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Barriers to upper gastrointestinal screening among the general population in high-prevalence areas: a cross-sectional study. 在高患病率地区的普通人群中进行上消化道筛查的障碍:一项横断面研究。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1097/XEB.0000000000000396
Xin Chen, Yuan Ze, Wanya Yi, Yuling Yang, Renjuan Sun, Huiming Tu

Background: In China, there are large differences between regions in the use of gastroscopies and public awareness of upper gastrointestinal (UGI) screening.

Objective: This study investigated the current context and analyzed the barriers that influence UGI screening behavior among the general population in UGI cancer high-prevalence areas.

Methods: A total of 320 participants anonymously answered an online questionnaire. The rank sum test was used to analyze the difference in the scores of the UGI screening awareness questionnaire among participants with different socio-demographic characteristics. Using the awareness level of UGI screening and gastroscopy as the dependent variable, and the socio-demographic characteristics as the independent variable, simple linear regression and binary logistic regression analysis were used to determine the factors influencing attitudes toward gastroscopy screening. We used Spearman's correlation analysis to examine the correlation between UGI screening awareness level and willingness to undergo a gastroscopy.

Results: There was a correlation between the willingness to undergo gastroscopy and the awareness level of UGI screening (r = 0.243, p < 0.001). Linear regression analysis found that age, type of residence, education level, employment status, monthly income, history of gastroscopy, dietary habits, physical exercise, and convenience in obtaining information were significantly correlated with the awareness level of UGI screening ( p < 0.05). Binary logistic regression analysis found that factors significantly associated with gastric cancer screening behavior include residence, monthly income, and self-perceived health status ( p  < 0.05).

Conclusion: It is necessary to improve education about UGI cancer and screening knowledge, with a focus on populations with lower education and income.

背景:在中国,胃镜检查的使用和公众对上胃肠道(UGI)筛查的认识在地区之间存在较大差异。目的:本研究调查UGI癌症高发地区普通人群UGI筛查行为的现状,分析影响UGI筛查行为的因素。方法:共有320名参与者匿名填写在线问卷。采用秩和检验分析不同社会人口特征的被试在UGI筛选意识问卷得分上的差异。以UGI筛查和胃镜检查的知晓程度为因变量,社会人口学特征为自变量,采用简单线性回归和二元logistic回归分析确定胃镜检查态度的影响因素。我们使用Spearman相关分析来检验UGI筛查意识水平与接受胃镜检查意愿之间的相关性。结果:接受胃镜检查的意愿与UGI筛查的知晓程度存在相关性(r = 0.243, p < 0.001)。线性回归分析发现,年龄、居住类型、受教育程度、就业状况、月收入、胃镜病史、饮食习惯、体育锻炼、信息获取便利性与UGI筛查知晓程度显著相关(p < 0.05)。二元logistic回归分析发现,与胃癌筛查行为显著相关的因素包括居住地、月收入和自我感知健康状况(p)。结论:有必要加强对UGI癌和筛查知识的教育,重点关注教育程度和收入较低的人群。
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引用次数: 0
Massive multi-site audit projects: preparation, organization, and project management. 大规模多地点审计项目:准备、组织和项目管理。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-05-01 DOI: 10.1097/XEB.0000000000000427
Yanni Wu
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引用次数: 0
Health care providers' communication with pediatric patients and carers: a best practice implementation project. 医疗服务提供者与儿科患者和护理人员的沟通:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-29 DOI: 10.1097/XEB.0000000000000425
Maryam Shoaran, Sakineh Hajebrahimi, Neda Kabiri, Hanieh Salehi Pourmehr, Amin Talebpour

Introduction and objectives: Health care providers need a high level of communication skills in dealing with pediatric patients and their carers. The objective of this project was to evaluate current practice and implement best practices promoting health care provider communication with pediatric patients and carers in a children's hospital in Tabriz, Iran.

