Jbi Evidence Implementation最新文献

Introduction: There are widespread efforts to implement change and innovation to improve care for older people in aged care. Relational factors are among the key determinants of implementation in care settings, and are an emerging area of implementation research attention.

Aim: This study aimed to identify relational factors that influence implementation in aged care.

Methods: We conducted inductive descriptive qualitative content analysis of studies included in a recent comprehensive scoping review of implementation in aged care.

Results: We identified a variety of relational factors that influence implementation. Collaboration among stakeholders was a key factor, in particular between disciplines, and among the aged care staff as well as with external service providers. We found that managers' support was vital, as was clear and frequent communication between stakeholders. Implementation was aided by established, cohesive, trusting, non-hierarchical relationships, as well as shared values and visions.

Conclusions: A range of factors in the socio-relational context can influence implementation in aged care. Assessing these factors and tailoring implementation strategies accordingly can promote successful implementation to improve care for older people.

Spanish abstract: http://links.lww.com/IJEBH/A384.

Aim: This study aimed to understand stakeholder engagement in aged care by examining four key objectives: who was engaged, how they were engaged, the factors that supported their engagement, and the outcomes realized from the process.

Introduction: The aged care sector must innovate to meet increased service demand, staff shortages, insufficient funding, and rising client expectations. Effective innovation in this sector requires meaningful stakeholder engagement, yet the definitions and processes surrounding engagement are often ambiguous and criticized for being tokenistic.

Eligibility criteria: We conducted a descriptive secondary analysis of data from a scoping review that examined factors affecting the implementation of innovations in community and residential aged care settings.

Methods: Data were inductively coded based on the four key objectives. The findings were validated and interpreted in collaboration with a Research Advisory Group composed of aged care clients, staff, and sector representatives.

Results: The majority of studies engaged aged care staff, with limited involvement of clients, families, and the community. Approaches encouraging open communication and collaboration fostered stronger participation and relationships. Clear information, resources, and leadership support improved outcomes, enhanced staff capability, and built stakeholder trust.

Conclusions: Our study underscores the importance of meaningful stakeholder engagement in implementing innovations within the aged care sector. Expanding involvement to ensure clients, family members, and the wider community are involved could enhance outcomes. Adopting more interactive and inclusive approaches also fosters equitable participation, ensuring that diverse perspectives contribute to the success of these innovations.

Spanish abstract: http://links.lww.com/IJEBH/A387.

Abstract: The Medical Research Council proposed a framework to develop and implement complex interventions in practice. How to adopt these interventions is described in recommendations of evidence-based clinical practice guidelines. Many factors may influence the complexity of a guideline. The aim of this paper is to describe the determinants of complexity in the development and implementation of an evidence-based clinical practice guideline.A working group with 16 participants was established, consisting of a debate team and a Delphi panel. The debate team discussed online to define the key elements of the MRC's definition of a complex intervention to see whether these elements are applicable to guidelines. These elements were presented to the Delphi panel to assess their relevance.After the first round, consensus was reached on eight elements, with the inter-rater reliability varying from 0.83 to 1.00. After the second Delphi round, consensus was reached on two more elements. The consensus stated that these ten elements all define an aspect of the complexity in guidelines. There was no agreement regarding the exclusion of a specific element.Developers and end-users consider that the complexity of a guideline and its implementation is affected when the number of components, settings, targeted behaviors, and stakeholders increase; when a gap exists between the guideline and the reality of clinical practice; or when differences in education are evident between end-users. Moreover, the level of collaboration required of the different end-users, the scope of change, the level of evidence in the guideline, and the workload for end-users also determine complexity.

Spanish abstract: http://links.lww.com/IJEBH/A333.

Introduction: Frailty in older adults can lead to a gradual decline in organ function. Without timely diagnosis and intervention, this condition can progress rapidly, increasing the risk of disability and mortality.

Objectives: The aim of this project was to implement evidence-based practices for managing frailty in the medical ward to prevent disability in older patients.

Methods: This project was conceptually informed by the JBI Evidence Implementation Framework. This framework uses an audit and feedback approach and a pre- and post-test design to measure baseline compliance, develop implementation strategies responsive to gaps in compliance, and conduct a final evaluation to measure changes in compliance. JBI PACES and JBI GRiP situational analysis software were used to support data collection and implementation planning. Ten audit criteria were used with a sample of 30 patients in a regional teaching hospital in southern Taiwan.

Results: The baseline audit showed poor compliance, with rates below 30% for all ten audit criteria. Through strategies such as professional training and education, the implementation of evidence-based care guidelines, and interdisciplinary consensus-building, the follow-up audit revealed an increase in compliance to over 90% for each audit criterion.

