Jbi Evidence Implementation最新文献

Introduction: Ward rounds are crucial inpatient activities during which patients' conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results.

Methods: An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out.

Results: The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, "best medical therapy" rates, and inpatient complications. A statistically significant improvement in nurses' confidence to lead discussions during medical rounds was also observed ( p  = 0.026).

Conclusions: This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses' confidence in team communication, bolstering their ability to provide high-quality patient care.

Introduction and objectives: Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day.

Methods: A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice.

Results: Compliance increased in the use of the short swallow screening tool, rising from 64% ( n  = 25) in the baseline audit to 71% ( n  = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n  = 12) to 86% ( n  = 12). All patients ( n  = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n  = 7) at pre-implementation.

Conclusions: This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.

Background: A gap exists between scientific discovery and implementation and adoption of research findings in healthcare and public health practice. This gap is due to the fact that research on treatment efficacy and safety in clinical trials ends prematurely with the publication of results, leaving a lack of knowledge of treatment effectiveness in real-world clinical and community settings. Comparative effectiveness research (CER) can facilitate the translation of research findings, reducing the gap between discovery and adoption into practice. Getting CER findings to patients and healthcare providers requires efforts to disseminate and train providers to successfully implement and sustain change in the healthcare setting. Advanced practice registered nurses (APRNs) are instrumental in the implementation of evidence-based research in primary care settings and an important group to target for the dissemination of research findings. There are numerous implementation training programs, but none focus specifically on APRNs.

Objective: The objective of this article is to describe the infrastructure established to develop a 3-day implementation training program for APRNs and an implementation support system.

Method: A description of the processes and strategies is provided, including stakeholder engagement through focus groups and the formation of a multistakeholder program planning advisory team, which includes APRNs, organization leaders, and patients. The program also includes curriculum development and program planning as well as the development of an implementation toolkit.

Results: Stakeholders were instrumental in shaping the implementation training program, including the content of the curriculum and the program agenda. In addition, the unique perspective of each stakeholder group contributed to the selection of the CER findings disseminated through the intensive training program.

Conclusion: It is important that strategies to address the lack of implementation training opportunities for APRNs be discussed and disseminated within the healthcare community. This article discusses the plan to address implementation training for APRNs through the development of an implementation curriculum and toolkit for APRNs.

Introduction and aims: The aim was to explore clinical decision support (CDS) use in the practice of primary healthcare nurses. The objectives were to recognize to what extent nurses (registered nurses, public health nurses, and practical nurses) use CDS, what factors were associated with the CDS used, what kind of organizational support nurses need, and what were nurses' views about CDS development needs.

Methods: The study was conducted with a cross-sectional study design, using an electronic questionnaire developed for this purpose. The questionnaire contained 14 structured questions and nine open-ended questions. The sample consisted of randomly selected primary healthcare organizations ( N  = 19) in Finland. Quantitative data were analyzed using cross-tabulation and Pearson's chi-squared test, and qualitative data with quantification.

Results: A total of 267 healthcare professionals (age range 22-63 years) volunteered to participate. Participants were mainly registered nurses, public health nurses, and practical nurses (46.8, 24, and 22.9%, respectively). Overall, 59% of the participants had never used CDS. The majority (92%) found it necessary to develop nursing-specific content for CDS. The most commonly used features were medication recommendations and warnings (74%), reminders (56%), and calculators (42%). Half of the participants (51%) had not received training on the use of CDS. The older age of participants was associated with the feeling of not having enough training to use CDS ( P  = 0.039104). Nurses felt that CDS was helpful in their clinical work and decision-making, promoting evidence-based practice, and narrowing the research-into-practice gap, improving patient safety and the quality of care, and helping those who are new in their work.

Conclusion: CDS and its support structures should be developed from a nursing perspective to achieve the full potential of CDS in nursing practice.

Objective: To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department.

Methods: A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different methods of fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time, and 28-day mortality rate of the two groups were observed. The hemodynamic indices, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and complications of the two groups before and after treatment were compared.

Results: After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in both the improved and control groups.

Conclusion: Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve hemodynamics, reduce the incidence of ARDS, and prevent patient deaths. It is worthy of clinical application.

Introduction and aims: Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis, and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously affects the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC.

Methods: This evidence-based audit and feedback project was implemented using a three-phase approach at a third-class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria derived from the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit to assess the results of the interventions implemented to improve practice.

Results: After evidence application, the compliance rate for audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate for audit criterion 2 increased from 0% to 100%. The compliance rate for audit criterion 3 increased from 22 to 62%. The compliance rate for audit criterion 4 increased from 88 to 100%. The compliance rate for audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate for audit criterion 6 increased from 0 to 55%.

Conclusion: Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.

Objectives: The objective of this project was to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to the intrapartum unit.

Introduction: Hypertension during pregnancy has been associated with adverse maternal and fetal outcomes. Ongoing evaluation and nursing care are key in the prevention of complications resulting from hypertensive disorders in pregnancy.

Methods: The implementation of this best practice project was guided by the JBI Model of Evidence-based Healthcare and used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to an intrapartum unit. Eight audit criteria that were representative of best-practice recommendations for nursing assessment of pregnant women with hypertensive disorders were used. A baseline audit was conducted, followed by the implementation of multiple strategies that were determined by the key stakeholders. The project was finalized with a follow-up audit to determine a change in compliance with best-practice recommendations.

Results: Baseline audits revealed an average 45% compliance rate with the eight best practice audit criteria. An on-site simulation event, which included a nursing assessment of normal and abnormal lung sounds along with the hands-on practice of deep tendon reflexes, was provided by project members. Evidence-based assessment guidelines were presented and reviewed with all participants. Input from the nursing staff was gathered regarding current documentation practices and electronic health record accessibility. As a result, an electronic health record change was requested, and improvements in nursing practice were observed for five of the eight audit criteria. Follow-up audits revealed an average compliance rate of 73% for all eight audit criteria, a 28% improvement.

Conclusion: Continuing nursing education and ongoing competency refreshers can affect the quality of client care and outcomes by offering occasions to improve or strengthen clinical expertise and proficiency. For this project, the simulation training event improved nursing staff compliance with best practices.

Introduction and aims: Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder management strategies for perinatal women at a maternity hospital in Taiwan.

Methods: The project was implemented using the JBI framework and the JBI Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intrapartum and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to changing practice.

Results: A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from 37% and 50% to 100% for criteria 1 and 2, respectively; from 0% to 100% for criteria 3, 5, and 10; and from 7%, 28%, 50%, and 17% to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively.

Conclusions: This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project.

Objective: This study assessed compliance with the best practices for pressure injury prevention among ICU patients at a tertiary hospital in São Paulo, Brazil.

Introduction: Intensive care patients are at high risk of developing a pressure injury; preventing this requires a best practice protocol.

Method: This best practice implementation project was conducted in a Brazilian tertiary hospital in three phases following the JBI Model of Evidence-based Healthcare. Ten criteria derived from the best available evidence were audited and monitored before and after best practice implementation.

Results: The baseline and follow-up audits evaluated 28 patients at each step. A total of 448 h of care were analyzed using a monitoring camera and medical records. Compliance with all 10 audited criteria increased, with a 50% reduction in the prevalence of pressure injuries in intensive care. Of the 223 employees, 71% claimed to have some knowledge of pressure injury prevention, and 66% reported adequate adherence to prevention protocols.

Conclusion: The audit and feedback strategy improved compliance with the criteria. Future audits are needed to promote the sustainability of evidence-based practice.