Methods: This project used the JBI Model of Evidence-Based Healthcare, which guided the conceptualization of evidence implementation, context analysis, project implementation, and evaluation of outcomes using evidence-based quality indicators. An audit and feedback strategy was adopted to measure baseline compliance with best practices, develop strategies to address areas of non-compliance, and conduct a final audit to measure any changes in compliance. Four criteria were developed for the baseline and follow-up audits. Criteria 1 and 2 were evaluated using a sample of 30 health care providers, while Criteria 3 and 4 were evaluated using a sample of 80 pediatric patients and carers.

Results: All four criteria improved at the end of the project. Criterion 1 (health care staff receive communication skills training) had the highest mean score at baseline and follow-up (63% and 83%, respectively). Criterion 2 (implementation of local strategies by health care organizations) increased from 45% to 55%. However, this rate of improvement was the lowest of all the criteria. Criterion 3 (pediatric patients receive relevant education) improved from low to moderate, rising from 18% to 49%. A more significant improvement was noted for Criterion 4 (parents receive relevant education), which rose from 19% to 56%.

Conclusions: The strategies implemented in this project successfully improved health care provider communication with pediatric patients and their carers. To ensure project sustainability, repeat audits will be conducted after 3, 6, and 12 months.

Spanish abstract: http://links.lww.com/IJEBH/A199.

导言和目标:医护人员在与儿科病人及其护理人员打交道时需要具备高水平的沟通技巧。本项目旨在评估伊朗大不里士一家儿童医院的现行做法,并实施促进医护人员与儿科患者及其护理人员沟通的最佳做法:本项目采用了 JBI 循证医疗模式,该模式指导了循证实施的概念化、背景分析、项目实施以及使用循证质量指标对结果进行评估。该项目采用审计和反馈策略来衡量最佳实践的基线达标情况,制定策略以解决不达标的领域,并进行最终审计以衡量达标情况的变化。为基线审计和后续审计制定了四项标准。标准 1 和标准 2 的评估对象是 30 名医疗服务提供者,标准 3 和标准 4 的评估对象是 80 名儿科患者和护理人员:结果:在项目结束时,所有四项标准都有所改善。标准 1(医护人员接受沟通技巧培训)在基线和后续评估中的平均得分最高(分别为 63% 和 83%)。标准 2(医疗机构实施当地战略)从 45%提高到 55%。然而,这一改进率是所有标准中最低的。标准 3(儿科患者接受相关教育)从低度改善到中度,从 18% 上升到 49%。标准 4(家长接受相关教育)的改善更为明显,从 19% 上升到 56%:本项目实施的策略成功地改善了医疗服务提供者与儿科患者及其护理人员的沟通。为确保项目的可持续性,将在 3 个月、6 个月和 12 个月后进行重复审核。西班牙文摘要:http://links.lww.com/IJEBH/A199。
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引用次数: 0
Promoting safe and appropriate use of miltefosine to treat tegumentary leishmaniasis in Brazil: a best practice implementation project. 在巴西推广安全、适当地使用米替福新治疗利什曼病:最佳实践质量改进项目。
IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-02 DOI: 10.1097/XEB.0000000000000416
Sarah Nascimento Silva, Laís Raquel Ribeiro, Kelli Borges Dos Santos, Gláucia Cota

Introduction: Miltefosine is a new drug that was recently approved for the treatment of tegumentary leishmaniasis (TL) by the Brazilian health system. It has a teratogenic potential and requires follow-up of patients undergoing treatment. Improving compliance with best practices is essential to ensure the safe and appropriate use of this drug.

Objective: This project aimed to implement best practices for the safe and appropriate use of miltefosine in the treatment of TL in the state of Minas Gerais, Brazil.

Methods: This project was guided by the JBI Evidence Implementation Framework. Five best practice criteria were established based on the best available evidence. A baseline audit was conducted to measure current practice against best practice. Barriers to best practice were then identified and a follow-up audit was conducted to evaluate changes after the implementation of improvement strategies. Two sites were analyzed: a leishmaniasis reference service in Belo Horizonte, the capital of Minas Gerais, and 28 regional offices.

