Jbi Evidence Implementation最新文献

Introduction: Quality improvement (QI) in health care involves systematic, data-driven approaches to enhance service quality, safety, and efficiency. Sampling is critical to ensure that data collection is feasible, contextually appropriate, and aligned with improvement goals. However, sampling methods in QI-often pragmatic and non-probability based-are inconsistently reported and poorly justified.

Aim: This scoping review, the first to address this topic, aimed to identify and synthesize sampling strategies, frameworks, and sample size considerations for QI initiatives, situating them within the broader evidence implementation and implementation science context.

Methods: This review followed the JBI methodology for scoping reviews and was registered in the Open Science Framework (osf.io/rs83a). Peer-reviewed and gray literature from 2000 to 2024 was searched for in PubMed, Web of Science Core Collection, and CINAHL Ultimate (EBSCOhost), as well as organizational websites (e.g., Institute for Healthcare Improvement, Agency for Healthcare Research and Quality, National Institute for Health and Care Excellence, and the World Health Organization). Sources offering conceptual, methodological, or theoretical insights into sampling in QI were included, while empirical QI studies were excluded. Two reviewers independently screened and extracted data, with findings synthesized narratively and in tables.

Results: Ten sources were included. Sampling in QI was primarily intended to support timely, relevant, and credible decision-making rather than statistical inference. Non-probability methods-particularly judgment, purposive, and convenience sampling-were dominant, valued for contextual fit and feasibility. Decisions were shaped by local constraints, perceived risks, and implementation stage. While limitations such as bias, generalizability, and unclear sample size guidance were acknowledged, few sources provided actionable frameworks.

Conclusion: The results indicate that QI sampling reflects a balance between pragmatism and statistical rigor. This highlights the need for clearer, fit-for-purpose guidance to support transparent, context-sensitive, and methodologically sound sampling decisions.

Introduction: The nursing management of intracranial hypertension in adult patients with severe brain injury is crucial for maintaining the stability of intracranial pressure, which ultimately improves patient outcomes.

Objectives: This project aimed to implement evidence-based practices for the nursing management of intracranial hypertension in adult patients with severe brain injury.

Methods: This evidence implementation project was conducted in a neurosurgery intensive care unit in a large tertiary hospital in Guangzhou, China. The project was guided by the JBI Evidence Implementation Framework, which is an audit and feedback model with seven stages. The Ottawa Model of Research Use was used to identify barriers and facilitators to best practices and to develop improvement strategies.

Results: Thirty-three nurses and 50 patients with severe brain injury participated in the baseline and follow-up audits. After project implementation, follow-up audits revealed significantly improved compliance with best practices compared with baseline. Nurses' awareness of best practices increased (41% to 96%); nursing assessment, monitoring, and interventions related to intracranial hypertension rose significantly (from 82%, 75%, and 59% to 98%, 84%, and 87%, respectively); and patients' optic nerve sheath diameter was notably lower (6.002±0.677 mm to 5.698±0.730 mm).

Conclusions: The systematic integration of consistent training and education, together with the refinement of care processes and the creation of relevant tools, led to a significant improvement in awareness and adherence to best practices. Further testing of this program in more hospitals is needed.

Spanish abstract: http://links.lww.com/IJEBH/A243.

Introduction: Ambulatory care settings are at high risk for errors when identifying patients and matching them to their intended care.

Objective: The objective of this project was to improve correct and consistent patient identification and matching to their intended care by nurses in ambulatory care settings.

Methods: The seven-phase JBI Evidence Implementation Framework was used to guide this project. JBI tools were used to audit current practices and implement best practices in four ambulatory care units. The implementation plan included a baseline audit and two follow-up audits. Feedback was obtained through interviews with ambulatory care nursing staff, educational sessions were conducted for nursing staff, and unit guidelines were developed.

