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Rehabilitation exercises for kidney transplant recipients in an organ transplant ward: a best practice implementation project. 器官移植病房肾移植受者的康复训练:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000417
Huan Liu, Jia Liu, Qirong Chen, Le Zeng, Jia Guo, Xiao Zhu, Pengpeng Zhang, Jiarui Chen, Mei Sun, Xiaoting Huang, Jinfeng Ding, Lifang Liu

Introduction and objectives: Kidney transplantation is an effective treatment for end-stage kidney disease. Kidney transplant recipients (KTRs) are prone to experiencing reduced physical function, depression, fatigue, and lack of exercise motivation due to their sedentary lifestyle before surgery. Exercise is an effective intervention for KTRs, but it has not been properly implemented in many practice settings. This project aimed to promote evidence-based exercises as part of KTRs' rehabilitation to improve their health outcomes.

Methods: This project was informed by the JBI Evidence Implementation Framework. The project was conducted in the organ transplant ward of a tertiary comprehensive hospital in Changsha, China. Based on a summary of best evidence, 12 audit criteria were developed for the baseline and follow-up audits involving 30 patients and 20 nursing staff. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool were used to identify barriers and facilitators and develop targeted strategies to improve issues.

Results: Compared with the baseline audit, significant improvements were achieved in most of the criteria in the follow-up audit, with 9 of the 12 criteria reaching 100% compliance. Notably, the 6-minute walk distance test results were significantly higher, while the Self-Rating Depression Scale and Self-Rating Anxiety Scale scores were significantly lower ( p < 0.05).

Conclusions: This project demonstrates that evidence-based practice can improve the clinical practice of rehabilitation exercises for KTRs. The GRiP strategies proved to be extremely useful, notably, the formulation of a standardized rehabilitation exercise protocol, training, and enhancement of the exercising environment. Head nurses' leadership and decision-making also played an important role in the success of this project.

Spanish abstract: http://links.lww.com/IJEBH/A180.

导言和目标:肾移植是治疗终末期肾病的有效方法。肾移植受者(KTRs)由于手术前久坐不动的生活方式,很容易出现身体功能下降、抑郁、疲劳和缺乏运动动力等问题。运动是针对肾移植受者的有效干预措施,但在许多实践环境中并未得到正确实施。本项目旨在推广循证运动,将其作为 KTR 康复的一部分,以改善他们的健康状况:该项目参考了 JBI 证据实施框架。该项目在中国长沙一家三级综合医院的器官移植病房开展。在总结最佳证据的基础上,为基线审核和后续审核制定了12项审核标准,涉及30名患者和20名护理人员。采用JBI临床证据实际应用系统(PACES)和将研究融入实践(GRiP)工具来识别障碍和促进因素,并制定有针对性的策略来改善问题:与基线审核相比,后续审核中的大部分标准都有了明显改善,12 项标准中有 9 项达到了 100%。值得注意的是,6 分钟步行距离测试结果明显提高,而抑郁自评量表和焦虑自评量表得分明显降低(P < 0.05):本项目表明,循证实践可以改善 KTR 康复锻炼的临床实践。事实证明,GRiP 策略非常有用,尤其是制定标准化康复锻炼方案、培训和改善锻炼环境。护士长的领导力和决策力也为该项目的成功发挥了重要作用。西班牙文摘要:http://links.lww.com/IJEBH/A180。
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引用次数: 0
Keys to successful clinical audit and feedback: essential steps to making impactful improvements in patient care. 成功进行临床审核和反馈的关键:对患者护理进行有影响力改进的基本步骤。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000448
Alana Delaforce, Diana Moore

Abstract: Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback.

Spanish abstract: http://links.lww.com/IJEBH/A239.

