Jbi Evidence Implementation最新文献

Background: Cystic fibrosis (CF) is a genetic disease with increasing life expectancy due to advances in treatment. However, this increased life expectancy has led to new health challenges, especially diabetes. Nearly 25% of adults with CF develop diabetes, but only a minority receive endocrinology care.

Objective: This study aimed to co-design, implement, and evaluate a nested diabetes model of care (MOC) for adults with CF and diabetes in a single tertiary adult CF center in Australia.

Methods: We used several implementation frameworks to co-design the MOC with consumer and provider end-users. Following MOC implementation, we used database-driven analytics to evaluate changes in the primary clinical outcome (HbA1c) pre and post study at 1 year. A mixed methods approach was used to evaluate secondary clinical and non-clinical outcomes.

Results: The MOC promoted multidisciplinary collaboration and streamlined patient journeys, leading to high engagement. Thus, 76.7% of the entire CF cohort with confirmed diabetes was reviewed within the first year of operationalization. Engagement with the MOC was associated with a statistically significant decline in HbA1c (-0.54% vs +0.33%, p-value 0.004) and a 0.22% [95% CI 0.19 -0.32] per month increment in percent predicted forced expiratory volume (ppFEV1).

Conclusion: Our co-designed MOC demonstrated high engagement as well as improving glycemic management and lung function in adults with CF and diabetes. Our approach to CF diabetes care may reduce the treatment burden in the order of initiating a new diabetes medication while concurrently enhancing end-user experiences of health care.

Spanish abstract: http://links.lww.com/IJEBH/A473.

Introduction: Chemotherapy drug extravasation (CDE) is a well-documented complication associated with a significant potential for severe adverse outcomes.

Objective: This project aimed to implement evidence-based strategies to prevent CDE in hospitalized adults in the general surgery ward.

Methods: This project used the JBI Evidence Implementation Framework, together with the JBI Practical Application of Clinical Evidence System (PACES) system. A baseline audit was conducted with 27 nurses and 30 patients, using six evidence-based criteria to measure initial compliance with best practices. JBI's Getting Research into Practice (GRiP) approach was then used to identify barriers and implement strategies, including objective structured clinical examination (OSCE), medium fidelity simulation (MFS), interprofessional education, and patient-centered educational materials. A follow-up audit was then conducted to assess improvements in compliance with best practices following the intervention.

Results: The baseline audit revealed compliance rates ranging from 3%-76% for the six criteria. Following the implementation of best practices, all six criteria rose to 93%-100% compliance. Moreover, nursing staff demonstrated improvements in knowledge and skills related to CDE. Importantly, no cases of CDE were reported during the post-implementation period.

Conclusions: This project highlights the importance of improving nurses' competency in CDE management through OSCE and MFS. Additionally, the development of patient-centered educational materials enhanced patients' understanding of chemotherapy extravasation risks, thereby contributing to improved patient safety and quality of care.

Spanish abstract: http://links.lww.com/IJEBH/A480.

Introduction: Electronic patient-reported outcome measures (ePROMs) have a robust evidence base showing that when they are routinely collected and actioned in clinical settings, they enhance patient-centered care and clinical decision-making. However, their integration into routine oncology care has often been hindered due to system and individual-level resistance as well as barriers to implementation, warranting a targeted change management approach. This case study presents the statewide change management approach to the implementation of an electronic patient-reported measures (ePRM) system in New South Wales (NSW), Australia.

Methods: This study describes the process of statewide change management, guided by the ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement) change management model to support adoption and sustainability. A retrospective case study methodology is used. Change management strategies employed during the implementation of the ePRM system across NSW cancer services were elicited through stakeholder interviews and meetings with the change management team. Each phase of the ADKAR framework was mapped to implementation activities, stakeholder engagement efforts, and system refinements. Identified barriers were coded using the Consolidated Framework for Implementation Research (CFIR), and corresponding mitigation strategies were aligned with the Expert Recommendations for Implementing Change (ERIC) taxonomy.

