Jbi Evidence Implementation最新文献

Introduction: Post-operative pain is the most prevalent type of acute pain. Nurses are the health care professionals who most frequently assess pain, as well as evaluating the patient's response to pain management treatment and monitoring for the occurrence of adverse events. Thus, to improve outcomes and quality of care, the interventions used by nurses should be based on best practices.

Objectives: The aim of this project was to implement best practices in post-operative pain management in an intensive care unit.

Methods: This evidence implementation project was conducted in a hospital for the surgical treatment of orthopedic diseases and trauma. The project followed the JBI evidence implementation framework. The project used JBI PACES software as well as JBI's Getting Research into Practice (GRiP) audit and feedback tools to develop eight audit criteria for the baseline and follow-up audits.

Results: The baseline audit showed that criteria 3 and 6 had low compliance, with few patients having documented plans and goals, and receiving multimodal analgesia in the ICU, respectively. Criteria 7 and 8, which assessed the use of opioids and follow-up by a pain specialist, revealed compliance of 60% and 50%, respectively. Criterion 3 improved from 0% to 20%. Criteria 6, 7, and 8 also improved, rising to 30%, 22.8%, and 50%, respectively.

Conclusion: The project improved compliance with best practices in post-operative pain management. Further studies are needed to ensure the project's long-term sustainability.

Introduction: The emergency department is a fast-paced and complex health care setting, where critical care is provided to patients of all ages. However, various environmental factors, such as high patient volumes, overburdened staff, and frequent nurse turnover, can hinder the use of evidence-based practices during procedural sedation. Proper patient monitoring is essential to prevent adverse events during procedural sedation.

Objectives: The goal of this implementation project was to enhance compliance with best practices for patient monitoring during procedural sedation in the emergency department.

Methods: The project used the JBI Model of Evidence-Based Healthcare and JBI's Getting Research into Practice (GRiP) tool for implementing evidence-based monitoring practices for adult patients during procedural sedation in the emergency department. A baseline audit was conducted to assess current practice against evidence-based recommendations, followed by the implementation of strategies to improve compliance with best practices. The project concluded with a follow-up audit to determine any improvement in practice.

Results: The baseline audit revealed 81% overall compliance with evidence-based practice. Three barriers were identified, namely, lack of staff education, increased turnover rate of nurses, and the need for nurses to be mobile during procedural sedation. Strategies were implemented to improve compliance with evidence-based practice. The follow-up audit showed an overall improvement of 95% after project implementation.

Conclusions: The project improved best practices for patient monitoring during procedural sedation in the emergency department. However, more work remains to be done to ensure the sustainability of the best practices, including monitoring of end-tidal capnography and vital sign assessment.

Introduction: Immunosuppressed patients face increased health risks due to infections such as influenza or COVID-19. Scientific evidence supports improved health-related outcomes in this patient population, such as reduced hospitalizations, with up-to-date vaccinations. The project setting, a community-based rheumatology clinic, did not have a vaccination record specific to the needs of immunosuppressed patients, which may lead to a suboptimal immunization status in these patients.

Objective: This project aimed to promote evidence-based practices regarding the use of vaccinations in patients diagnosed with autoimmune disorders receiving immunosuppressive agents.

Methods: This project used the JBI evidence implementation framework to promote best practices regarding vaccination. Two audit criteria were identified using a JBI Evidence Summary. Baseline audits identified gaps between the evidence and current practice. Barriers to best practice were then identified, and strategies implemented. Post-implementation audits measured changes in compliance.

Results: Baseline audits revealed 67% compliance with the two best practices. Barriers included a lack of provider awareness of the current vaccination recommendations for immunosuppressed patients and a lack of customizable vaccine records. Strategies to address these barriers included educating providers about current national vaccination recommendations and implementing a new patient vaccination history intake form. Post-implementation audits revealed 83% compliance, with a 16% increase from baseline.

Conclusions: This evidence-based implementation project enhanced best practices by educating providers and implementing an updated patient vaccination history form. Recommendations include the improved compliance with the use of the new form and to assess the effectiveness and usability of a customizable electronic form that interfaces with the clinic's electronic medical records.

Objective: The aim of this best practice implementation project was to promote evidence-based practices (EBPs) for human papilloma virus (HPV) vaccination among eligible HIV-positive patients.

Introduction: HPV-induced cancers are largely preventable by prophylactic vaccination of HPV-naïve individuals. Immunosuppression in HIV-positive patients prevents clearance of HPV, which increases the risk of developing cancer. Health care agencies caring for individuals living with HIV must implement interventions to enhance uptake of HPV vaccination.

Methods: This project was guided by the JBI Model of Evidence-Based Healthcare and JBI's Getting Research into Practice (GRiP) tool. A baseline audit was conducted to assess current practice against EBPs and to identify areas for improvement. A follow-up audit was used post-implementation to determine whether compliance with EBPs improved.