摘要:多达 40% 的病人护理不是浪费就是有害。审计和反馈实践有助于确定护理工作可以改进的地方。然而,此类审核必须以系统的方式执行,并与临床医生合作,以最大限度地发挥反馈的作用,最终改善患者的治疗效果。目前,审核培训并未纳入正规教育途径,临床医生需要指导来支持他们开展这项活动。本文探讨了当代研究,旨在提供实用的建议意见,以最大限度地发挥审核和反馈的作用。西班牙文摘要:http://links.lww.com/IJEBH/A239。
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引用次数: 0
When is enough enough? Implementation science models and frameworks. 何时才算足够?实施科学模型和框架。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-01 DOI: 10.1097/XEB.0000000000000447
Timothy A Carey
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引用次数: 0
Screening and early detection of post-extubation oropharyngeal dysphagia: a best practice implementation project. 拔管后口咽吞咽困难的筛查和早期检测:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-25 DOI: 10.1097/XEB.0000000000000450
Paulo Carlos Garcia, Karina Sichieri, Tatiane Martins de Matos, Daniel Malissani Martins, Emília Cristina Peres, Milena Vaz Bonini, Diley Cardoso Franco Ortiz, Vilanice Alves de Araújo Püschel, Diná de Almeida Lopes Monteiro da Cruz

Introduction: Patients undergoing intubation and mechanical ventilation in an intensive care unit risk developing post-extubation oropharyngeal dysphagia (PED). PED can lead to aspiration complications, aspiration pneumonia, and prolonged hospitalization, as well as increased repeat intubation and in-hospital morbidity and mortality.

Objective: This evidence implementation project aimed to promote evidence-based screening and early detection of PED in an adult intensive care unit in a secondary public hospital in Brazil.

Method: The project followed the seven-phase JBI Evidence Implementation Framework to promote changes at the study site. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) approach were also used. The project was developed considering the main barriers to best practices, which were identified through a baseline audit. An educational program was designed to address the identified barriers. Two follow-up audits were then conducted to assess the changes in compliance with the evidence-based practices.

Results: The baseline audit showed deficits in current practices. The first follow-up audit indicated improved compliance with best practices, with five of the seven audit criteria showing 100% compliance. The second follow-up audit indicated that compliance remained at 100% for those five criteria and increased for the other two after an additional intervention to address poor results in nursing care documentation.

Conclusion: The first follow-up audit showed good adherence to the educational program for the screening and detection of PED by nurses. The second follow-up audit, in line with the new strategies, showed improvement in nursing documentation.

Spanish abstract: http://links.lww.com/IJEBH/A241.

简介:在重症监护病房接受插管和机械通气的患者有可能出现拔管后口咽吞咽困难(PED)。PED 可导致吸入并发症、吸入性肺炎和住院时间延长,并增加重复插管、院内发病率和死亡率:该循证实施项目旨在巴西一家二级公立医院的成人重症监护病房推广循证筛查和早期发现 PED:方法:该项目遵循JBI证据实施框架的七个阶段,以促进研究地点的变革。此外,还采用了JBI临床证据实际应用系统(PACES)和将研究付诸实践(GRiP)的方法。项目的制定考虑到了最佳实践的主要障碍,这些障碍是通过基线审计确定的。针对发现的障碍设计了一项教育计划。随后进行了两次后续审计,以评估在遵守循证做法方面的变化:结果:基线审计显示了当前实践中的不足。第一次跟踪审计表明,对最佳做法的遵守情况有所改善,七项审计标准中有五项达到了 100%。第二次跟踪审计表明,这五项标准的达标率仍为 100%,另外两项标准的达标率在采取额外干预措施以解决护理文件记录效果不佳的问题后有所提高:第一次跟踪审计表明,护士对筛查和检测 PED 的教育计划的遵守情况良好。西班牙文摘要:http://links.lww.com/IJEBH/A241。
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引用次数: 0
Assessment and management of post-surgical pain in adult patients undergoing thoracic surgery: a best practice implementation project. 胸外科手术成年患者术后疼痛的评估和管理:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-17 DOI: 10.1097/XEB.0000000000000449
Delia González de la Cuesta, Esther González María, Nieves López Ibort, Ana Carmen Lahuerta Martínez, Isabel de la Torre Arrieta, Ana Sofía Martínez Mompel, M Pilar Martín Ramo, Eva Belsue Cortés, Mariana Monge Nieto, Cristina Cayón Geli, Mercedes Nuria Ferrando Margeli

