Jbi Evidence Implementation最新文献

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: Peripheral central venous catheters are common vascular access devices used in patients with tumors. To prevent catheter shedding and displacement, it is essential to use medical adhesives to secure the catheters. Repeated adhesion and removal of medical adhesives can weaken the barrier function of the skin, leading to medical adhesive-related skin injuries (MARSI), which can increase the patients' pain and medical expenses.

Objectives: The objective of this project was to utilize the best evidence to prevent and manage MARSI in tumor patients with peripheral central venous catheters.

Methods: This evidence-based audit and feedback project was theoretically informed by the JBI Evidence Implementation Framework. The framework involves seven phases in which a project team was established; measurable criteria were selected; baseline data were collected; improvement strategies were implemented to address gaps in compliance; a follow-up audit was conducted to assess improvements in compliance; and sustainability measures were considered. The project also used the JBI Practical Application of Clinical Evidence System (PACES) for project management, including data collection and analysis. The JBI Getting Research into Practice (GRiP) approach was also used to support implementation and compliance.

Results: In the baseline audit, the compliance rate for the nine audit criteria was low. In the follow-up audit, the compliance rate significantly improved, with each audit criterion exceeding a minimum of 80%, and four audit criteria reaching 100%. Knowledge of MARSI among nurses and patients significantly improved (p  < 0.05) and the incidence of MARSI among patients with peripheral central venous catheters decreased.

Conclusions: This project successfully enhanced nurses' compliance with MARSI prevention and management and increased the knowledge and skills of both nurses and patients about MARSI.

Spanish abstract: http://links.lww.com/IJEBH/A285.

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.

Introduction: Uptake of virtual care solutions in primary care settings has increased exponentially, and current evidence suggests high patient satisfaction but mixed clinician views.

Aims: This paper aimed to identify factors influencing its' implementation to support delivery to the right patient, in the right clinical context, at the right time. Further, this paper evaluates how the updated Consolidated Framework for Implementation Research (CFIR) can be used to assess these factors that contribute to the uptake of virtual care innovations.

Methods: This systematic scoping review identified empirical research on factors influencing the uptake of virtual care solutions in the Australian primary care setting. Searches were undertaken in Embase, PubMed, Scopus, and Web of Science. The CFIR was used to code factors influencing the implementation of virtual care solutions. Inductive coding was used to generate new constructs where no appropriate CFIR construct could be identified.

Results: Fourteen eligible studies were identified as eligible for inclusion. Five common influencing factors were identified. Three are from the existing CFIR framework, and two are newly developed constructs. CFIR constructs included innovation relative advantage, capability, and IT infrastructure. New constructs included accessibility and suitability. A further six new constructs were identified (trust, privacy, governance, unintended consequences, preference, and choice) but these were not prominently mentioned.

Conclusions: Common factors influence virtual care uptake in Australian primary care. The CFIR assisted in conceptualizing these but was not sufficient for capturing factors unique to virtual care. Newly developed constructs are noted to be of importance in the literature, but further research is needed to understand whether they are applicable in multiple contexts.

Spanish abstract: http://links.lww.com/IJEBH/A286.

Introduction: Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments.

Objectives: This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting.

Methods: This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project.

Results: Compliance for Criterion 1 (patient education) increased from 0% to 60% ( p  < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% ( p  < 0.001).

Conclusions: The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation.

Spanish abstract: http://links.lww.com/IJEBH/A284.

Introduction: Falling out of bed is the most common unintentional cause of injury among patients and is a major safety problem in health care facilities. Current practices for fall prevention may not always be aligned with established best practices, leading to variability in patient outcomes. This uncertainty underscores the need to assess and improve compliance with best practice guidelines for fall prevention.

Objectives: This project aimed to improve fall prevention in the surgical ward of a general hospital in Tabriz, Iran.

Methods: This study was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted using eleven audit criteria representing best practices for fall prevention. After the implementation of improvement strategies, a follow-up audit was conducted to evaluate changes in practice.

Results: The results revealed significant improvements, notably, fall risk assessment upon admission (87% to 92%), fall risk assessment upon ward transfer (39% to 79%), patient participation in fall risk assessment (26% to 68%), reassessment upon change in condition (53% to 74%), communicating fall prevention information to at-risk patients and their families/caregivers (42% to 63%), engagement of patients (100% to 100%), implementation of targeted strategies (89% to 92%), post-fall assessment and interventions (82% to 87%), revising patient fall risk status and reviewing care management plan (41% to 74%), fall prevention information to patients and their families/caregivers upon discharge (44% to 66%), and person-centered education of health care professionals (77% to 81%).

