Jbi Evidence Implementation最新文献

Introduction and objectives: Health care providers need a high level of communication skills in dealing with pediatric patients and their carers. The objective of this project was to evaluate current practice and implement best practices promoting health care provider communication with pediatric patients and carers in a children's hospital in Tabriz, Iran.

Methods: This project used the JBI Model of Evidence-Based Healthcare, which guided the conceptualization of evidence implementation, context analysis, project implementation, and evaluation of outcomes using evidence-based quality indicators. An audit and feedback strategy was adopted to measure baseline compliance with best practices, develop strategies to address areas of non-compliance, and conduct a final audit to measure any changes in compliance. Four criteria were developed for the baseline and follow-up audits. Criteria 1 and 2 were evaluated using a sample of 30 health care providers, while Criteria 3 and 4 were evaluated using a sample of 80 pediatric patients and carers.

Results: All four criteria improved at the end of the project. Criterion 1 (health care staff receive communication skills training) had the highest mean score at baseline and follow-up (63% and 83%, respectively). Criterion 2 (implementation of local strategies by health care organizations) increased from 45% to 55%. However, this rate of improvement was the lowest of all the criteria. Criterion 3 (pediatric patients receive relevant education) improved from low to moderate, rising from 18% to 49%. A more significant improvement was noted for Criterion 4 (parents receive relevant education), which rose from 19% to 56%.

Conclusions: The strategies implemented in this project successfully improved health care provider communication with pediatric patients and their carers. To ensure project sustainability, repeat audits will be conducted after 3, 6, and 12 months.

Spanish abstract: http://links.lww.com/IJEBH/A199.

Introduction: Miltefosine is a new drug that was recently approved for the treatment of tegumentary leishmaniasis (TL) by the Brazilian health system. It has a teratogenic potential and requires follow-up of patients undergoing treatment. Improving compliance with best practices is essential to ensure the safe and appropriate use of this drug.

Objective: This project aimed to implement best practices for the safe and appropriate use of miltefosine in the treatment of TL in the state of Minas Gerais, Brazil.

Methods: This project was guided by the JBI Evidence Implementation Framework. Five best practice criteria were established based on the best available evidence. A baseline audit was conducted to measure current practice against best practice. Barriers to best practice were then identified and a follow-up audit was conducted to evaluate changes after the implementation of improvement strategies. Two sites were analyzed: a leishmaniasis reference service in Belo Horizonte, the capital of Minas Gerais, and 28 regional offices.

Results: The baseline audit evaluated data from 197 miltefosine requests distributed across 13 regional sites. All requests from the reference service were compliant (100%). This is in contrast to the 60% compliance rate at the regional offices. The improvement strategies included intensifying direct communication with the regional health professionals, which increased the average compliance rate to 79.5%, 6 months after the interventions were introduced.

Conclusion: This best practice implementation project effectively increased the compliance rate for the audited procedures. Communication from the reference site with the regional health professionals successfully increased compliance with best practices and promoted the safe and appropriate use of miltefosine. These strategies should analyzed and applied to improve other programs.

Spanish abstract: http://links.lww.com/IJEBH/A184.

Introduction: Evidence-informed decision-making (EIDM) plays a vital role in public health practice. Canada has invested in support for evidence-informed approaches in public health. Despite growing expectations for EIDM, evidence integration has not been thoroughly evaluated.

Objective: This study explores EIDM within Canadian public health organizations before the COVID-19 pandemic. A secondary objective is to explore how EIDM in public health was affected by the COVID-19 pandemic.

Methods: Using a qualitative descriptive approach, data were collected and analyzed from interviews with public health professionals across Canada.

Results: From interviews with 20 participants in four Canadian provinces and one territory, all participants noted that EIDM was valued, but there was considerable variation in implementation. Participants reported differences in consistency of evidence use, resources available at their public health organizations to support EIDM, and staff knowledge and skills in EIDM. Leadership emerged as a strong influencer of EIDM; however, leadership investment in EIDM varied. Changes in evidence use during the COVID-19 pandemic revealed an urgency for decision-making amidst an influx of evidence and reallocated staff roles.