Conclusions: Frailty management strategies based on evidence-based audit criteria were implemented and routinely measured. The most effective strategies for improving compliance included the development of a training course, a digitized assessment tool, team meetings, interdisciplinary collaboration, communication, and consensus-building.

Spanish abstract: http://links.lww.com/IJEBH/A225.

Aim: This review examines how innovation attributes can affect the implementation of innovations in aged care organizations.

Introduction: Aged care organizations are increasingly implementing new care models and types of technology to improve care quality and sustain operational viability. However, selecting and implementing these innovations is complex, as integrating new practices within established systems requires careful consideration. Identifying specific attributes of innovations that influence implementation outcomes is essential to enhancing sustainability and success.

Methods: We conducted a secondary data analysis of a comprehensive scoping review on factors affecting innovation implementation in aged care. Key innovation attributes based on Greenhalgh's Diffusion of Innovation in Service Organizations model were used as a framework for analysis.

Results: Of the 192 studies in the original scoping review, 122 provided insights into innovation attributes that influence implementation. Key attributes identified included the innovation's impact on workloads, its relevance to roles, and the level of staff knowledge and confidence to adopt within their context. Additionally, the included studies highlighted the importance of sufficient ongoing support, compatibility with existing organizational values and systems, and the innovation's adaptability to specific care settings. Balancing these innovation attributes presents unique opportunities and challenges within the aged care sector.

Conclusion: Our findings indicate that successful innovation implementation in aged care requires a nuanced understanding of the innovation attributes that may improve the likelihood of successful implementation. This secondary review offers a practical framework for evaluating innovation suitability, supporting decision-makers in selecting innovations that align with the specific needs and context of aged care settings.

Spanish abstract: http://links.lww.com/IJEBH/A383.

Background: Accidental falls among inpatients are a significant cause of hospital-acquired injury. Appropriate evidence-based strategies to prevent falls and standard operating procedures for fall prevention and management are vital to mitigate the risk of falls in hospitals.

Objective: The objective of this study was to improve fall prevention practices among health care practitioners and post-operative patients in a neurology ward through the implementation of evidence-based practices.

Methods: This project followed the seven-phase JBI Evidence Implementation Framework, which uses a pre- and post-test audit methodology. A baseline audit was conducted of fall management practices among 60 health care staff and 40 patients in a hospital in Taiwan. Using the baseline audit results, barriers to best practices were identified and improvement strategies were developed to address the barriers. A follow-up audit was conducted to measure improvements.

Results: Post-implementation audit compliance rates improved from baseline. Specifically, the compliance rate for Criteria 1, 3, 5, and 10 increased to 100%. Compliance also increased for Criteria 2 (90%), 4 (93%), 6 (95%), 7 (95%), 8 (88%), 9 (88%), and 11 (97%).

Conclusion: This study used best practices to reduce the incidence of falls, which did not exceed 0.08%. Key factors contributing to the success of the project included a democratic approach to leadership, multidisciplinary interventions, the Plan-Do-Study-Act cycle, and on-the-job training for nurses.

Spanish abstract: http://links.lww.com/IJEBH/A409.

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 guided 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: 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: Post-operative pain is often underestimated (70% of surgical patients experience some degree of pain) and is insufficiently treated. This increases morbidity and mortality, mainly due to respiratory and thromboembolic complications, longer hospital stays, deterioration in quality of life, and occurrence of chronic pain.

Objectives: This study aimed to improve post-operative pain management in the first 4 hours after total hip and knee replacement by promoting best practices.

Methods: This project used the JBI Evidence Implementation Framework. JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tools were used to collect data and develop implementation strategies, in line with identified barriers. The project was conducted in a special care unit in a primary hospital in Spain using a sample of 30 patients. Three phases of activity were followed: conducting a baseline audit, implementing improvement strategies, and conducting follow-up audits to assess intervention outcomes. The evaluation criteria used in the audits were derived from a JBI Evidence Summary on post-operative pain management.

Results: The baseline audit identified five barriers: lack of nursing staff knowledge of appropriate pain assessment scales; lack of complete pain assessment record in the electronic nursing records; lack of staff confidence in evidence-based practice; lack of dedicated training time for staff; and low staff participation in consensus process. Strategies were formulated to address these barriers using JBI's GRiP method. Following implementation, compliance with all audit criteria significantly improved.

Conclusion: The strategies developed using the JBI Evidence Implementation Framework positively influenced compliance with best practices.

Spanish abstract: http://links.lww.com/IJEBH/A339.