and after the initiative. Qualitative data were collected through 13 individual semi-structured interviews with stakeholders, including implementation team members, hospital staff, and managers. Thematic analysis was conducted inductively and then categorized deductively using an evidence-based sustainability framework. Mixed methods data were integrated for interpretation.

Results: Drug omission rates showed potential medium-term improvement; however, long-term outcomes were inconclusive due to changes in national audit methodology. The initiative included multifaceted interventions co-produced with staff, focusing on system change (e.g., prescription ordering) and staff behavior change (e.g., education). Eight years after the initiative's completion, system-based interventions remained embedded with sustained benefits; however, behavioral interventions did not continue after the initiative. Interview participants identified key enablers and barriers to sustaining change, offering valuable lessons for future hospital initiatives.

Conclusion: This study provides long-term insights into designing and sustaining large-scale changes in hospital settings. The findings highlight the importance of system-level interventions, staff engagement, and ongoing leadership support. The study offers actionable strategies for health care managers and professionals to enhance the sustainability of improvement efforts.

Spanish abstract: http://links.lww.com/IJEBH/A549.

Introduction: Total hip replacement (THR) constitutes one of the most frequently performed surgical interventions in Germany. Despite robust evidence demonstrating that routine post-operative movement restrictions neither reduce dislocation risk nor enhance functional recovery, such precautions remain commonplace.

Objectives: This project aimed to assess and improve clinical practice among health care professionals in a German university hospital-including physicians, physiotherapists, and occupational therapists-regarding patient education on post-operative movement precautions after THR.

Methods: This implementation project followed the 7-phase JBI Evidence Implementation Framework, which uses an audit and feedback approach to promote change. A baseline audit was conducted to assess adherence to the best practice recommendation that no routine hip movement precautions should be applied to patients after THR surgery. This was followed by two implementation workshops that included evidence-based presentations and group discussions, culminating in a re-audit to assess compliance improvements.

Results: The baseline audit revealed a compliance rate of 16.67% with the best practice recommendation. Following the intervention, compliance improved to 100%.

Conclusions: This project significantly enhanced adherence to best practice recommendations. Future efforts should focus on ensuring the sustainability of these short-term changes through policy integration and ongoing education, and validating the results for generalizability.

Spanish abstract: http://links.lww.com/IJEBH/A533.

Introduction: Peripheral intravenous (PIV) therapy, the most common invasive procedure in hospitals, frequently results in complications. Infiltrations occur when infused fluids enter the surrounding tissue without harming the skin, while extravasations irritate the skin and tissue, occasionally necessitating surgical intervention. Evidence-based practices recommend the use of quality standards, such as Assess, Compare, Touch (ACT) and a 60-minute rounding tool to address the rising incidence of intravenous complications.

Objectives: The objective of this evidence implementation project was to decrease the complications associated with infiltration and extravasation at the site of PIV catheters in pediatric populations.

Methods: This project was guided by the JBI Evidence Implementation Framework. A baseline audit identified inconsistent adherence to policy, including the crucial hourly rounding to assess the infusion site. Barriers to best practice were identified and improvement strategies were implemented, including education on hourly PIV assessment using ACT and a rounding tool for nurses. Additionally, an algorithm for extravasations and infiltrations was implemented. A follow-up audit was conducted to determine changes in practice.

Results: The baseline audit revealed that although 100% of PIV sites were properly stabilized with adhesive dressings, only 9.09% of catheters were assessed every hour using ACT. Additionally, 100% of catheters were removed and infusions stopped immediately after extravasation or infiltration, but none of the affected extremities were elevated. Only 27.27% of cases involved notifying a physician or nurse practitioner, and there was no established protocol for managing extravasation or infiltration. Survey results from 40 nurses showed that 72.5% felt educated on catheter securement and assessment, but only 52.5% had received education on managing PIV-related injuries.

Conclusions: Continuing education and protocols can improve the quality of care of pediatric patients with PIV by strengthening staff knowledge and skills to prevent infiltrations and extravasations.

Spanish abstract: http://links.lww.com/IJEBH/A545.

Introduction: Nursing electronic documentation fulfills a vital legal and quality assurance role; however, nurses perceive it as a significant time and effort burden.

Objectives: This project aimed to improve the quality and effectiveness of nursing documentation by implementing a framework for free-text documentation using the SBAR-D framework in a general medicine ward.

Methods: This evidence implementation project used the JBI Evidence Implementation Framework. The JBI Framework follows a seven-phase approach and is grounded in an audit and feedback process, along with a structured method for identifying and managing barriers to compliance with recommended clinical practices. A novel translation of a communication tool was developed as a framework for nursing documentation. Time-saved data were collected from electronic medical record user reports and were presented descriptively.