Results: In the baseline audit, compliance with best practice criteria for patient matching and identification was below 62% for 7/13 criteria. After conducting education sessions and other strategies, 1/3 pre- and post-clinical intervention criteria improved in compliance, while 2 were unchanged. For blood product administration criteria, 2/5 improved, 1 was unchanged, and 2 were lower than baseline. Nurses' education in patient identification procedures improved (1/1) and knowing where to access relevant policies remained unchanged at 100%. Criteria for patients knowing the importance of patient identification (2/2) and the identification band following national standards (1/1) improved from baseline.

Conclusions: The results support the use of education sessions and infrastructure changes to promote and sustain change in evidence-based practice in ambulatory care units. Not all criteria improved, and the audit team identified strategies to improve the implementation of evidence-based practice in ambulatory care units.

Spanish abstract: http://links.lww.com/IJEBH/A275.

Introduction: Cancer pain remains a major challenge, affecting nearly half of patients-even during treatment. Cancer pain is often under-assessed in the ICU due to communication barriers, limited nurse training, and lack of standardized protocols.

Aim: This project aimed to optimize pain assessment by nurses in ICU patients with cancer through the implementation of best practices.

Methods: This project followed the seven-phase JBI Evidence Implementation Framework, which is grounded in an audit and feedback strategy. Participants included 26 nurses and 20 ICU patients with cancer. A baseline and follow-up audit were used to measure nurses' accuracy in assessing the patients' pain.

Results: The baseline audit revealed the following compliance metrics: 20.6% for routine assessment of nursing documentation, 52.6% for correct use of the assessment tool, 68% for appropriate pain management when the Visual Analog Scale ≧  3 points or the Behavioral Pain Scale ≧  5 points, and 0% for the detection of cancer pain. In the follow-up audit, these four metrics increased significantly to 100%, 100%, 91.2%, and 70%, respectively.

Conclusions: Leaders can provide education and develop innovative materials to improve nurses' assessment of pain in ICU patients with cancer. Protocols, validated pain tools, on-site checklists, and evidence-based education are effective strategies to enhance nurses' accuracy in assessing cancer pain.

Spanish abstract: http://links.lww.com/IJEBH/A418.

Objectives: The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies.

Introduction: Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes.

Methods: This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice.

Results: The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline.

Conclusions: Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As a next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods.

Spanish abstract: http://links.lww.com/IJEBH/A289.

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.

Objective: This study explores factors that affect the sustainable implementation of best practice guidelines (BPGs) and provides a basis for developing corresponding action strategies to promote project sustainability.

Methods: Using the NHS (National Health Service) questionnaire scoring system, surveys were conducted among nurses who implemented BPGs in three hospitals in China. Data were analyzed using statistical analysis. We adhered to the STROBE guidelines for cross-sectional studies.

Results: The average total score was 85.18/100, while the average scores of the process dimension, staff dimension, and organization dimension were 25.85, 45.88, and 13.45, respectively. The average score of the three dimensions was 83.12%, 87.56%, and 81.52%, respectively. This means that the three dimensions of the NHS SM had high scores and the implemented BPGs had a high likelihood of being sustained. The sustainable implementation of guidelines involves three factors: project characteristics, staff dimensions, and organizational environment.

Conclusion: Important factors that influence project sustainability include the clinical value of the project, a supportive environment provided by human resources and project infrastructure, and the degree of cooperation between interprofessional teams.

Spanish abstract: http://links.lww.com/IJEBH/A305.

Introduction: Falls are a major health concern for older adults, particularly those with cognitive impairment. Many factors contribute to the risk of falls, making it a complex issue to manage.

Aim: This systematic review aimed to identify and describe the implementation strategies used for fall prevention in community-dwelling older people with cognitive impairment.

Eligibility criteria: The review included studies on fall prevention interventions for community-dwelling adults aged > 50 years with cognitive impairment. Eligible studies were primary research, including experimental, quasi-experimental, qualitative, and mixed methods designs, with detailed implementation strategies. Systematic reviews, protocols, editorials, opinions, commentaries, and conference papers were excluded.