Introduction and objectives: Effectiv. e management of post-operative pain improves the condition of patients and reduces their hospital stay. This, in turn, has an impact on caregivers, professionals, and institutions and, as such, is considered a primary indicator of quality. The aim of this project was to improve the assessment and management of post-surgical pain in thoracic surgery patients.

Methods: This implementation project was conducted in a thoracic surgery unit of a tertiary hospital in Spain. The project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted with 44 patients, and barriers to best practice were identified. Strategies were then implemented to improve the assessment and management of post-operative pain. Three follow-up audits were performed using nine audit criteria with 34, 40, and 46 patients, respectively.

Results: The baseline audit revealed poor compliance with best practices. After implementing strategies to address areas of non-compliance, health education for patients and caregivers improved up to 80%, while the measurement of pain upon admission and post-surgery rose to 91%. However, patients undergoing pre-operative assessment to guide their post-operative pain management at hospital discharge remained below 50%.

Conclusions: Using a methodology to implement best practices, together with clinical audits, improved compliance with the use of validated scales to assess and manage pain. A multidisciplinary approach improves the quality of care received by patients and contributes to their recovery.

Spanish abstract: http://links.lww.com/IJEBH/A240.

导言和目标:有效控制术后疼痛可以改善患者的状况,缩短住院时间。这反过来又会对护理人员、专业人员和医疗机构产生影响,因此被视为衡量医疗质量的首要指标。本项目旨在改善胸外科患者手术后疼痛的评估和管理:该实施项目在西班牙一家三甲医院的胸外科进行。该项目以 JBI 证据实施框架为指导,该框架以审核、反馈和再审核策略为基础。对 44 名患者进行了基线审核,并确定了最佳实践的障碍。随后,实施了改进术后疼痛评估和管理的策略。采用九项审核标准对 34、40 和 46 名患者分别进行了三次后续审核:结果:基线审核结果显示,最佳实践的合规性较差。在针对不符合标准的地方实施了相关策略后,对患者和护理人员的健康教育提高到了 80%,而入院时和手术后的疼痛测量提高到了 91%。然而,接受术前评估以指导出院时术后疼痛管理的患者仍低于 50%:结论:采用一种方法来实施最佳实践,再加上临床审核,可以提高使用有效量表来评估和管理疼痛的依从性。多学科方法提高了患者接受护理的质量,有助于他们的康复。西班牙文摘要:http://links.lww.com/IJEBH/A240。
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引用次数: 0
Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project. 在马拉维引入多学科查房:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-04 DOI: 10.1097/XEB.0000000000000443
Beverley Johnson, Clare Bennett, Judith Carrier, Dianne Watkins, Chimwemwe Mula, Raphael Kazidule, Pricilla Salley, Miloslav Klugar, Jitka Klugarova

Introduction: The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction.

Objectives: This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi.

Methods: The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice.

Results: The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round.

Conclusions: This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care.

Spanish abstract: http://links.lww.com/IJEBH/A233.