Conclusions: Despite gains in the recognized value of EIDM, gaps remain in the integration of evidence into decision-making and adequate resource investment to support EIDM. Time, resources, and skills to adapt processes and implement EIDM are needed for public health organizations in Canada to fully integrate EIDM into all aspects of public health decision-making.

Spanish abstract: http://links.lww.com/IJEBH/A249.

Objectives: The project aimed to assess health visitors' concordance with evidence-based criteria regarding identification and support of postnatal depression in mothers receiving the health visiting service.

Introduction: Timely identification is critical to support mothers at risk of postnatal depression. Undetected and untreated postnatal depression can result in severe consequences for the mother's health, infant health and development, and well-being of the family as a whole. Due to their unique role of universal home visiting, health visitors are ideally placed to identify and support mothers, and evidence-based practice is key to positive outcomes.

Methods: A baseline audit was carried out using evidence-based audit and feedback informed by the JBI Model of Evidence-based Healthcare and guided by the seven-phase implementation framework, involving 12 health visitors and 60 health visiting records from one health board in Wales, UK. The first step involved project development and generating evidence. A baseline audit was completed and a training program on perinatal and infant mental health was implemented. Finally, a post-implementation audit was completed involving 6 health visitors and 30 health visiting records.

Results: Receiving training in perinatal and infant mental health resulted in an improvement in baseline audit results. Health visitor concordance with best practice guidelines increased, with three of the six criteria in the post-implementation audit reaching 100% concordance, and two other criteria increasing to 83% and 93%, respectively.

Conclusion: The implementation project achieved improvements in concordance with best practice recommendations for identifying and supporting mothers experiencing, or at risk of experiencing, postnatal depression.

Spanish abstract: http://links.lww.com/IJEBH/A293.

Introduction: Stroke patients frequently experience debilitating deficits, and some receive a. terminal diagnosis. Palliative care services are introduced to prioritize care, with the goal of improving quality of life. However, palliative care communication (PCC) is often delayed or used inefficiently with stroke patients.

Objectives: This project aimed to promote PCC evidence-based practices (EBPs) with stroke patients.

Methods: This project used the JBI Evidence Implementation Framework to improve compliance with PCC EBPs with stroke patients in a medical center in Mississippi, USA. Four EBPs were identified from a JBI evidence summary and used as audit criteria. A baseline audit was conducted to measure compliance of current practice with best practice. Barriers to EBPs were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine compliance changes.

Results: The baseline audit revealed 53% to 80% compliance with the four EBPs. Barriers to EBPs included lack of health care professionals' knowledge regarding EBPs; lack of PCC, miscommunication, or delayed PCC with patients regarding hospitalization timeline and quality of life; and no standardized documentation or location for PCC within the electronic health record. Improvement strategies included a PCC education program for health care professionals and a concise statement and validation checkbox to the "progress note" in the electronic health record to promote daily PCC with patients. The follow-up audit revealed 20% to 34% compliance rate improvement with EBPs.

Conclusions: Annual PCC training should be conducted for health care professionals. Implementing PCC through a multidisciplinary approach can promote more meaningful discussion and efficient decision-making, prioritizing patients' quality of life.

Spanish abstract: http://links.lww.com/IJEBH/A174.

Introduction: Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes.

Objective: This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care.

Methods: This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention.

Results: The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%.

Conclusions: The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices.

Spanish abstract: http://links.lww.com/IJEBH/A205.

Introduction: In the UK, the Royal College of Midwives and the Chartered Society for Physiotherapy advocate that women undertake early and effective pelvic floor muscle training (PFMT) during the childbirth period to reduce the incidence of urinary incontinence (UI).

Objectives: This project sought to assess and improve midwives' compliance with best practice recommendations for PFMT in a UK NHS maternity service, with the goal of improving PFMT for women.

