Jbi Evidence Implementation最新文献

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.

Introduction: Subcutaneous anticoagulant therapy is commonly used in the cardiology department. However, these injections often cause localized bleeding and discomfort, reducing patient medication compliance and nursing satisfaction. Evidence indicates that standardized injection procedures can significantly reduce complications.

Objectives: This project aimed to implement best practices to minimize post-injection issues-including subcutaneous hemorrhage, pain, and hematomas-following the subcutaneous administration of low-molecular-weight heparin.

Methods: This project was conducted in a cardiovascular department of a tertiary care hospital in Changsha, China. Using the JBI Evidence Implementation Framework, a baseline audit was conducted to compare current practices against 14 evidence-based recommendations. The sample included 15 nurses and 74 patients. Barriers to compliance with best practices were identified and a follow-up audit was conducted to measure the impact of the improvement strategies.

Results: The follow-up audit revealed significant improvements compared to baseline, with 12 of the 14 criteria reaching 80% compliance or higher. The incidence of pain was significantly lower in patients (68.6% vs 33.3%, X 2  = 9.162, p  < 0.05), as was the average degree of pain and subcutaneous bleeding (Z1 = -3.223, Z2 = -2.389, p  < 0.05). Nurses' theoretical knowledge of standardized subcutaneous injection procedures also significantly improved (53.07 ± 6.86 vs 91.40 ± 4.70, t  = -19.129, p  < 0.001).

Conclusions: This project successfully demonstrated that standardization of care minimizes post-injection complications. The nurse manager's leadership was instrumental in the success of the initiative. Subsequent initiatives should provide targeted training to address low-adherence areas, continuous monitoring of nursing practices, and further research to optimize compliance with evidence-based guidelines.

Spanish abstract: http://links.lww.com/IJEBH/A439.

Introduction and aims: Applying knowledge generated from implementation science can improve the process teams use to move evidence into practice. To facilitate the use of implementation science knowledge in practice, training and resources for healthcare providers and leaders are needed. Our team developed a toolkit for maternal-newborn settings to provide guidance and tools on how to apply implementation science knowledge to their practice change initiatives. The aim of this study was to evaluate the toolkit for acceptability, appropriateness, feasibility, usability, and potential adoption.

Methods: We conducted a convergent mixed-methods study. Healthcare providers and leaders working in Ontario maternal-newborn care read the toolkit and completed a feedback survey and interview. The questionnaire included questions on toolkit content and format and validated measures on acceptability, appropriateness, feasibility, and usability. The interviews explored questionnaire responses and application of the toolkit. Quantitative data were analyzed descriptively. Qualitative data were analyzed using directed content analysis.

Results: Participants (n = 17) rated the toolkit as acceptable, appropriate, feasible, and usable, indicating the toolkit meets the need for practical resources to guide implementation. Most participants indicated their intention to use the toolkit and refer it to others. Several areas for improvement were identified including simplifying language and content and improving the format. Participants highlighted the need to effectively disseminate the toolkit and offer training and support for its successful implementation.

Conclusions: The toolkit has the potential to improve maternal-newborn teams' implementation processes and outcomes; future work is needed to improve the toolkit and evaluate its use and impact in practice.

Spanish abstract: http://links.lww.com/IJEBH/A431.

Introduction: Nurses and midwives play a central role in ensuring the sustainability of evidence-based practices in the clinical setting. However, for this role to be effectively fulfilled, an understanding is needed of how sustainability concepts are applied, together with the continuous evaluation of practice changes over time.

Aim: This study aimed to explore nurses' and midwives' experiences regarding the sustainability of evidence-based inpatient postnatal care in a maternity unit in Kazakhstan.

Design: The study used an interpretive description design and individual in-depth interviews with nine participants. The COREQ checklist was used to report the study.

Results: Four themes emerged from the analysis. Theme 1: Awareness and Accessibility of Evidence-Based Inpatient Postnatal Care Standards. This theme emphasizes the importance of nurses and midwives continuously using the protocol or standards for postnatal care while being aware of and having access to the protocol and standards. Theme 2: Management Support, Relationships, and Professional Satisfaction. This theme focuses on the dynamics within the unit among nurses and midwives and their managers, and the impact of these dynamics on staff autonomy and professional identity. Theme 3: Training and Updates. This theme refers to the regular training conducted in the unit on the protocol for postnatal care. Theme 4: Practicing Evidence-Based Inpatient Postnatal Care. This theme relates to the activities of nurses and midwives while caring for patients.

