Jbi Evidence Implementation最新文献

Introduction: Effective communication is essential in dementia care, as it helps reduce patient anxiety and enhance caregiver-patient interactions. However, many caregivers lack specialized training in dementia communication, leading to challenges in daily care.

Objective: This project aimed to enhance dementia communication skills among caregivers at the Hua-Suei Nursing Home in Taiwan by addressing training barriers and implementing best practices.

Methods: A three-phase approach was used, following the JBI Evidence Implementation Framework. This included a baseline audit of compliance with seven JBI-recommended best practice criteria, tailored improvement strategies using the JBI Getting Research into Practice (GRiP) approach, and a follow-up audit to measure changes. The Dementia Communication Knowledge Assessment (DCKA) quiz evaluated caregivers' knowledge before and after the training.

Results: At baseline, 92% of caregivers received classroom-based training, but only 30.4% observed instructors frequently asking questions, and 17.4% saw tailored content. None of the participants had specific dementia communication training, resulting in 0% compliance with detailed enquiries. The average pre-training score was 56.8/100. After implementing strategies such as adaptive scheduling and multifaceted training, compliance rates improved to 100% across all criteria in the follow-up audit. The average post-training score increased to 96.8/100, indicating significant enhancement in caregivers' understanding and application of dementia communication techniques.

Conclusions: The project improved compliance with best practices and enhanced the caregivers' dementia communication skills. Correcting the misconception that general dementia training is sufficient is therefore crucial. Sustainable improvement requires ongoing professional development, integrating training into organizational culture, and regular follow-up audits. Future efforts should expand these training programs and examine their long-term impact on caregiver performance.

Spanish abstract: http://links.lww.com/IJEBH/A360.

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.

Background: Effective delirium management is crucial, considering its association with adverse outcomes. Adherence to best practices has the potential to reduce the incidence and prevalence of delirium and improve health outcomes.

Objectives: The objectives of this project were to describe self-assessed adherence to best practices in delirium management by health care professionals in intensive care units (ICUs) in Brazil, assess the health care professionals' perception of the importance of adequate delirium prevention and treatment in ICUs, and compare the compliance rates with best practices between public and private ICUs.

Method: A cross-sectional study was conducted in Brazil using an online questionnaire consisting of three parts, namely, data about the health care professionals and the ICU in which they worked; statements about the 17 best practices; and questions related to perceptions of delirium prevention and management by ICU physicians and nurses. The survey was sent to email addresses registered with the Brazilian Association of Intensive Care Medicine.

Results: The compliance rate exceeded 50% for only eight best practices. These included the identification and management of pressure sores and falls in delirium patients, with compliance rates of 77.8% and 74.1%, respectively.

Conclusion: Among ICU professionals in Brazil, adherence to best practices in delirium management is low, particularly for practices involving patient education and involvement of their relatives in their care. These results emphasize the importance of enhancing delirium management in Brazilian health care institutions, regardless of hospital classification.

Spanish abstract: http://links.lww.com/IJEBH/A274.

Introduction: Champions are a well-recognized strategy for supporting the implementation of innovations in care settings, yet there is limited clear guidance to support their use in the particular context of aged care.

Aim: This study aimed to identify key lessons for optimizing the use of champions as an implementation strategy in aged care settings.

Methods: We conducted a secondary analysis of literature included in a recent scoping review on implementing innovations in aged care.

Results: The individuals who acted as champions came from a variety of roles and disciplines. The functions performed by champions largely involved influencing others, as well as other activities such as facilitating, educating, enabling, and reinforcing implementation. Key characteristics of champions included being enthusiastic and well-regarded by others, as well as having empathy and appropriate skills and knowledge. Champions were reportedly challenged by resourcing issues such as high workload, staff turnover, and competing priorities. The support of leaders and peers, a clearly identified role, adequate training, and appropriate selection were identified as key to optimizing champions' effectiveness.

Conclusions: For champions to be an effective implementation strategy, the champions need to be carefully selected, appropriately trained, and well supported. These findings can inform approaches to optimize the use of champions for implementing innovations in aged care.

Spanish abstract: http://links.lww.com/IJEBH/A318.

Introduction: Opioid drug use is increasing at alarming rates. Educating non-medical bystanders on opioid overdose recognition and reversal techniques is critical in preventing fatal opioid overdoses in the public school setting.

Objective: The objective of this project was to improve non-medical bystanders' response to opioid overdose within a public school setting by educating school staff members on the signs of opioid overdose and the administration of the opioid antagonist, naloxone.

Methods: The JBI Evidence Implementation Framework was used in this project to optimize compliance with best practices for the early identification of the signs and symptoms of opioid overdose and its prevention by administering naloxone.

