Jbi Evidence Implementation最新文献

Introduction: The efficient and effective management of gastrostomy patients should be based on best practices.

Objective: This project aimed to improve gastrostomy management in a semi-intensive care unit of a private hospital in São Paulo, Brazil.

Methods: This study followed the JBI Evidence Implementation Framework. The JBI approach to evidence implementation is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted to measure current practices against recommended best practices. Feedback from the audit was used to identify barriers and design implement strategies to improve practice. A follow-up audit was then conducted to measure changes in compliance with best practices.

Results: The baseline audit involved an evaluation of 33 nurses and 90 nursing technicians, as well as 10 gastrostomy patients. The follow-up audit evaluated 37 nurses and 80 nursing technicians, as well as 10 gastrostomy patients. The follow-up audit revealed that compliance increased to 90% for three of the eight criteria. For the remainder, it varied between 20% and 50%.

Conclusion: The baseline audit and feedback strategy led to improved compliance in five of the eight criteria. Future audits will be necessary to maintain these results.

Spanish abstract: http://links.lww.com/IJEBH/A259.

Introduction: Operating room pressure injuries (ORPIs) serve as a critical measure of health care quality.

Objective: The aim of this project was to reduce incidence of ORPIs in an operating room of a medical center in eastern Taiwan by promoting evidence-based strategies.

Methods: This project was conceptually informed by the JBI Model of Evidence-based Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. Within the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance, develop an implementation strategy responsive to gaps in compliance, and undertake a final evaluation to measure changes in compliance to evaluate the impact of our project. The JBI software, PACES, and JBI's situational analysis method, GRiP, were used to support data collection and implementation planning. There were five evidence-based criteria; our sample size was 30 patients for each criterion. The team carried out the project from March to July 2024.

Results: After implementing the strategies, the average knowledge test score for the prevention of ORPIs among nurses rose from 40 to 100. Compliance of patients with prevention management of ORPIs using evidence-based guidelines reached 100%, while the incidence of ORPIs decreased from 1.31% to 0.34%.

Conclusions: ORPIs are a crucial medical care quality indicator in hospital. In our project, through multidisciplinary collaboration, innovative experiential learning methods, and a virtual nurse application, it was possible to enhance the knowledge and compliance of nurses in terms of reducing ORPIs.

Spanish abstract: http://links.lww.com/IJEBH/A364.

Introduction: Implantable venous ports (IVPs) are widely used in patients with cancer for administering intravenous medications and fluids. Inadequate IVP care increases the risk of occlusion or infection, necessitating IVP removal.

Aim: This project aimed to improve nurses' IVP management in oncology patients by implementing evidence-based recommendations.

Methods: The project was conducted in a medical center in Taiwan. Using the JBI Evidence Implementation Framework, four audit criteria were developed to conduct baseline and follow-up audits. Nurses' IVP care skills and compliance were evaluated through an objective structured clinical examination (OSCE) and bedside observations. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers and design strategies for project planning and implementation. To address these barriers, nurses were given IVP training (through videos), which enabled them to provide appropriate IVP care at the bedside.

Results: Although 62.5% of the nurses had received training on IVP care before project implementation, only 18.8% passed the OSCE. The nurses neither administered topical local anesthetics nor implemented measures to minimize patient discomfort before or during IVP needle insertion. Moreover, nurses did not use normal saline to flush and lock IVPs when not in use, as recommended by best practices. After project implementation, compliance with all four audit criteria increased to 100%. No episodes of occlusion were reported. Furthermore, the IVP infection rate markedly decreased from 8.45‰ to 2‰.

Conclusion: Proper IVP management skills are important for oncology nurses in providing good quality of care and preventing IVP infection. Nurse practitioners can play a key role in developing evidence-based care protocols and addressing barriers to IVP care in clinical settings. The evidence-based video training and bedside observations successfully improved oncology nurses' competence and compliance with best practices for IVP management.

Spanish abstract: http://links.lww.com/IJEBH/A408.

Introduction: Although health care agencies are encouraged to use quality improvement (QI) initiatives to improve quality of care, the ethical integrity of such initiatives has received little attention.

Objective: This project aimed to develop and evaluate key criteria to operationalize the Assessment of the Ethical Integrity of QI Studies (AEGIS).

Methods: The study used a four-phase sequential mixed methods design, comprising (i) a systematic mapping study to identify [Phase I] and map [Phase II] preliminary criteria against international ethical guidelines; (ii) an e-Delphi study to reach consensus on the transformed AEGIS criteria [Phase III]; and (iii) a psychometric evaluation to assess the utility and reliability of the AEGIS criteria [Phase IV].

Results: Phase I identified 23 preliminary AEGIS criteria, which were mapped against 18 ethical guidelines/statements [Phase II]. No statements were mapped to the five levels of ethical review; 0%-61.5% were mapped to four criteria for ethical review exemption; 15.4%-30.8% were mapped to seven triggers for ethical review; and 69.2%-100% were mapped to seven ethical principles. Preliminary criteria were transformed into 18 criteria, with a Delphi panel reaching > 70% consensus on all criteria [Phase III]. A panel of international experts tested the AEGIS tool against five randomly selected publications of QI activities [Phase IV], demonstrating that the tool had good internal consistency (α = 0.734), moderate interrater reliability (κ = 0.481), and good utility.

Conclusions: The 18-item AEGIS tool demonstrated excellent face and content validity, good internal consistency and utility, moderate interrater reliability, and broad application and international relevance. Thus, the AEGIS tool represents an important step toward improving the ethical conduct and integrity of QI projects.

Spanish abstract: http://links.lww.com/IJEBH/A451.

