Jbi Evidence Implementation最新文献

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.

Introduction: The aged care sector is undergoing significant reform and innovation. The successful implementation of innovations requires effective strategies, tailored to address the particular barriers and enablers experienced by individuals in their own context.

Aim: This study aimed to identify key factors relating to individuals' attitudes and capabilities that influence implementation in aged care.

Methods: This study provides an in-depth, inductive qualitative content analysis of the literature included in a recent comprehensive scoping review on the implementation of innovations in aged care.

Results: Attitude and capability factors were frequently identified as influencing implementation in aged care, as either barriers or enablers. Attitudes held by staff were predominant, and were primarily related to the innovation as well as the change process. Attitudes included resistance, concern, and defensiveness as well as enthusiasm, motivation, and a growth mindset. The beliefs that underpinned attitudes primarily related to the benefits associated with the innovation as well as perceived fears and threats, need/relevance, difficulty, enjoyment, and conflict. Capability factors largely related to staff knowledge of the innovation, background knowledge, and relevant skills as well as clarity of role-related responsibilities. The generally low skill level of the aged care workforce was also a factor, as were the capabilities of older people/clients.

Conclusions: Attitudes and capabilities are key factors that can influence implementation, particularly those held by staff as well as other stakeholders. Identifying and monitoring stakeholders' attitudes, underlying beliefs, and capabilities enables the selection of appropriate implementation strategies to optimize the successful introduction and sustainment of innovations to improve care for older people.

Spanish abstract: http://links.lww.com/IJEBH/A373.

Introduction: The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia.

Objectives: The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community.

Methods: The project followed the JBI Model of Evidence-based Healthcare and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance.

Results: This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome.

Conclusions: Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study.

Spanish abstract: http://links.lww.com/IJEBH/A294.

Background: The Mobile Inpatient Care at Home (MIC@Home) initiative was implemented as a promising solution to address challenges brought about by rising demand for hospital services due to an aging population. This initiative leveraged technology and remote care delivery.

Aim: To explore key strategies for the effective expansion of MIC@Home in Singapore.

Methods: This study examined local qualitative insights reported in the literature and explored the implementation and policy implications through the Policy Labs method. Thirty-two clinicians, administrators, and policymakers participated in the study. Data were collected through facilitated discussions in three Policy Lab sessions. The findings were analyzed and key strategies were identified to prioritize plans for implementation improvements and policy redesign.

Results: The priorities that would aid in upscaling MIC@Home in Singapore included (1) policy redesign: optimize manpower, shift stakeholder mindsets, enhance third-party providers, and integrate mainstream financing options to support effective implementation; (2) guidelines and clinical operations: emphasize innovative IT solutions for triage, quality-focused training programs, operational efficiency through standardized protocols, nationalized logistics, and collaboration across MIC@Home clusters; and (3) leadership and governance: advocate a clear mandate to establish professional societies for accreditation and create a balanced governance structure that addresses MIC@Home's unique complexities.

Conclusion: This study offers valuable insights into the challenges and strategies affecting the MIC@Home model's scalability, highlighting critical areas for implementation and policy redesign. By addressing the identified challenges through targeted strategies, Singapore can champion the MIC@Home model as a viable and sustainable alternative to traditional inpatient care.

Spanish abstract: http://links.lww.com/IJEBH/A340.