Conclusion: The study findings suggest that sustainability in the clinical setting is precarious and multifaceted. The four themes related to the experiences of the staff, were a dynamic and integral component of patient care, driving the sustainability of evidence in the clinical setting.

Spanish abstract: http://links.lww.com/IJEBH/A428.

Introduction: Retention of surgical items (RSI) is a "never event" and has serious consequences for patients, providers, and the organization.

Objectives: This project aimed to implement best practices for surgical counts to reduce the incidence of RSI in patients undergoing intra-abdominal surgery.

Methods: This project followed the seven-phase JBI Evidence Implementation Framework. The framework recommends a before-and-after audit and feedback approach. A baseline audit was conducted to determine current compliance with best practices. Strategies were then implemented to address gaps in compliance, and two follow-up audits were conducted to measure changes in compliance. The audits used five evidence-based criteria adapted from JBI Evidence Summaries, with a sample size of 30 patients.

Results: Although there was moderate to high compliance (50% to 100%) for four of the five criteria in the baseline audit, compliance was low for "surgical pause" (Criterion 4; 16.7%). A key barrier was that surgeons failed to conduct wound exploration before wound closure, despite reinforcement by nurses. Including surgeons as key stakeholders in the revised "surgical pause" protocol significantly improved compliance, which rose to 66.7% in follow-up audit 1 and 86.7% in follow-up audit 2.

Conclusions: Following project implementation, compliance with best practices increased. However, human factor issues remain a challenge in mitigating the occurrence of RSI. Poor inter-professional collaboration and misalignment of values and attitudes toward improvement interventions could hamper efforts to reduce RSI events.

Spanish abstract: http://links.lww.com/IJEBH/A430.

Background: Vaccine communication is critical to improve pregnancy and childhood vaccination uptake. However, communication about vaccination in pregnancy between health care providers and patients is suboptimal. The Sharing Knowledge About Immunization (SKAI) is an Australian multicomponent intervention aimed at improving vaccine communication to increase vaccine uptake in pregnancy and childhood. However, it is unclear whether and how effective the intervention would be in the Canadian context.

Objectives: The objectives of this study were to (1) determine what components of SKAI addressed vaccine communication and barriers identified by providers and parents in Canada, and (2) if necessary, identify additional intervention components that could improve vaccine communication during pregnancy in Canada.

Methods: This multi-method study used the Behaviour Change Wheel and the Theory and Techniques Tool to (1) identify behavior change techniques (BCTs) in the SKAI intervention; (2) map the identified BCTs to the barriers and enablers of vaccination in pregnancy communication, as reported by providers and parents in Canada, using the Theoretical Domains Framework; and (3) if the BCTs identified did not address reported barriers, develop a shortlist of possible BCTs to target barriers reported in Canada but not identified in SKAI.

Results: A total of 22/93 BCTs were identified in the SKAI intervention materials for providers and 8/93 BCTs in the materials for patients. The majority of BCTs from both the providers' and the patients' materials targeted the barrier domains, Knowledge and Environmental Context and Resources, focusing on providing information. The domains with the fewest BCTs identified were Intention and Behavior Regulation. BCTs that targeted barriers in Skills, Belief About Capabilities, and Behavior Regulation for providers and Reinforcement, Social Influences, and Emotions for parents and not identified in SKAI were shortlisted (n = 26) for the Canadian intervention.

Conclusion: A tailored Canadian intervention aimed at improving vaccine communication during pregnancy should move beyond simply providing information, and should include BCTs that target Skills, Belief About Capabilities, and Behavior Regulation for providers. For parents, BCTs should target Reinforcement, Social Influences, and Emotions. Including BCTs that target these barriers that are unique to the Canadian context will increase the likelihood of changing patients' and providers' communication behavior and improving vaccine acceptance during pregnancy.

Spanish abstract: http://links.lww.com/IJEBH/A427.