导言:英国皇家内科学院(RCP)和皇家护理学院(RCN)提倡使用结构化的多学科小组(MDT)查房,因为这种查房可以实现安全、有效、更好的护理并提高员工满意度:本项目旨在马拉维一家医院的男科病房实施 MDT 查房的最佳实践:方法:该项目按照 JBI 证据实施框架进行。对六名工作人员进行了 MDT 查房基线审计。审核标准包括 JBI、RCP 和 RCN 推荐的十项最佳实践。召开了利益相关者会议,审查基线审计结果,并强调不符合标准的地方。利用 JBI 的 "将研究付诸实践"(GRiP)工具来确定遵守最佳做法的障碍,并进行后续审计以确定实践中的变化:结果:只有一项标准有所改善,即护士参加查房的比例从 33% 提高到 100%(n=6):本研究显示了证据实施项目中的一些挑战,以及如何部分克服这些挑战。虽然结果只显示了一项标准的改进,但本文显示了如何利用审计来促进最佳实践,在本案例中,护士更多地参与了查房,改善了多学科小组的沟通,加强了护士对决策的参与,从而改善了患者护理。西班牙文摘要:http://links.lww.com/IJEBH/A233。
{"title":"Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project.","authors":"Beverley Johnson, Clare Bennett, Judith Carrier, Dianne Watkins, Chimwemwe Mula, Raphael Kazidule, Pricilla Salley, Miloslav Klugar, Jitka Klugarova","doi":"10.1097/XEB.0000000000000443","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000443","url":null,"abstract":"<p><strong>Introduction: </strong>The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction.</p><p><strong>Objectives: </strong>This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi.</p><p><strong>Methods: </strong>The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice.</p><p><strong>Results: </strong>The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round.</p><p><strong>Conclusions: </strong>This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A233.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Frailty management in older patients: a best practice implementation project. 老年患者的虚弱管理:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-02 DOI: 10.1097/XEB.0000000000000442
Chih Wen Chen, Mei-Chen Lee, Kuei Fen Liu, Li-Ju Lin, Shu-Fang Vivienne Wu

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.

导言老年人体弱会导致器官功能逐渐衰退。如果不及时诊断和干预,这种情况会迅速恶化,增加残疾和死亡的风险:本项目的目的是在内科病房实施以证据为基础的体弱管理实践,以预防老年患者的残疾:该项目在概念上借鉴了 JBI 循证实施框架。该框架采用审计和反馈方法以及前后测试设计来衡量基线依从性,针对依从性方面的差距制定实施策略,并进行最终评估以衡量依从性方面的变化。JBI PACES 和 JBI GRiP 情境分析软件用于支持数据收集和实施规划。在台湾南部的一家地区教学医院中,对 30 名患者进行了抽样调查,采用了 10 项审计标准:结果:基线审核结果显示,所有十项审核标准的合规率均低于 30%。通过专业培训和教育、循证护理指南的实施以及跨学科共识的建立等策略,后续审核结果显示,每项审核标准的符合率都提高到了 90% 以上:结论:基于循证审计标准的虚弱管理策略得到了实施和常规衡量。提高合规性的最有效策略包括开发培训课程、数字化评估工具、团队会议、跨学科合作、沟通和建立共识。西班牙文摘要:http://links.lww.com/IJEBH/A225。
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引用次数: 0
Barriers and facilitators for the implementation of co-created nursing innovations in a Dutch university hospital. 荷兰一所大学医院实施共创护理创新的障碍和促进因素。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-28 DOI: 10.1097/XEB.0000000000000444
Myrthe van der Zanden, Onno Helder, Heleen Westland, Erwin Ista

Introduction: Escalating global nursing shortages require solutions for efficient care, fewer injuries and lost workdays. When commercial solutions are lacking, innovations developed through co-creation can be a viable alternative. However, many co-created nursing innovations are ineffectively implemented. Understanding the barriers and facilitators for the successful implementation of co-created nursing innovations is crucial.

Objective: This study explored nurses' perceived determinants influencing the implementation of co-created nursing innovations.

Methods: We conducted a qualitative study using semi-structured interviews with nurses at a Dutch university hospital who were working with co-created nursing innovations. The Theoretical Domains Framework (TDF) was employed to identify the barriers and facilitators. Data analysis followed a deductive theoretical thematic analysis approach based on the 14 TDF domains. Determinants were labeled as a barrier, facilitator, or both.

Results: Of the 14 TDF domains, 9 appeared relevant, including Intention, Professional Role and Identify, and Knowledge. The absence of a "superuser," lack of storage space, and negative experiences during use were perceived as barriers to the implementation of nursing innovations. The importance of time-saving features, user-friendliness, reminders to use the innovation, and team enthusiasm were perceived as facilitators.

