Jbi Evidence Implementation最新文献

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.

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 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.

Introduction: People with stroke are at risk of poor oral hygiene caused by neurological deficits, which can be motor, sensory, or cognitive. Good oral hygiene has been shown to reduce adverse events and improve the patient's quality of life. Although nurses recognize the benefits of oral hygiene, evidence shows that this area of care is frequently overlooked.

Aim: This evidence implementation project aimed to improve oral hygiene in stroke patients through the application of best practices.

Methods: This project was conducted in a stroke unit in a hospital in northern Portugal. The project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Four audit criteria were used in the baseline and follow-up audits. Observation of nursing care and analysis of nursing records were used to assess current practice against best practice recommendations. Nurses were engaged in the project through brainstorming to identify barriers, co-create strategies to address the barriers, and ensure project sustainability.

Results: The baseline audit revealed low compliance with the four audit criteria. The follow-up audit showed increased compliance, with Criterion 1 improving from 0% to 100%, with all nurses receiving training on oral hygiene assessment and management. Compliance increased by 40% for Criterion 2 and 36.7% for Criteria 3 and 4, respectively.

Conclusions: The project successfully promoted compliance with best practice recommendations and increased evidence-based practice for oral hygiene in patients with stroke in a stroke unit.

Spanish abstract: http://links.lww.com/IJEBH/A302.

Introduction: Falling out of bed is the most common unintentional cause of injury among patients and is a major safety problem in health care facilities. Current practices for fall prevention may not always be aligned with established best practices, leading to variability in patient outcomes. This uncertainty underscores the need to assess and improve compliance with best practice guidelines for fall prevention.

Objectives: This project aimed to improve fall prevention in the surgical ward of a general hospital in Tabriz, Iran.

Methods: This study was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted using 11 audit criteria representing best practices for fall prevention. After the implementation of improvement strategies, a follow-up audit was conducted to evaluate changes in practice.

Results: The results revealed significant improvements, notably, fall risk assessment upon admission (87% to 92%), fall risk assessment upon ward transfer (39% to 79%), patient participation in fall risk assessment (26% to 68%), reassessment upon change in condition (53% to 74%), communicating fall prevention information to at-risk patients and their families/caregivers (42% to 63%), engagement of patients (100% to 100%), implementation of targeted strategies (89% to 92%), post-fall assessment and interventions (82% to 87%), revising patient fall risk status and reviewing care management plan (41% to 74%), fall prevention information to patients and their families/caregivers upon discharge (44% to 66%), and person-centered education of health care professionals (77% to 81%).

Conclusion: The use of standard clinical audit tools in hospitals can improve the quality of patient care and increase the effectiveness of interventions by identifying weaknesses in the patient care process.

Spanish abstract: http://links.lww.com/IJEBH/A283.

Introduction: Many factors can influence the implementation of innovations in aged care.

Aim: This study aimed to develop a comprehensive Readiness Assessment Tool (Tool) to support aged care organizations' implementation efforts.

Method: Our study employed a structured, two-stage approach. In Stage 1, we conducted a secondary analysis of a scoping review to identify factors that indicate implementation readiness. The findings were synthesized and refined through consultations with a Research Advisory Group. We then applied a modified Delphi technique in Stage 2 to refine and validate the Tool. Participants were involved in two rounds of surveys where they could rate each statement's importance and provide detailed feedback, ensuring the Tool's clarity, relevance, and practicality.

Results: The secondary analysis of the scoping review yielded 93 statements encapsulating key readiness factors for implementing innovations in aged care. Two Delphi study rounds reduced this to 51 essential statements organized into five key categories: individual attitudes and capabilities, organizational context, characteristics and fit of the innovation, interpersonal interactions and connections, and implementation strategies.

Conclusion: Our study presents a comprehensive, user-friendly Tool specifically designed to guide the preparation for implementing innovations in aged care. This new Tool can enhance the capacity of aged care organizations to implement innovations effectively and sustainably, supporting improved care quality and operational resilience. Future work could involve longitudinal studies to validate the Tool's impact on innovation processes and outcomes across various aged care settings.