Methods: This project used the JBI Evidence Implementation Framework and JBI's best practice recommendations for PFMT. Following a baseline audit of midwives' practice, the results were considered. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers and facilitators to improve compliance with recommendations. A follow-up audit was undertaken after the development of a revised continuing professional development (CPD) program for midwives on PFMT.

Results: The results showed improved compliance with all four audit criteria. Criterion 1 (midwives' engagement with PFMT) increased from 76% to 92%; Criterion 2 (PFMT during the antenatal period) rose from 50% to 92%; Criterion 3 (postnatal risk assessment for UI) rose from 45% to 67%; and Criterion 4 (PFMT for high-risk women during the postnatal period) increased from 49% to 92%.

Conclusion: Whilst this study presented some challenges in implementing evidence-based initiatives in a UK NHS maternity service, it also demonstrated that an audit approach can overcome these, thereby improving compliance with best practices. In this case, changes to a CPD PFMT program increased midwives' compliance with evidence-based practice criteria. In the future, when implementing change in the NHS system, consideration should be given to organizational and leadership factors. Further audits will need to be carried out to monitor practice and effect change.

Spanish abstract: http://links.lww.com/IJEBH/A322.

Aims: This project aimed to improve physicians' adherence to evidence-based practices regarding the selection and administration of intra-articular knee injections for patients with osteoarthritis. The project also aimed to empower patients by increasing their awareness of these evidence-based practices.

Introduction: In the management of knee osteoarthritis, intra-articular injections are commonly used when initial treatments prove inadequate. However, issues such as patients' demand for rapid relief and variability in physicians' familiarity with optimal practices often lead to suboptimal treatment decisions and potential adverse outcomes.

Methods: This project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Initially, physicians were surveyed on the topic under consideration, and hospital records were reviewed. Subsequently, targeted interventions were implemented, including briefings and the distribution of informative flyers.

Results: The baseline audit indicated low adherence with all audit criteria. Various parameters, such as adherence to best clinical practices, informed decision-making by patients, and the recommendation of alternative treatment modalities, were significantly lacking. Following the interventions, substantial improvements were observed, including higher rates of adherence to best clinical practices by physicians for multiple criteria, such as stepwise referral to conservative therapy options and the content of intra-articular injections.

Conclusions: Adherence to best clinical practices can be improved through educational briefings for physicians on the most current evidence-based treatment practices for injectable substances in knee osteoarthritis. The active engagement of patients, facilitated by informative flyers and physician assistance, contributed to better involvement in their treatment choices. However, the participation of health care institutions and providers as well as lifelong education practices may be necessary for more comprehensive and sustainable changes.

Spanish abstract: http://links.lww.com/IJEBH/A277.

Introduction: In health care, effective communication enhances teamwork and safety by minimizing adverse events. Evidence suggests that ongoing education should include communication skills training, as interprofessional communication relies on tools that facilitate seamless interaction.

Objective: This project aimed to improve communication practices among nurses in a long-term care unit by promoting evidence-based recommendations.

Methods: This project followed the seven phases proposed by the JBI Evidence Implementation Framework. This framework is grounded in an audit, feedback, and re-audit process, along with a structured approach to addressing barriers to compliance with best practices. JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) approach were also used.

Results: A baseline audit was conducted focusing on three audit criteria. Compliance was measured by observing 250 handovers and administering a questionnaire to 14 nurses. After analyzing the results, the nursing team identified barriers and designed strategies to promote change, such as educational sessions and a focus group. The results of the follow-up audit showed significant improvements across all criteria. Nurses received training in communication for Criterion 1, which improved from 0% to 78%. For Criterion 2, training in teamwork and conflict management improved from 21% to 50%. For Criterion 3, the use of a structured communication tool (ISBAR) during handovers improved from 43.6% to 91%.

Conclusions: The nursing team's involvement enabled effective change. Adapting ISBAR to a long-term care unit was an unexpected goal. The next objective is to refine and share it with similar units. Integrating communication training into health care institutions' priorities is crucial, and future audits will ensure sustainability.

Spanish abstract: http://links.lww.com/IJEBH/A295.