Conclusions: Participants confirmed that the Social Influences domain, combined with Behavioral Regulation and Knowledge, were barriers to implementation, while Intentions and Reinforcements and Rewards were seen as facilitators.

Spanish abstract: http://links.lww.com/IJEBH/A235.

导言:全球护理人员短缺问题日益严重,这就需要有高效护理、减少受伤和损失工作日的解决方案。在缺乏商业解决方案的情况下,通过共同创造开发的创新方案不失为一种可行的替代方案。然而,许多共同创造的护理创新并未得到有效实施。了解成功实施共创护理创新的障碍和促进因素至关重要:本研究探讨了护士认为的影响共创护理创新实施的决定因素:我们采用半结构化访谈的方式,对荷兰一所大学医院中从事共创护理创新工作的护士进行了定性研究。我们采用了理论领域框架(TDF)来识别障碍和促进因素。数据分析采用基于 14 个 TDF 领域的演绎式理论主题分析方法。结果:在 14 个 TDF 领域中,有 9 个似乎与之相关,其中包括意图、专业角色和认同以及知识。没有 "超级用户"、缺乏存储空间以及使用过程中的负面体验被视为实施护理创新的障碍。省时功能的重要性、用户友好性、使用创新的提醒以及团队的热情被视为促进因素:参与者证实,社会影响领域以及行为调节和知识是实施的障碍,而意向和强化与奖励则被视为促进因素。西班牙文摘要:http://links.lww.com/IJEBH/A235。
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引用次数: 0
Fall assessment and intervention among community-dwelling older people in a primary health care center in Spain: a best practice implementation project. 西班牙一家初级医疗保健中心对居住在社区的老年人进行跌倒评估和干预:最佳实践实施项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-26 DOI: 10.1097/XEB.0000000000000440
María García Fernández, Mónica Martínez Pantiga, Carmen Pino Fernández, Laura Albornos Muñoz, Carmen Gutierrez Guerrero

Introduction: The implementation of fall prevention programs in the community is complex. Although there is solid scientific evidence that supports the effectiveness of such programs, there are multiple barriers that should be addressed using multifaceted strategies.

Aims: The aim of this project was to increase compliance with evidence-based recommendations regarding fall risk screening and preventive interventions among older adults in a primary health care setting.

Methods: This project used a pre-/post-implementation clinical audit based on the JBI Evidence Implementation Framework. Eight audit criteria were derived from JBI evidence summaries. The sample size was 62 patients aged 70 years or older. Data collection methods included a review of medical records and a questionnaire. A baseline audit was conducted and five barriers to best practice were identified. Strategies were then developed to increase compliance with the evidence-based recommendations, guided by JBI's Getting Research into Practice (GRiP) analysis. A follow-up audit was conducted in July 2022 to evaluate changes in compliance with best practices.

Results: The baseline audit showed 0% compliance with best practice recommendations for seven out of eight audit criteria. Five barriers were identified: (1) absence of fall risk screening tools, (2) lack of fall prevention intervention protocols, (3) insufficient reporting of fall episodes in the records, (4) need for staff training, and (5) high staff turnover. Following the implementation of a fall risk assessment and intervention protocol, along with staff training, seven out of eight audit criteria increased from 0% to between 22.6% and 100%.

Conclusions: This evidence-based implementation project improved nursing practice in relation to compliance with best practice interventions to prevent falls.

Spanish abstract: http://links.lww.com/IJEBH/A229.