Results: Educating non-medical bystanders regarding opioid overdose prevention measures can improve the response and outcome of a potential opioid overdose in the public school setting. Training was provided to educate non-medical staff about best practice recommendations, which could potentially prevent a fatality on campus related to opioid drug use. The pre- and post-audit results determined whether best practice recommendations were followed in the implementation strategies regarding opioid overdose prevention and naloxone administration.

Conclusions: Opioid overdose prevention education and training should be completed yearly during staff development for non-medical bystanders in the public school setting. By increasing awareness of signs and symptoms related to opioid overdose, prevention measures can be deployed to decrease the likelihood of a fatality of a student, staff member, or campus visitor while on school grounds. Continued education is vital and should be supported, utilized, and encouraged by the school district.

Spanish abstract: http://links.lww.com/IJEBH/A372.

Introduction: Pre-operative stoma site marking is a strongly recommended practice for preventing complications and improving the health-related quality of life of intestinal stoma patients. Despite its benefits, this practice is not routinely implemented in clinical practice.

Objectives: This study aimed to increase the rate of pre-operative stoma site marking.

Methods: This evidence implementation project was conducted in three hospitals at the Brandenburg Medical School, Germany. The project followed the seven-stage JBI audit and feedback process recommended in the JBI Evidence Implementation Framework: (1) identification of practice area for change, (2) stakeholder involvement, (3) situational analysis of context, (4) baseline audit of stoma site marking rate, (5) strategy implementation (workshops with surgeons in each hospital to discuss baseline results), (6) 1-year follow-up audit, and (7) assessing the sustainability of practice changes.

Results: The baseline audit revealed the following marking rates: 163 of 305 cases (53%) were marked across the three hospitals between 2017 and 2022. Elective cases were more often marked (145 of 200, 73%) than emergency cases (18 of 105, 17%). Barriers included poor physical state of emergency patients, lack of time, memory recall, and communication issues between surgeons and nurses. At follow-up 1 year after the workshops, 86 of 173 cases (50%) were marked (elective cases: 57 of 80, 71%; emergency cases: 29 of 93, 31%).

Conclusions: Audit and feedback did not increase the overall rate of pre-operative stoma site marking, but did improve the rate in emergency cases. A single workshop may be insufficient to effect change. Electronic patient data lacked standardized documentation for pre-operative stoma site marking.

Spanish abstract: http://links.lww.com/IJEBH/A329.

Introduction: In pediatric inpatient settings, there has been an increase in patients with mental health problems who display aggressive behavior toward staff.

Aim: The aim of this project was to prevent aggression in patients in a pediatric inpatient unit through the promotion of best practices.

Methods: The project was guided by the JBI Model of Evidence-Based Health care and the JBI Evidence Implementation Framework. An audit and feedback strategy was used, with baseline and follow-up audits conducted. Eight evidence-based practices were used for the audit criteria. Strategies to improve compliance with best practices were implemented following the baseline audit. A follow-up audit was conducted to measure any changes in clinical practice.

Results: Gaps between evidence and practice were identified for three of the audit criteria. Barriers included the lack of a policy for preventing or managing aggressive behavior in patients, the lack of a process to identify triggers of aggressive behavior, and inconsistent use of the aggression prevention care plan in the electronic health record. To address these barriers, the project team created a unit protocol, or written guidance, for preventing aggressive behavior, implemented a process to document triggers, and developed a general aggression care plan in the electronic health record. Overall compliance with evidence-based practices increased from 30% to 34%.

Conclusions: This evidence implementation project used a clinical audit process, which led to a small overall improvement in compliance with evidence-based practices. This project has a potential long-term benefit, with staff being better prepared to prevent aggressive outbursts in patients in the general pediatric unit. However, further work is required to continue improving compliance with evidence-based practices.

Spanish abstract: http://links.lww.com/IJEBH/A358.

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.

Introduction: Diarrhea, the most common complication for patients during enteral nut. rition, poses a range of risks and care burdens. Medical staff are aware of the importance of proactively preventing and managing enteral nutrition-related diarrhea. However, clinical prevention and management methods are not standardized, and the scientific basis and effectiveness of these methods need to be further verified.

Objectives: This project aimed to promote evidence-based practices for the prevention and management of enteral nutrition-related diarrhea among adult inpatients in a public tertiary hospital in China.

Methods: This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tools. Twelve audit criteria were developed to conduct a baseline audit to measure compliance with best practices. A barrier analysis was conducted, and strategies were implemented to overcome the barriers. The project was finalized with a follow-up audit to determine any changes in compliance with best practices.

Results: The overall compliance rate for the audit criteria increased from 27.37% at baseline to 89.62% in the follow-up audit, with six criteria achieving a compliance rate of 100%.

Conclusions: The implementation of evidence-based practices can effectively narrow the gap between current practice and best practice. This project improved the ability of medical staff to prevent and manage enteral nutrition-related diarrhea, as well as promoting evidence-based practice in the hospital.

Spanish abstract: http://links.lww.com/IJEBH/A168.