Results: The project met the target 80% compliance with best practice recommendations. Three barriers were identified and seven strategies to overcome these barriers were successfully implemented. Time saved through the implementation was quantified.

Conclusion: Implementing the SBAR-D framework for free-text documentation has significantly improved compliance with best practice recommendations of logical, sequential nursing documentation, improving the quality of documentation in the pilot setting. This positive pilot has led to the successful expansion of the SBAR-D framework into four other acute wards. The study institution has also begun expanding the SBAR-D framework hospital-wide and codifying this evidence-based practice change as part of regular standard operating procedures, making it a core part of induction packages for new staff and an area of focus for continuing education.

Spanish abstract: http://links.lww.com/IJEBH/A531.

Introduction: The management of cancer pain requires specific knowledge and skills from health professionals.

Objectives: The aim of this project was to improve compliance with best practices for the management of cancer pain in outpatients at an oncology center of a philanthropic hospital in São Paulo.

Methods: This project was based on the evidence implementation methodology proposed by JBI. The JBI approach comprises a baseline audit, analysis of barriers, tailored strategies, and follow-up audit to assess impact and sustainability.

Results: The baseline audit included 34 patients and 45 health care professionals. Eight criteria were assessed, with two showing high compliance and the remaining six showing low compliance. Following the implementation of improvement strategies, a follow-up audit was conducted with 59 patients and 45 health care professionals. The audit revealed improved compliance of >50% for seven of the eight audited criteria.

Conclusions: The use of JBI's implementation framework improved compliance with recommendations for cancer pain as well as identifying new opportunities for the sustainability of best practices. These findings reinforce the importance of structured methodologies for better pain relief implementation.

Spanish abstract: http://links.lww.com/IJEBH/A534.

Introduction: Medical adhesive-related skin injury (MARSI) is common in intensive care units, increasing pain and infection risk. Assessment is critical for MARSI prevention.

Objective: This study reports on a best practice implementation project to improve MARSI assessment in two intensive care units in a tertiary hospital in China.

Methods: This project was guided by the JBI Model of Evidence-Based Healthcare and the JBI Evidence Implementation Framework, which is based on an audit and feedback process. JBI best practice recommendations were used to develop audit criteria. A baseline audit was conducted to measure current practices against best practices. Barriers to compliance were identified and improvement strategies were developed. Two follow-up audits were conducted to gauge the effectiveness of the strategies.

Results: The baseline audit revealed that compliance with the five audit criteria ranged from 30%-53%, with a median MARSI knowledge score of 55 (interquartile range 45-60) among nurses and a MARSI incidence rate of 21.67%. Following the implementation of strategies (training, validated assessment tools, electronic documentation), the first follow-up audit showed that compliance with the five audit criteria ranged from 48%-100% and the nurses' median MARSI knowledge score was 85 (interquartile range 80-90). The incidence rate of MARSI decreased to 13.33%. Omitted assessment tasks were identified as a new barrier, leading to the addition of pop-up prompts. The second follow-up audit showed that compliance with the five audit criteria increased to 83%-100%, the median MARSI knowledge score was 90 (interquartile range 85-95), and MARSI incidence further dropped to 11.67%.

Conclusions: The implementation of this project improved compliance with the five audit criteria and nurses' MARSI knowledge score.

Spanish abstract: http://links.lww.com/IJEBH/A543.

Introduction: Intravenous insulin infusion is essential for managing hyperglycemia in patients in the intensive care unit (ICU). Inadequate management can result in serious complications, including hypoglycemia, which, if untreated, can lead to irreversible nerve damage or death.

Objective: This project aimed to implement evidence-based practices for managing intravenous insulin infusion among critically ill ICU patients at a public tertiary hospital in China.

Methods: This quality improvement project employed a pre-post audit design guided by the JBI Implementation Framework and the JBI Model of Evidence-Based Health care. The project followed a seven-phase approach incorporating evidence-based auditing and feedback mechanisms. JBI's Practical Application of Clinical Evidence System (PACES), Getting Research into Practice (GRiP) tool, and the CFIR-ERIC Implementation Strategy Matching Tool supported data collection, analysis, and implementation planning.

Results: Significant improvements in compliance with the best practices were observed. Timely initiation of insulin infusion increased from 45% to 86.67%, while maintaining glucose within the target range increased from 0% to 70%. The use of validated insulin infusion protocols increased from 0% to 78.3%, blood glucose monitoring frequency from 80% to 95%, and arterial sampling for blood glucose monitoring from 1.4% to 68.8%.