前言在社区实施跌倒预防计划是一项复杂的工作。尽管有确凿的科学证据支持此类计划的有效性,但仍存在多种障碍,应采用多方面的策略加以解决。目的:本项目旨在提高基层医疗机构中老年人对有关跌倒风险筛查和预防干预措施的循证建议的依从性:方法:该项目采用基于 JBI 循证实施框架的实施前/后临床审核。八项审核标准来自 JBI 证据摘要。样本量为 62 名 70 岁或以上的患者。数据收集方法包括审查医疗记录和问卷调查。通过基线审核,确定了最佳实践的五个障碍。随后,在 JBI 的 "将研究付诸实践"(GRiP)分析指导下,制定了提高循证建议依从性的策略。2022 年 7 月进行了一次后续审计,以评估最佳实践遵守情况的变化:基线审计显示,在八项审计标准中,有七项与最佳实践建议的符合率为 0%。发现了五个障碍(1) 缺乏跌倒风险筛查工具,(2) 缺乏预防跌倒干预方案,(3) 记录中对跌倒事件的报告不足,(4) 需要对员工进行培训,以及 (5) 员工流失率高。在实施了跌倒风险评估和干预方案以及员工培训后,八项审计标准中的七项从 0% 提高到了 22.6% 到 100% 之间:该循证实施项目改善了护理实践中对预防跌倒最佳干预措施的遵守情况。西班牙文摘要:http://links.lww.com/IJEBH/A229。
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引用次数: 0
Goal-oriented temperature management in severely traumatized children in the emergency department: an evidence-based practice project. 以目标为导向的急诊科严重创伤儿童体温管理:循证实践项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-06-25 DOI: 10.1097/XEB.0000000000000439
Wenchao Wang, Yanhong Zhang, Fang Ling, Shenjie Hu, Ying Gu

Introduction and objectives: Hypothermia commonly occurs in trauma patients. Evidence-based practices for hypothermia prevention are not strictly followed by all medical staff in the emergency department. This study aimed to assess compliance with evidence-based practices regarding goal-oriented temperature management for severely traumatized children in a Chinese hospital.

Methods: This project used the JBI Evidence Implementation Framework to translate evidence into practice. The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used to identify barriers to compliance with best practices. A goal-oriented temperature management strategy for trauma patients was developed based on the identified barriers, along with a simulation training module, and the supply of warming materials. Field observation, review of medical records, and interviews with medical staff and patients were used to assess baseline and follow-up audit compliance with best practices.

Results: Twelve criteria were audited in the baseline and follow-up audits, with 11 and 37 trauma patients, respectively. In the follow-up audit, compliance with all criteria increased, with a reduction in shivering and cold discomfort scores. Except for two patients who died, hypothermia did not occur in any of the patients.

Conclusions: The JBI Evidence Implementation Framework was used to successfully improve compliance with best practices. Future audits should be conducted to sustain the evidence-based behavior of all medical staff.

Spanish abstract: http://links.lww.com/IJEBH/A234.

导言和目标:体温过低通常发生在创伤患者身上。在急诊科,并非所有医务人员都严格遵守以证据为基础的低体温预防措施。本研究旨在评估一家中国医院中严重创伤儿童目标导向体温管理的循证实践的遵从情况:方法:该项目采用了JBI证据实施框架,将证据转化为实践。方法:该项目采用JBI证据实施框架,将证据转化为实践,并采用卫生服务研究实施综合促进行动(i-PARIHS)框架来识别最佳实践的遵从障碍。根据识别出的障碍,为创伤患者制定了以目标为导向的体温管理策略,并提供了模拟培训模块和保暖材料。通过实地观察、查阅医疗记录、采访医务人员和患者,对最佳实践的基线和后续审核遵守情况进行了评估:在基线和后续审核中,分别对 11 名和 37 名创伤患者的 12 项标准进行了审核。在后续审核中,所有标准的合规性都有所提高,颤抖和寒冷不适的评分有所下降。除两名死亡患者外,其他患者均未出现体温过低的情况:结论:使用 JBI 证据实施框架成功地提高了最佳实践的合规性。今后应进行审计,以维持所有医务人员的循证行为。西班牙文摘要:http://links.lww.com/IJEBH/A234。
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Jbi Evidence Implementation
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