Results: The baseline audit revealed an average compliance rate of 46% with the two EBPs for increasing vaccination uptake. Three barriers to compliance were identified and strategies were implemented to address these barriers. The follow-up audit revealed 71% average compliance with the EBPs, a 25% increase from baseline.

Conclusions: Interventions aimed at promoting HPV vaccination among HIV-positive individuals can reduce the risk of specific cancers. This project revealed an increase in compliance with EBPs for HPV vaccination for eligible HIV-positive patients when a vaccination reminder and recall system was placed in a frequently visited section of the electronic health record. However, a more sustainable solution would be to collaborate with the information technology staff to ensure that the health maintenance section in the electronic health record is configured correctly.

Objective: The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care.

Introduction: Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care.

Inclusion criteria: This review included studies of any design, that examined the implementation of innovations in aged care settings.

Methods: Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops.

Results: Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies.

Conclusions: Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.

Objectives: The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients.

Introduction: The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care.

Methods: This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients.

Results: The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit.

Conclusion: The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

Introduction: Poststroke depression (PSD) is common but insufficiently addressed by health professionals, and management is not always evidence-based.

Objectives: This evidence implementation project aimed to improve adherence to evidence-based practice for screening, prevention, and management of patients with PSD in the neurology ward of the Fifth Affiliated Hospital of Zunyi Medical University, China.

Methods: This project was based on the JBI methodological approach and was conducted in three phases, from January to June 2021: a baseline audit, implementation of strategies, and a follow-up audit. We utilized the JBI Practical Application of Clinical Evidence System software and the Getting Research into Practice tools. Fourteen nurses, 162 stroke patients, and their caregivers participated in this study.

Results: The results of the baseline audit showed that compliance with evidence-based practice was poor, with 3/6 criteria showing 0% adherence and the other three audit criteria showing 5.7, 10.3, and 49.4% adherence, respectively. Through feedback to nurses regarding the baseline audit results, the project team identified five barriers and adopted a battery of strategies to overcome these barriers. The follow-up audit revealed significantly enhanced outcomes across all the best practice criteria, and the compliance of each criterion reached at least 80%.

Conclusion: The implementation program designed to screen, prevent, and manage PSD in a tertiary hospital in China improved nurses' knowledge and compliance with evidence-based management of PSD. Further testing of this program in more hospitals is needed.

Background: Prescription writing error is a common phenomenon in the health sector. Appropriate handwritten prescription practices minimize medical errors during medical drug dispensing.

Objectives: This project aimed to identify the extent to which clinicians adhere to handwritten drug prescription best practices and implement evidence-based strategies to improve compliance with handwritten prescription best practices in an outpatient department.

Methods: The project was conceptually informed by the JBI Model of Evidence-Based Health care and the JBI Evidence Implementation Framework. Baseline and follow-up audit data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. The JBI Getting Research into Practice (GRiP) program was used to identify potential barriers and design intervention strategies. The project was conducted in a public hospital outpatient department in Uasin Gishu County, Kenya.

Results: There was a 100% improvement in compliance with the number of prescribers who had received education on essential features of a handwritten drug prescription. High compliance was observed in prescriptions that indicated the patient name (99%) and date of prescription (98%) in the follow-up audit. Approximately half of the prescriptions included a diagnosis of the disease in both the baseline and the follow-up audit. However, in the follow-up audit, only 21% of the prescriptions had legible handwriting and 27% prescribed drugs using the generic drug name.

Conclusion: Regular audits and dissemination of audit findings through continuous medical education, hospital communication forums, and notices improved compliance with the number of prescriptions that contained the patient identifier and the date of prescription.

Objectives: This project determined current compliance with best practice recommendations for self-management in patients with multiple sclerosis (MS) and used a web-based intervention to implement strategies to improve the quality of self-management in discharged patients with MS.

Methods: Guided by the JBI Evidence-based Model of Health care, this project applied the 7 phases of the JBI Evidence Implementation Framework to improve the quality of self-management in MS patients.

Results: After implementation, compliance significantly improved across all criteria compared with the baseline audit. All patients were assessed to determine their ability to self-manage (Criterion 1). All health care providers were trained to facilitate self-management and behavioral change (Criterion 2). All patients had self-management goals and action plans that were set together by both health care providers and patients (Criteria 3, 5, 6, 7). All patients received education through online patient education courses and were given an education handbook (Criterion 4). The agreed action plan was documented (Criterion 8). All members of the multidisciplinary team coordinated the services required by the patients (Criterion 9) and provided appropriate support to help patients achieve their goals and solve problems through a WeChat group and the communication module on the self-management online platform (Criterion 10).

Conclusion: This implementation project effectively promoted practice change by enhancing patients' knowledge of self-management and staff awareness of delivering self-management support to MS patients.