Results: The baseline audit evaluated data from 197 miltefosine requests distributed across 13 regional sites. All requests from the reference service were compliant (100%). This is in contrast to the 60% compliance rate at the regional offices. The improvement strategies included intensifying direct communication with the regional health professionals, which increased the average compliance rate to 79.5%, 6 months after the interventions were introduced.

Conclusion: This best practice implementation project effectively increased the compliance rate for the audited procedures. Communication from the reference site with the regional health professionals successfully increased compliance with best practices and promoted the safe and appropriate use of miltefosine. These strategies should analyzed and applied to improve other programs.

Spanish abstract: http://links.lww.com/IJEBH/A184.

简介米替福新是巴西卫生系统最近批准用于治疗利什曼病(TL)的一种新药。该药有致畸可能,需要对接受治疗的患者进行随访。要确保安全、适当地使用这种药物,就必须更好地遵守最佳操作规范:本项目旨在巴西米纳斯吉拉斯州实施安全、合理使用米替福新治疗 TL 的最佳实践:该项目以 JBI 证据实施框架为指导。根据现有的最佳证据制定了五项最佳实践标准。进行了基线审计,以对照最佳实践衡量当前实践。然后确定最佳实践的障碍,并进行后续审核,以评估实施改进策略后的变化。对两个地点进行了分析:米纳斯吉拉斯州首府贝洛奥里藏特的利什曼病参考服务机构和 28 个地区办事处:基线审计评估了分布在 13 个地区办事处的 197 份米替福新申请数据。参考服务机构的所有申请均符合要求(100%)。而地区办事处的合规率仅为 60%。改进策略包括加强与地区卫生专业人员的直接沟通,从而在采取干预措施 6 个月后将平均达标率提高到 79.5%:结论:这一最佳实践实施项目有效地提高了审计程序的合规率。参考点与地区卫生专业人员的沟通成功提高了最佳实践的依从性,并促进了米替福新的安全和合理使用。应分析并应用这些策略来改进其他项目。西班牙文摘要:http://links.lww.com/IJEBH/A184。
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引用次数: 0
Oral hygiene in critically ill patients at a tertiary hospital in São Paulo, Brazil: a best practice implementation project. 巴西圣保罗一家三级医院重症患者的口腔卫生:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-21 DOI: 10.1097/XEB.0000000000000413
Mariana Davies Ribeiro Bersaneti, Renata Desordi Lobo, Thais Bianca Brandão, Regina Claudia Silva Souza, Vanessa de Brito Poveda

Objectives: This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil.

Introduction: The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs.

Methods: This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit and (7) consideration of the sustainability of changes in practice.

Results: Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement.

Conclusion: This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients.

Spanish abstract: http://links.lww.com/IJEBH/A175.

目标:该项目旨在推广与巴西重症监护病房重症患者口腔健康相关的循证实践:机械通气患者的口腔卫生是护理质量的重要组成部分,明确的指导方针可确保提供适当的护理。机械通气与呼吸机相关肺炎的风险有关,而呼吸机相关肺炎会增加死亡率、住院时间、机械通气时间和医院成本:该项目以 JBI 循证实施框架为指导,包括七个阶段:(1)确定要改变的实践领域;(2)变革推动者的参与;(3)背景评估和变革准备;(4)根据循证审计标准审查实践;(5)实施实践变革;(6)使用后续审计重新评估实践;(7)考虑实践变革的可持续性:结果:制定了四项审计标准,以评估最佳做法的合规性。在后续审计中,标准 1、2 和 3 的合规率≥ 80%。因此,就标准 1 而言,所有机械通气时间超过 24 小时的患者都接受了口腔医疗团队的评估,因此达标率为 100%。标准 2 "适当的口腔卫生措施 "的达标率为 80%。对于标准 3,39 名专业人员(90.7%)参加了与危重病人口腔健康协议相关的教育活动,达标率为 90.7%。标准 4 涉及患者在接受任何口腔健康护理前接受评估,但改进率较低(仅为 50%),表明需要进一步改进:该最佳实践项目改善了护理人员的专业实践,提高了危重病人口腔健康最佳实践的依从性。西班牙文摘要:http://links.lww.com/IJEBH/A175。
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引用次数: 0
Palliative care communication with stroke patients: a best practice implementation project. 与中风患者的姑息关怀沟通:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-15 DOI: 10.1097/XEB.0000000000000414
Ashley Brook Schaefer, Candon Garbo, Michelle Palokas