Introduction: Patients with breast cancer are 50% more likely to experience sleep disturbances during treatment. Sleep disturbances may affect physiological and psychological functions and even induce cancer recurrence. Screening, assessment, and management of sleep disturbances improves sleep quality in breast cancer patients.

Objectives: This project aimed to establish a care process for breast cancer patients with sleep disturbances in a cancer ward.

Methods: The project was implemented using the JBI Evidence Implementation Framework, which is grounded in audit and feedback. A baseline audit examined the existing care for sleep disturbances in breast cancer patients undergoing chemotherapy. Eight criteria were applied to evaluate compliance with best practice recommendations. A JBI Getting Research into Practice (GRiP) analysis was conducted, and five barriers to recommended practices were identified. Fourteen improvement strategies were then implemented and a follow-up audit was conducted to measure changes in practice.

Results: The baseline audit showed that the sleep screening rate was 71% (Criterion 1). However, for the remaining criteria (2-8), the compliance rate was 0%. After project implementation, all criteria improved. Thus, 100% of nurses received education on sleep disturbance; the screening rate increased to 90%; 100% of screened patients received comprehensive sleep assessment; and 100% of assessed patients received tailored, multimodal sleep management based on their assessment results.

Conclusions: This project improved compliance with evidence-based practices in caring for breast cancer patients with sleep disturbances. Process orientation, interdisciplinary collaboration, and leadership contributed to project success. Further studies in digitalized sleep assessment are needed to ensure the efficiency and sustainability of sleep care.

Spanish abstract: http://links.lww.com/IJEBH/A300.

Abstract: Inadequate sustainability of health care innovations or evidence-based interventions has led to calls from policymakers, researchers, and funders for research on how sustainability can be optimized to avoid research waste. In this discussion paper, we argue that research on health care innovation sustainability needs to be advanced. We critically examine the literature on the concept of sustainability and propose that research should address the fundamental question: How can we advance knowledge on health care innovation sustainability? We provide examples of important work undertaken in the field of implementation science, including definitions and conceptualizations of sustainability. We also highlight theories, models, and frameworks that have been proposed to inform sustainability research and guide how to plan for sustainability. Our analysis of the literature reveals a growing interest in the sustainability of health care innovations but also confirms that implementation science has yet to put sustainability at the center of its research endeavors. To assist this shift, we identify priority research gaps and use the United Nations 2030 Agenda for Sustainable Development as a road map for an implementation science research agenda to drive health care innovation sustainability. We propose three new research directions that, overall, aim for "better health for all, leaving no one behind." These directions include: (1) advancing substantive research on sustainability while avoiding duplication; (2) identifying barriers, facilitators, and strategies to sustain engagement with multiple partners; and (3) advancing methods and tools to support monitoring, evaluation, and revision of strategies over time.

Spanish abstract: http://links.lww.com/IJEBH/A323.

Abstract: Implementation science has been gaining traction over the last decade to support health care systems in adopting and sustaining evidence-based interventions, programs, and policies. Given the inherent complexity of implementation research and practice, and their associated methodologies, implementation scientists play a central role in translating research into practice. However, many health care system stakeholders often struggle to understand how best to collaborate with implementation scientists. This commentary discusses the significant benefits of such collaboration, outlining ten critical actions drawn from the collective experience of 25 implementation scientists with over 173 years of combined expertise. This project was conducted under the SPHERE Implementation Science Platform, as part of the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE).The ten recommendations for working with an implementation scientist to optimize implementation efforts include the following: (1) involve implementation scientists early during intervention design, (2) recognize the unique nature and value of implementation science data, (3) integrate implementation assessments into the research plan, (4) foster collaborative partnerships inclusive of implementation science, (5) differentiate between factors affecting implementation and wider constraints, (6) work with implementation scientists to address implementation challenges, (7) prioritize implementation scale and sustainment, (8) embrace that implementation requires continuous learning and adaptation, (9) promote knowledge exchange between implementation science and subject matter experts, and (10) focus on capability- and capacity-building for implementation within the system. By following these recommendations, researchers, clinicians, decision-makers, and implementation scientists can foster impactful collaborations that enhance the translation of research into clinical practice and improve the quality of health care delivery.

Spanish abstract: http://links.lww.com/IJEBH/A374.

Introduction: Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting.

Objective: The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention.

Methods: The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies.

Results: The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention.

Conclusions: This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future.

Spanish abstract: http://links.lww.com/IJEBH/A261.

Introduction: The occiput-posterior (OP) fetal position is the most frequent form of labor dystocia. This position has been associated with delaying the second stage of labor and adverse outcomes.

Objectives: This project aimed to improve the quality of intrapartum care provided by midwives for OP fetal positions during the second stage of labor.

Methods: This best practice implementation project was conducted at the Río Hortega University Hospital in Valladolid, Spain. The project followed the JBI Evidence Implementation Framework, which is based on an audit, feedback, and re-audit process. Current practices were compared against best practices in a baseline audit using 13 audit criteria. Barriers to compliance with best practices were identified and improvement strategies were implemented. An initial follow-up audit was carried out after 4 months to avoid secondary bias. After another 4 months, a second follow-up audit was conducted. Data were collected and compared using the JBI Practical Application of Clinical Evidence System (JBI PACES).

Results: The results revealed an improvement in all structure criteria (1-3), five of the process criteria (4-6, 8, 10), and all results criteria (11-13). One process criterion (8) reached maximum compliance in all audits. A key finding was the inadequate recording of upright positions (criterion 7) and the interpretation of cardiotocography (criterion 9).

Conclusions: Evidence-based interventions for managing OP labor improved the quality of care and underlined the importance of ongoing training for midwives. Additional studies are required on positions and fetal monitoring during labor.

Spanish abstract: http://links.lww.com/IJEBH/A279.