Results: The structured application of the ADKAR model enabled the change management team to anticipate and address a range of barriers. Strategies included tailored stakeholder engagement to build awareness and desire, role-specific training to develop knowledge, site-based troubleshooting and workflow adaptation to support ability, and performance monitoring to reinforce long-term use. Barriers such as perceived redundancy and time constraints were effectively mitigated through context-specific strategies mapped to relevant CFIR and ERIC constructs. The resulting implementation checklist provides a practical guide for organizations undertaking similar digital health transformations.

Conclusions: Structured change management enabled the successful implementation of a digital health innovation-the ePRM system-at scale. By combining proactive planning, iterative design, and embedded support, digital health interventions can achieve sustained adoption. These findings offer actionable guidance for policymakers and health care leaders seeking to embed digital tools such as ePROMs into routine clinical care.

Spanish abstract: http://links.lww.com/IJEBH/A493.

Introduction: Theories, models, and frameworks are essential resources for planning effective implementation. However, it is unclear whether the reporting of principles in the published implementation literature reflects their role as a core foundation for practice change.

Aim: Our aim was to evaluate manuscripts informed by the JBI Model of Evidence-based Healthcare to identify and describe the reporting frequency of the four core principles of Culture, Communication, Capacity, and Collaboration (4Cs) which underpin the model.

Methods: This was a retrospective descriptive study which used eight purposively selected published JBI implementation reports. We piloted and extracted data in the form of verbatim text, which was mapped to the CFIR-2 sub-domains and the JBI Model's 4C principles. Data were then condensed into related concepts for frequency counts.

Results: There were 337 instances of the JBI 4C principles, with a mean of 42 reported per publication. Instances ranged from 17 to 147, with the highest frequencies occurring for Capacity (n = 147) and Culture (n = 142), and the lowest for Communication (n = 31) and Collaboration (n = 17).

Conclusions: The data suggest that the JBI 4Cs have intrinsic value and utility for authors, yet are used variably. Principles presented without operational definitions or descriptions are difficult for implementers to engage with. Therefore, further conceptual and operational studies are needed to increase the clarity and specificity of use case for the JBI 4Cs.

Spanish abstract: http://links.lww.com/IJEBH/A478.

Introduction: Patients with liver cancer experience varying degrees of post-operative pain (POP) after hepatic resection, which adversely affects their quality of life, clinical outcomes, and satisfaction. POP assessment, the first step in POP management, is often inadequate.

Objective: This project aimed to implement best practices for POP assessment in the General Surgery department of a hospital in China.

Methods: Using the JBI Evidence Implementation Framework, we conducted a non-concurrent control study. A baseline audit evaluated adherence to evidence-based practices. Then, a barriers analysis was conducted, and a follow-up audit was performed after the implementation of strategies. Patient outcomes as well as nurses' knowledge and attitudes were also evaluated at baseline and follow-up.

Results: Baseline compliance with best practices was low. However, after implementation, significant improvements were observed: a multidisciplinary team was established; nurse training coverage increased from 40% to 100% ( p  < 0.001); regular rest POP assessment rose from 0% to 66.67% ( p  < 0.001); twice daily POP assessment during activity increased from 0% to 80% ( p  < 0.001); provision of pre-operative pain diary instruction and patient use of pain diary increased from 0% to 70% and 60%, respectively (both p  < 0.001). Patient satisfaction with POP management and education significantly increased ( p  < 0.001), as did patients' pain-related knowledge, attitudes, and behaviors (all p  < 0.001). Nurses' knowledge and attitudes toward POP assessment also improved significantly ( p  < 0.001).

Conclusion: The implementation of multifaceted, evidence-based strategies substantially improved POP assessment practices in patients after hepatectomy, demonstrating the effectiveness of a systematic approach for quality improvement in POP management.

Spanish abstract: http://links.lww.com/IJEBH/A492.