Introduction: Stroke patients frequently experience debilitating deficits, and some receive a terminal diagnosis. Palliative care services are introduced to prioritize care, with the goal of improving quality of life. However, palliative care communication (PCC) is often delayed or used inefficiently with stroke patients.

Objectives: This project aimed to promote PCC evidence-based practices (EBPs) with stroke patients.

Methods: This project used the JBI Evidence Implementation Framework to improve compliance with PCC EBPs with stroke patients in a medical center in Mississippi, USA. Four EBPs were identified from a JBI evidence summary and used as audit criteria. A baseline audit was conducted to measure compliance of current practice with best practice. Barriers to EBPs were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine compliance changes.

Results: The baseline audit revealed 53% to 80% compliance with the four EBPs. Barriers to EBPs included lack of health care professionals' knowledge regarding EBPs; lack of PCC, miscommunication, or delayed PCC with patients regarding hospitalization timeline and quality of life; and no standardized documentation or location for PCC within the electronic health record. Improvement strategies included a PCC education program for health care professionals and a concise statement and validation checkbox to the "progress note" in the electronic health record to promote daily PCC with patients. The follow-up audit revealed 20% to 34% compliance rate improvement with EBPs.

Conclusions: Annual PCC training should be conducted for health care professionals. Implementing PCC through a multidisciplinary approach can promote more meaningful discussion and efficient decision-making, prioritizing patients' quality of life.

Spanish abstract: http://links.lww.com/IJEBH/A174.

导言脑卒中患者经常会出现衰弱性功能缺失,有些患者会被诊断为晚期。姑息关怀服务的引入是为了优先照顾患者,以改善其生活质量。然而,姑息关怀沟通(PCC)在中风患者中往往被延迟或使用效率低下:本项目旨在向中风患者推广姑息关怀沟通的循证实践(EBPs):方法:该项目使用 JBI 证据实施框架来提高美国密西西比州一家医疗中心的卒中患者对 PCC EBPs 的依从性。从 JBI 证据摘要中确定了四项 EBP,并将其作为审核标准。进行了基线审核,以衡量当前实践是否符合最佳实践。确定了 EBPs 的障碍,实施了改进策略,并进行了后续审计以确定遵守情况的变化:结果:基线审计显示,四种 EBPs 的合规率为 53%至 80%。EBPs 的障碍包括:医护人员对 EBPs 缺乏了解;缺乏 PCC、沟通不畅或延迟与患者就住院时间和生活质量进行 PCC;电子病历中没有标准化的 PCC 文档或位置。改进策略包括为医护人员开展 PCC 教育计划,在电子病历的 "进展记录 "中加入简明的声明和验证复选框,以促进与患者的日常 PCC。后续审计显示,采用 EBPs 的依从率提高了 20% 至 34%:结论:应每年对医护人员进行 PCC 培训。通过多学科方法实施PCC可促进更有意义的讨论和更有效的决策,优先考虑患者的生活质量。西班牙文摘要:http://links.lww.com/IJEBH/A174。
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引用次数: 0
Prevention and management of enteral nutrition-related diarrhea among adult inpatients: a best practice implementation project. 成人住院患者肠内营养相关腹泻的预防和管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-13 DOI: 10.1097/XEB.0000000000000412
Xinyue Zhang, Meijie Du, Mei He, Mei Wang, Mengyao Jiang, Yue Cai, Mengying Cui, Ying Wang

Introduction: Diarrhea, the most common complication for patients during enteral nutrition, 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.