Methods: This review followed the JBI methodology for systematic reviews of effectiveness and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases were searched for studies published in English after 2000: MEDLINE (EBSCOhost), CINAHL Ultimate (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and Web of Science Core Collection. Data on implementation strategies and outcomes were extracted and synthesized using the ERIC framework and Proctor's implementation taxonomy.

Results: Twenty-one studies met the eligibility criteria. Twenty-four implementation strategies were identified, with 15 directly fitting the ERIC list and 9 additional strategies emerging. The most common strategies were engaging consumers (i.e., patients and family members or caregivers) (n = 13), adapting and tailoring to context (n = 9), and training and educating stakeholders (n = 8). Implementation outcomes were reported inconsistently across studies. Several implementation strategies were often used, but their combined effects on fall prevention outcomes were not clearly reported.

Conclusions: This review indicates that engaging consumers, particularly family members, was the most common implementation strategy to prevent falls. The review also highlights new strategies, such as providing culturally appropriate interventions and using dementia-trained instructors. Lastly, the review identifies the need for clearer reporting of implementation strategies and outcomes in future studies.

Review registration: PROSPERO CRD4202454689.

Spanish abstract: http://links.lww.com/IJEBH/A380.

Introduction: Stroke remains a leading cause of death and disability, with high readmission rates following discharge. Improving post-discharge stroke care can enhance risk factor control, community reintegration, and self-management.

Objectives: This project aimed to improve telephone follow-up (TFU) for acute ischemic stroke and transient ischemic attack survivors at a comprehensive stroke center in Mississippi, USA.

Methods: Guided by the JBI Evidence Implementation Framework, the project used clinical audits to assess barriers and enablers of compliance with evidence-based practices (EBPs). Two such practices were used as audit criteria. A baseline audit was conducted, barriers to EBPs were identified, and strategies to address the barriers were planned and implemented. Follow-up audits were conducted, using the same two audit criteria and methods, with the results compared to baseline.

Results: The baseline audit (n = 30) revealed low compliance with both EBPs (0% and 40%). An unclear and outdated TFU protocol for stroke patients was identified as the primary barrier to achieving EBPs. The improvement strategy focused on three key initiatives: (i) creating a standardized, multidisciplinary discharge TFU process; (ii) creating and implementing a post-discharge TFU template in the electronic health record; and (iii) providing staff education on the new process and documentation. The post-intervention audit (n = 30) showed statistically significant improvements (100% for both criteria; p < 0.001).

Conclusion: Implementing a structured TFU protocol significantly improved post-discharge follow-up for stroke survivors. Future efforts should focus on sustaining these improvements and evaluating their long-term impact.

Spanish abstract: http://links.lww.com/IJEBH/A449.

Introduction: Oral mucositis is an inflammatory toxic reaction that can affect up to 100% of patients undergoing radiotherapy for head and neck cancer.

Objective: This study aimed to promote best practices for the assessment, prevention, and management of oral mucositis in patients undergoing radiotherapy for head and neck cancer.

Method: The study adhered to the seven-phase JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. The study was conducted from October 2022 to August 2023 in the radiotherapy department of a university hospital in Brazil. Eight evidence-based criteria were established to assess compliance with recommendations before and after implementation. Data were analyzed using JBI PACES. Barriers, strategies, and resources were identified using the JBI GRiP approach and improvement strategies were implemented. A follow-up audit was conducted to measure changes in compliance.

Results: In the follow-up audit, six of the eight criteria achieved 100% compliance. These included standardized initial and follow-up oral cavity assessments, treatment of oral mucositis based on damage, education about oral mucositis, oral hygiene protocols, and standardized assessment for malnutrition. The criterion related to the involvement of a multidisciplinary team in treating oral mucositis reached 90% compliance, while the criterion for referring malnourished patients to a nutritionist showed 66.7% compliance.

Conclusions: The high level of compliance with the best practice criteria demonstrates the feasibility of using evidence in clinical practice. The project highlights that strategies and resources can be used to overcome barriers, such as the active involvement of a multidisciplinary team, education, and systematizing the evaluation, prevention, and management of oral mucositis.

Spanish abstract: http://links.lww.com/IJEBH/A442.