Introduction: Older adults are at higher risk of dehydration due to age-related physiological and cognitive factors. They are commonly affected by hypertonic dehydration, usually caused by inadequate fluid intake.

Objectives: This project aimed to promote evidence-based practices (EBPs) for dehydration prevention in older adults in a nursing home in rural Mississippi, USA.

Methods: Guided by the JBI Evidence Implementation Framework, the project used clinical audits to assess barriers and enablers of EBP compliance. Nine EBPs derived from a JBI Evidence Summary served as audit criteria. The baseline audit included a policy review, leadership interviews, and staff survey. Identified barriers informed strategies which were then implemented. A follow-up audit using the same nine criteria was then conducted. The results were compared to baseline data to assess changes in compliance with EBPs.

Results: The baseline audit showed average compliance of 27%. Two barriers to EBPs were identified: (1) lack of staff awareness, knowledge, and training regarding hydration EBPs, and (2) inadequate resources or materials related to hydration care. A hydration protocol was created and implemented. Staff were trained and observed using the protocol. An educational pamphlet was developed for residents and visitors. Post-intervention audits showed 62% compliance, a 35% increase from baseline.

Conclusions: Post-audit results showed significant improvement, especially regarding residents' recommended fluid intake. Embedding the hydration protocol into standard procedures and maintaining leadership support will enhance the project's sustainability.

Spanish abstract: http://links.lww.com/IJEBH/A452.

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: Prolonged sleep deprivation and poor sleep quality are common complaints among pregnant and postpartum women, and they have adverse effects on the physiological and psychological well-being of mothers antenatally and postnatally.

Objectives: The aim of this project was to improve antenatal and postnatal mothers' night-time sleep quality during hospitalization in an obstetric ward through multifaceted interventions.

Methods: This project followed the JBI Model of Evidence-based Healthcare and applied the seven phases of the JBI Evidence Implementation Framework to conduct context analysis, strategy implementation, and review of practice using evidence-based audit criteria. JBI's Practical Application of Clinical Evidence System and the Getting Research into Practice situational analysis tool were used to support data collection and identify barriers and strategies. Mothers' sleep quality was measured using an adapted St. Mary's Hospital Sleep Questionnaire.

Results: Baseline audit results (0%) revealed that midwives and nurses were not implementing the multifaceted interventions to promote sleep in mothers. The results in follow-up audit 1 and follow-up audit 2 achieved compliance of 63.3% ( p  < 0.000), respectively. Overall, the mothers were fairly satisfied with their sleep quality, were able to sleep longer, and felt more alert when waking up in the morning.

Conclusions: There was an increase in compliance with best practices to improve mothers' sleep quality in the obstetric wards, although these results could be further improved. Mothers' perspectives of sleep promotion strategies should be explored in future projects to tailor the strategies to their needs. Sustainability plans include conducting follow-up audits and engaging ward nurses to continue implementing the multifaceted interventions.

Spanish abstract: http://links.lww.com/IJEBH/A307.

Abstract: This article explores the development and utility of the PIECE (Practice/Problem of interest, Intervention/Implementation, Evaluation, Context, and Engagement) planning and question framework as a structured approach for planning and conducting evidence implementation projects. Traditionally, the PICO model has been used as a guiding framework for formulating clinical questions and structuring systematic reviews; however, the elements of PICO do not suit the unique requirements of evidence implementation projects in real-world settings. Each element of PIECE addresses a critical component of implementation: selecting a problem grounded in evidence, choosing effective interventions, defining evaluation metrics, assessing contextual factors, and engaging relevant stakeholders. Through examples of successful JBI implementation projects, we illustrate how PIECE can be used to conceptualize and execute implementation efforts. The proposed framework provides a structured yet flexible roadmap, allowing health care teams to initiate and sustain meaningful improvements. PIECE supports the planning phase of implementation projects, fostering better alignment with organizational goals and greater stakeholder engagement. As implementation science continues to evolve, PIECE offers a grounded approach for clinicians seeking to embed evidence into daily practice.

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.