导言:腹泻是肠内营养期间患者最常见的并发症,会带来一系列风险和护理负担。医务人员意识到积极预防和处理肠内营养相关腹泻的重要性。然而,临床预防和处理方法并不规范,这些方法的科学依据和有效性有待进一步验证:本项目旨在向中国一家公立三甲医院的成年住院患者推广以循证医学为基础的肠内营养相关腹泻预防和管理方法:该项目以JBI循证实施框架为指导,使用了JBI临床证据实际应用系统(PACES)和JBI将研究应用于实践(GRiP)工具。制定了 12 项审核标准,以进行基线审核,衡量最佳实践的合规性。进行了障碍分析,并实施了克服障碍的策略。项目最后进行了一次后续审计,以确定在遵守最佳做法方面是否有任何变化:结果:审计标准的总体合规率从基线的 27.37% 提高到后续审计的 89.62%,其中六项标准的合规率达到 100%:结论:实施循证实践可有效缩小当前实践与最佳实践之间的差距。该项目提高了医务人员预防和处理肠内营养相关腹泻的能力,并在医院内推广了循证实践。西班牙文摘要:http://links.lww.com/IJEBH/A168。
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引用次数: 0
Implementing evidence-based pre-operative education in hospitalized patients undergoing total knee replacement: a best practice implementation project 对接受全膝关节置换术的住院患者实施循证术前教育:最佳实践实施项目
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-10 DOI: 10.1097/xeb.0000000000000405
MiaoMiao Yang, Lin Wang, Zheng Yu, Ying-Zhang
Pre-operative education is a key factor influencing post-operative recovery, patient expectations of surgery, and patient satisfaction. Although there are guidelines for the pre-operative education of patients undergoing knee replacement, pre-operative education of patients remains suboptimal. This study aimed to improve the knowledge and skills of health care providers and patients undergoing elective knee replacement. The project used pre-operative education to increase compliance with best practices. This project was conducted from January to October 2022 in the orthopedic department of a tertiary hospital in China. The project was conceptually guided by the JBI Model of Evidence-Based Healthcare, while the JBI Evidence Implementation Framework was used to guide the implementation. Two audit criteria were developed for the baseline and follow-up audits, which assessed 20 patients undergoing elective knee replacement. A comparison of the audit outcomes revealed that for Criterion 1, the percentage of patients receiving pre-operative education in both audits was 100%. For Criterion 2, the compliance rate increased significantly from 0% in the baseline to 90% in the follow-up audit. A clinical audit is an effective approach to improving compliance with recommended best practices. Leadership, team resource management, education, and monitoring were helpful for staff in implementing the best practices. Further audits will need to be conducted to maintain practice changes and ensure that the project is sustainable.
术前教育是影响术后恢复、患者对手术的期望以及患者满意度的关键因素。虽然目前已有膝关节置换术患者术前教育指南,但患者的术前教育仍未达到最佳水平。 这项研究旨在提高医护人员和接受择期膝关节置换术患者的知识和技能。该项目利用术前教育来提高最佳实践的依从性。 该项目于2022年1月至10月在中国一家三甲医院的骨科开展。该项目以JBI循证医疗模式为理念指导,并使用JBI循证实施框架来指导实施。为基线审核和随访审核制定了两个审核标准,对20名接受择期膝关节置换术的患者进行了评估。 审计结果比较显示,就标准 1 而言,两次审计中接受术前教育的患者比例均为 100%。就标准 2 而言,达标率从基线审计的 0% 显著上升到后续审计的 90%。 临床审核是提高推荐最佳实践合规性的有效方法。领导力、团队资源管理、教育和监督对员工实施最佳实践很有帮助。今后还需要进行更多的审核,以保持实践的变化,确保项目的可持续性。
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引用次数: 0
Post-operative pain management by nurses in an intensive care unit: a best practice implementation project. 重症监护室护士的术后疼痛管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-10 DOI: 10.1097/XEB.0000000000000401
Érica Brandão de Moraes, Juliane de Macedo Antunes, Maria Fernanda Muniz Ferrari, Bárbara Ventura Fontes, Renata Castro da Silva Pereira, Luciana Ogawa, Donizete Vago Daher

