Jbi Evidence Implementation最新文献

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.

Objectives: The aim of the project was to reduce interruptions during oral medication rounds among nurses working in hematology-oncology wards by improving compliance with best practices by 20%.

Introduction: Medication errors can adversely affect patient safety. Hence, understanding the underlying contributors to medication errors is necessary. Nurses are the ones who administer medications to patients; however, in clinical areas, interruptions are prevalent and could contribute to medication errors. It is therefore recommended that interventions be implemented to minimize interruptions.

Methods: This project was conducted in two hematology-oncology wards from March 2022 to March 2023. Target participants were nurses who served medications in the morning. The project followed an evidence-based audit and feedback methodology using the seven-phase JBI Evidence Implementation Framework. JBI's Practical Application of Clinical Evidence System (PACES) was used to support the audit and feedback process. An interruption reduction bundle consisting of three best practices was implemented.

Results: At baseline, only 24% of medications administered occurred without interruption. One month after implementation, there was a 51% improvement in compliance. Six months after implementation, compliance increased to 58%. Nine months post-implementation, the compliance rate remained at 59%. Absolute interruption counts decreased from 47 (baseline), to 27 (1 month post-implementation), to 24 (6 months post-implementation), to 16 (9 months post-implementation). All types of interruptions decreased when comparing the baseline with the latest post-implementation result.

Conclusions: The project used evidence-based interventions in a bundle, effectively reducing interruptions during oral medication rounds, and sustaining positive results.

Spanish abstract: http://links.lww.com/IJEBH/A256.

Objective: The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization.

Introduction: Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems.

Methods: This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff.

Results: Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%.

Conclusions: The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project.

Spanish abstract: http://links.lww.com/IJEBH/A252.

Introduction: Cannulation with a central venous catheter (CVC) is a common procedure used in critical care. One of the main complications is occlusion, which can lead to delayed treatment, prolonged hospital stay, and increased health care costs.

Objective: The aim of this project was to promote evidence-based practice for nurses caring for patients with a CVC in a Spanish intensive care unit. The project also aimed to reduce CVC occlusion and ensure CVC patency.

Methods: This project was guided by the JBI Model of Evidence-based Healthcare and the JBI Evidence Implementation Framework. Seven phases were followed using evidence-based auditing and feedback. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to support data collection, data analysis, and implementation planning.

Results: After project implementation, the following results were obtained. Criterion 1 (assessing the CVC, flushing, and aspirating) reached 100% compliance in both audits. Criterion 2 (occlusion documentation) showed a modest improvement, rising from 13.33% to 36.67%. Improvement for Criterion 3 (the need for a policy and protocol) was excellent, rising from 0% at baseline to 100% following implementation. Criterion 4 (rapid instillation of an appropriate thrombolytic agent if a CVC is occluded) remained at 0% compliance in both audits. Criterion 5 (continuing education for health care professionals) improved from 10% to 60%. Criterion 6 (flushing and locking before procedures) improved from 90% to 100%.

Conclusion: The project objectives were largely met and resulted in a protocol, which has been shared with other departments within the hospital. The implementation of best clinical practice will be continued, including the use of thrombolytic agents.

Spanish abstract: http://links.lww.com/IJEBH/A200.

Objectives: This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India.

Introduction: Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs.

Methods: This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months.

Results: The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance.

Conclusions: This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence.

Spanish abstract: http://links.lww.com/IJEBH/A211.

Introduction and aims: This study examined critical care nurses', physicians', and allied health professionals' perceptions of factors that support, inhibit, or limit the use of sedation interruption (SI) to improve the use of this integral component of care for mechanically ventilated patients.

Method: We conducted a theory-based, descriptive qualitative study using semi-structured interviews with critical care registered nurses, respiratory therapists, a pharmacist, and a physician in a hospital in Ontario, Canada. The interview guide and analysis were informed by the Theoretical Domains Framework and transcripts were analyzed using content analysis.

Results: We identified 9 facilitators and 20 barriers to SI use by nurses. Facilitators included the innovation (importance of protocols) and potential adopters (comfort with the skill). The barriers were the potential adopters' (nurses) knowledge gaps regarding the performance and goal of SI and the practice environment (lack of time, availability of extra staff, and lack of multidisciplinary rounds).

Conclusion: This study identified facilitators and barriers to SI for mechanically ventilated patients. Implementation efforts must address barriers associated with nurses, the environment, and contextual factors. A team-based approach is essential, as the absence of interprofessional rounds is a significant barrier to the appropriate use or non-use of SI. Future research can focus on the indications, contraindications, and goals of SI, emphasizing a shared appreciation for these factors across disciplines. Nursing capacity to manage a patient waking up from sedation is necessary for point-of-care adherence; future research should focus on the best ways to do so. Implementation study designs should use theory and evidence-based determinants of SI to bridge the evidence-to-practice gap.

Spanish abstract: http://links.lww.com/IJEBH/A178.