Conclusions: The project greatly improved adherence to evidence-based practices in insulin infusion management and improved overall patient care in ICUs.

Spanish abstract: http://links.lww.com/IJEBH/A538.

Background: Patient falls remain a major concern in hospitals, leading to serious harm and significant costs. Although various fall prevention interventions exist, the factors influencing their successful implementation, especially across different hospital contexts, are poorly understood.

Aim: This study applied implementation theory to explore factors affecting the implementation of the Rauland Concentric Care digital fall prevention platform in two contextually different Australian hospitals.

Methods: Qualitative data were collected through semi-structured interviews and small focus groups with nurses: 12 participants from four wards in a newly built 300-bed rural referral hospital, and ten participants from three wards in a 400-bed community hospital. Data were coded using the Consolidated Framework for Implementation Research (CFIR), and barrier/enabler statements were developed through consensus. The most frequently cited factors were identified and compared across sites.

Results: Despite contextual differences, three common factors that influenced implementation emerged: Patient Needs and Resources (Hospital 1: n = 12; Hospital 2: n = 10), Design Quality and Packaging (Hospital 1: n = 11; Hospital 2: n = 10), and Knowledge and Beliefs About the Intervention (Hospital 1: n = 10; Hospital 2: n = 8). These findings suggest that certain factors consistently affected the implementation of the Rauland Concentric Care digital fall prevention platform across hospital settings.

Conclusion: Hospitals planning to implement this digital platform may benefit from proactively addressing these three key factors. As adoption expands across Australia, future research should explore whether these findings hold true in other health care settings.

Introduction: According to the 2018 Health Behavior in School-aged Children Study conducted by the World Health Organization (WHO) in Spain, 23.9% of adolescents experience frequent psychological distress. Therefore, early detection of mental health issues in adolescents is essential.

Objectives: The aim of this project was to improve mental health screening for adolescents aged 14-16 years by promoting evidence-based practices in a primary health center in León, Spain. The project also aimed to increase awareness of health care professionals and include mental health screening as a routine process.

Methods: This project used the JBI Evidence Implementation Framework, which integrates clinical audit and feedback. Convenience sampling was used to select 50 adolescents and 20 health care staff (nurses and physicians). A baseline audit was used to evaluate existing compliance with best practice recommendations. After the implementation of improvement strategies, a follow-up audit was conducted to measure changes in compliance.

Results: The baseline audit revealed key barriers such as limited knowledge and confidence among health care staff regarding adolescent mental health screening, lack of a validated tool, and low engagement from adolescents to seek help. Strategies were developed, resulting in improvements across all criteria, including the screening of adolescents for mental health or psychosocial issues (34% to 74%); informing adolescents and family members of goals of screening, potential risks of screening, and use of a validated tool (0% to 50%, respectively); staff access to referral pathways (5% to 80%); and knowledge of follow-up and treatment monitoring (5% to 65%).

Conclusions: Improvements were achieved after the implementation of improvement strategies. Additional training and follow-up will be needed to further improve results and consolidate practices.

Spanish abstract: http://links.lww.com/IJEBH/A535.

Introduction: Sedation assessment is essential in the management of agitation in ICU patients. Inadequate sedation or oversedation can increase complications, prolong hospital stay, and increase mortality. Correct sedation assessment can reduce the incidence of risk events resulting from inappropriate assessment.

Objectives: This project aimed to promote evidence-based practices for sedation assessment in critically ill patients under mechanical ventilation in the ICU.

Methods: This project was conducted in the comprehensive ICU on two campuses of a tertiary A hospital in Wuxi, Jiangsu Province, China. The project followed the seven-phase JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. Four evidence-based audit criteria were derived from a JBI Best Practice Evidence Summary. Five barriers to best practice were identified and strategies were implemented to improve sedation assessment. Finally, a follow-up audit was conducted to measure changes in compliance with best practices.

Results: Project participants included 60y mechanically ventilated patients and 55 health care workers. The results of the follow-up audit showed that compliance with the four audit criteria significantly improved. Notably, compliance for Criterion 1 increased from 0% to 90%, while Criterion 2 and Criterion 4 increased from 86.67% and 72.73% to 100%, respectively. Compliance for Criterion 3 increased from 26.67% to 93.33%.

Conclusion: The strategies of optimizing intelligent information systems, updating nursing documents, leadership, training, and continuous quality control were helpful in implementing best practice recommendations.

Spanish abstract: http://links.lww.com/IJEBH/A509.