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.

简介:术后疼痛是最常见的急性疼痛类型:术后疼痛是最常见的急性疼痛类型。护士是最常对疼痛进行评估的专业医护人员,她们还负责评估病人对疼痛控制治疗的反应并监测不良事件的发生。因此,为了提高治疗效果和护理质量,护士使用的干预措施应以最佳实践为基础:本项目旨在重症监护病房实施术后疼痛管理的最佳实践:该循证实施项目在一家骨科和创伤外科医院开展。该项目遵循 JBI 证据实施框架。该项目使用了JBI PACES软件以及JBI的 "将研究付诸实践"(GRiP)审计和反馈工具,为基线审计和后续审计制定了八项审计标准:基线审核结果表明,标准 3 和标准 6 的合规性较低,分别只有少数患者有记录在案的计划和目标,以及在重症监护室接受多模式镇痛。评估阿片类药物使用情况和疼痛专家随访情况的标准 7 和标准 8 的达标率分别为 60% 和 50%。标准 3 从 0% 提高到 20%。标准 6、7 和 8 也有所改善,分别提高到 30%、22.8% 和 50%:结论:该项目提高了术后疼痛管理最佳实践的依从性。为确保项目的长期可持续性,还需要进一步研究。
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引用次数: 0
Procedural sedation of adult patients in the emergency department: a best practice implementation project. 急诊科成人患者的手术镇静:最佳实践实施项目。
IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-09 DOI: 10.1097/XEB.0000000000000406
Jessica Pickens, Candon Garbo

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.

导言:急诊科是一个快节奏和复杂的医疗环境,需要为各个年龄段的患者提供重症护理。然而,病人数量多、工作人员负担过重、护士流动频繁等各种环境因素会阻碍在程序性镇静过程中使用循证实践。适当的患者监测对于防止手术镇静过程中发生不良事件至关重要:本实施项目的目标是提高急诊科在程序性镇静过程中患者监护最佳实践的依从性:方法:该项目采用JBI循证医疗模式和JBI的 "将研究付诸实践"(GRiP)工具,对急诊科成人患者在手术镇静期间实施循证监护。先进行基线审计,根据循证建议评估当前的实践,然后实施策略,以提高最佳实践的合规性。项目结束时还进行了后续审核,以确定实践中是否有任何改进:结果:基线审计显示,对循证实践的总体遵守率为 81%。结果:基线审计显示,循证实践的总体合规率为 81%,其中发现了三个障碍,即缺乏员工教育、护士流动率增加以及程序镇静过程中护士需要移动。为提高循证实践的依从性,实施了相关策略。后续审计显示,项目实施后,总体改善率达到 95%:该项目改进了急诊科程序性镇静过程中患者监护的最佳实践。然而,要确保最佳实践的可持续性,包括潮气末二氧化碳造影监测和生命体征评估,仍有许多工作要做。
{"title":"Procedural sedation of adult patients in the emergency department: a best practice implementation project.","authors":"Jessica Pickens, Candon Garbo","doi":"10.1097/XEB.0000000000000406","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000406","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objectives: </strong>The goal of this implementation project was to enhance compliance with best practices for patient monitoring during procedural sedation in the emergency department.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378593","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}
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Jbi Evidence Implementation
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