Conclusion: The use of standard clinical audit tools in hospitals can improve the quality of patient care and increase the effectiveness of interventions by identifying weaknesses in the patient care process.

Spanish abstract: http://links.lww.com/IJEBH/A283.

Introduction: More than 80% of patients experience post-surgical pain. Poor pain control decreases patients' quality of life; increases associated comorbidity, hospital length of stay and hospital costs; and delays functional recovery. Implementing evidence-based recommendations improves these negative factors as well as the patient's quality of life.

Objectives: This evidence implementation project aimed to improve post-operative pain management by implementing best practice recommendations.

Methods: This project used the JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. The project was conducted in the surgical unit of a tertiary hospital in Ciudad Real, Spain. We performed a baseline audit and two follow-up audits to measure audit criteria derived from a JBI evidence summary on pain management. A total of 30 surgical patients took part. We assessed the results of the baseline audit, identified the barriers to best practice, and implemented strategies to improve post-operative pain management.

Results: The first follow-up audit revealed an improvement in practice; however, these results worsened due to the delay in protocol approval and subsequent lack of staff motivation. The second follow-up audit showed greater compliance with best practices, although considerable room for improvement remains.

Conclusions: Implementing evidence-based practices in health care improved nurses' clinical practice. The health care staff complied with the recommendations more readily since they associated the best practices with a clear benefit for the patient.

Spanish abstract: http://links.lww.com/IJEBH/A276.

Introduction: Falls are the main cause of disability among psychiatric patients, as well as being the most common adverse event in hospitals.

Aim: The aim of this evidence implementation project was to improve fall prevention and management among psychiatric patients in a neurology ward in an Iranian tertiary psychiatric hospital.

Methods: This project used the JBI Evidence Implementation Framework, which recommends an audit, feedback, and re-audit strategy. A baseline audit was conducted to evaluate current fall prevention practices among 50 psychiatric patients and 20 health care professionals. The baseline audit was used to identify gaps in compliance. After the implementation of improvement strategies, a follow-up audit was conducted to measure any changes in practice.

Results: The baseline and follow-up audits revealed that compliance with best practices improved in ward transfer fall risk assessment (Criterion 2: 87% to 90%), patient participation in fall risk assessment (Criterion 3: 95% to 96%), revising patient fall risk status (Criterion 9: 50% to 86%), and person-centered education of health care providers (Criterion 11: 78% to 96%). Other audit criteria remained unchanged. However, for Criterion 6 on patient engagement in goal-setting and treatment planning, compliance dropped from 100% at baseline to 94% at follow-up.

Conclusions: This project successfully increased evidence-based practices regarding fall prevention and management, as well as providing mechanisms for sustaining the practice changes. Future audits are required to further improve outcomes.

Spanish abstract: http://links.lww.com/IJEBH/A267.

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.

Objectives: The aim of this project was to improve the self-management of diabetes among elderly residents in a Belgian home for the aged.

Introduction: Diabetes is a common chronic condition with significant comorbidity. Incidence is increasing, but a third of patients with diabetes are unaware that they have the disease. The treatment of diabetes requires a multifactorial approach. Treatment guidelines on diabetes recommend involving patients in monitoring their condition because supported self-management improves daily glycemic control.

Methods: This evidence implementation project used the JBI Evidence Implementation Framework, which follows three phases. In the first phase, the area of change, stakeholders' role, and practice context and readiness for change are investigated. In the second phase, a baseline audit is conducted to compare current practice with best practice. Strategies are then implemented to address any areas of non-compliance with best practice. In the third phase, a follow-up audit is conducted to evaluate changes in practice.

Results: At baseline, six criteria had 0% compliance, two criteria had compliance lower than 50%, and only 49% of health care workers were familiar with the procedure for hypoglycemia treatment. Improvement strategies included creating awareness among health workers. In the follow-up audit, one criterion improved from 0% to 100%, three criteria improved from 0% to 85%, two criteria reached the threshold of 50% compliance, and one criterion reached 19%. Further audits are needed to ensure sustainability.

Conclusions: This project improved diabetes self-management in elderly people living in a Belgian home for the aged. An in-depth planning phase with internal facilitation and interdisciplinary collaboration between all co-workers addressed barriers related to quality systems, structure, communication, and education.

Spanish abstract: http://links.lww.com/IJEBH/A258.