Spanish abstract: http://links.lww.com/IJEBH/A393.

Introduction: Hospital-acquired infections (HAIs) have a significant effect on the quality of patient care as well as increasing hospital costs in adult intensive care units (ICUs). The ICU infection rate at the study hospital (10.6‰) exceeded acceptable standards.

Aims: This study aimed to reduce the HAI rate in the adult ICU through chlorhexidine gluconate (CHG) bathing, in line with evidence-based practices.

Methods: This project followed the JBI Evidence Implementation Framework, supported by JBI's Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tool. Rogers' Diffusion of Innovations Theory was used to guide the change process. The study was conducted in a hospital in northern Taiwan. Baseline and follow-up audits were conducted involving 450 patients and 321 nurses across 12 adult ICUs. The audit criteria were derived from evidence-based recommendations.

Results: Post-implementation audit compliance rates improved significantly. Daily bathing of ICU patients with CHG increased from 24% to 96%; education of nursing staff on CHG bathing increased from 30.5% to 100%; documentation of patient hypersensitivities and allergies to CHG increased from 40% to 98%; and use of non-chlorhexidine soap and water for patients allergic to CHG increased from 76% to 100%. Following implementation of the project, the monthly incidence density of HAIs decreased markedly from 10.6‰ to 6.1‰.

Conclusions: The implementation of best practices significantly reduced HAIs in adult ICUs across the hospital. Key success factors included information technology, flat-structure communication, a top-down strategy, accountable management, and a centralized materials supply. These factors facilitated adoption of the project simultaneously across multiple units.

Spanish abstract: http://links.lww.com/IJEBH/A378.

Introduction: Telehealth services integrate technology with specialized medical care, and can be used to improve blood sugar management and reduce complications in patients with type 2 diabetes.

Objectives: This study aimed to improve telemedicine care for patients with type 2 diabetes in public health centers in remote Indigenous communities in Taiwan through evidence-based practices. This included increasing the rates of ophthalmic examinations and enhancing the capacity of health care providers.

Methods: This project followed the JBI Evidence Implementation Framework and was supported by the JBI Practical Application of Clinical Evidence System (PACES). Baseline and follow-up audits were conducted among health care providers and patients with type 2 diabetes to measure compliance with best practices and determine any improvements in practice after implementation. HbA1c levels in patients with type 2 diabetes were analyzed using paired sample t -tests, with statistical significance set at p  < 0.05.

Results: The follow-up audit revealed that compliance rates for the six audit criteria improved, with Criteria 1-5 increasing from 62.5% to 87.5% or 100%. Additionally, Criterion 6 improved from 37.5% to 62.5%. The HbA1c values of the patients showed pre- and post-intervention means of 7.8291% and 7.3236%, respectively.

Conclusions: Using a coaching leadership model along with JBI audit criteria to enhance the knowledge and skills of health care providers was essential for the success of the project. This approach resulted in significant advancements in caring for people with type 2 diabetes.

Spanish abstract: http://links.lww.com/IJEBH/A377.

Introduction and objectives: Venous leg ulcers are the most common ulcerations of the lower extremities. Compression is the most important consideration and the gold standard treatment for venous leg ulcers. This implementation project aimed to promote best practices in the management of venous leg ulcers in a rural community-care setting.

Methods: This project was guided by the JBI Evidence Implementation Framework, which is grounded in audit and feedback processes, along with a structured approach to identifying and managing barriers to compliance with recommended best practices.

Results: Compliance with best practices increased for most audit criteria. The use of compression therapy increased from 16.7% to 60%, documentation increased from 6.7% to 50%, replacement of compression bandages from 6.7% to 60%, patient education from 0% to 46.7%, and holistic assessment from 0% to 13%. However, compliance for individualized interventions to promote adherence remained at 0%.

Conclusions: This project succeeded in introducing compression therapy as a basic treatment for venous ulcers. However, continued improvement in the care for venous ulcers and guarantee of long-term implementation of evidence are necessary.

Spanish abstract: http://links.lww.com/IJEBH/A212.

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.