Jbi Evidence Implementation最新文献

Introduction: Central venous catheters (CVCs) and other central venous access devices (CVADs) facilitate the administration of intravenous drugs, fluids, blood products, and parenteral nutrition in patients with chronic or critical illnesses. A lack of standardized practices had been identified in some countries, leading to the development and publication of guidelines.

Aim: This project aimed to improve CVAD care by promoting evidence-based practices in an intensive care unit and a hemodialysis unit in a hospital in Badajoz, Spain.

Methods: The study was based on the JBI approach to evidence implementation. A retrospective baseline audit was conducted before developing and implementing an evidence-based protocol for the assessment, patency, and management of occlusions in CVCs. The JBI Getting Research into Practice (GRiP) method was used to identify the factors underpinning gaps between evidence and everyday practice, as well as strategies to overcome them. A follow-up post-implementation audit was also conducted. The sample size was 34 patients.

Results: Improvements in compliance were found in four of the six audited criteria. The barriers identified during the implementation process were mostly addressed, contributing to the positive results.

Conclusions: This evidence implementation project resulted in the development of an evidence-based protocol on CVAD care in the selected units and can now be expanded to other settings. The project also improved the quality of nursing records and the maintenance of best practices.

Spanish abstract: http://links.lww.com/IJEBH/A325.

Objective: The objective of this scoping review was to identify the key factors that influence embedding organization-wide culture change programs (OWCCP) in health care.

Introduction: OWCCP have been used as a mechanism in health care to assist the workforce to embed safe quality care. There is little research on the embedding phase of sustaining OWCCP.

Inclusion criteria: This review included studies explicitly on embedding OWCCP in health care at an organizational or facility level.

Methods: Searches were conducted in Scopus, Web of Science, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), ProQuest, OpenGrey, World Cat, and Bielefeld Academic Search Engine (BASE) for studies published between January 2013 and March 2024. Data from the full-text articles were extracted and reported according to the SQUIRE 2.0 guidelines. Factors that influence embedding were inductively coded, interpreted, and grouped into categories.

Results: Of the 7,922 studies screened, 17 were included in the final review. Ten key factors emerged as influencing the embedding of OWCCP in health care. These included education and training; integrating the change program into business; measurement, monitoring, and feedback of outcomes; supportive leadership; resources to support the change; alignment with organizational culture; shared and defined accountability; adaptable change programs; engaging key stakeholders; and alignment with the external environment.

Conclusions: Our findings can be used to guide and support sustaining OWCCP in health care. The review identified important gaps in the knowledge base of embedding OWCCP in health care, including a need for future studies to clearly define what embedding OWCCP entails, and investigate how the different populations, settings, systems, and processes influence the embedding of OWCCP.

Spanish abstract: http://links.lww.com/IJEBH/A319.

Introduction: Peripherally-inserted venous catheters (PIVC) are essential for cancer patients to receive treatment. Phlebitis is a major complication of PIVC. Currently, nurses' assessment of phlebitis mainly involves visual inspection. However, the latest literature suggests palpation for tenderness to promote the early detection of phlebitis.

Objectives: This project evaluated the effectiveness of a bundle approach to increase nurses' compliance with PIVC site assessment to promote early detection of phlebitis (grade 2 and above).

Methods: The JBI Evidence Implementation Framework was used to conduct this project in a 28-bed hematology-oncology ward in a Singapore hospital. The bundle approach used in this project consisted of a training presentation, medical mannequin, and phlebitis scale card. The rate of nurses' compliance with best practice for PIVC site assessment was measured at 1 month and 6 months post-implementation. The incidence of phlebitis was monitored up until 12 months post-implementation.

Results: Baseline data indicated that only 18.75% (3 out of 16) nurses palpated for tenderness when assessing for phlebitis. Data at 1 month and 6 months post-implementation reported sustained high compliance rates of 85.71% (24 out of 28) and 89.29% (25 out of 28), respectively. Late detection of phlebitis was reduced by 66% (from three cases to one case) at 6 months post-implementation, and no patients required invasive interventions.

Conclusions: The bundle approach used in this project facilitated early detection of phlebitis following the inclusion of palpation into nurses' assessment for phlebitis.

Spanish abstract: http://links.lww.com/IJEBH/A204.

Introduction and objectives: Type 1 diabetes is an autoimmune disease that destroys insulin-producing cells in the pancreas. Education is the cornerstone of effective diabetes care. In this implementation project, we aimed to improve compliance with best practices regarding type 1 diabetes educational interventions for adult hospitalized patients.

Methods: This project was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted involving 20 nurses and 20 type 1 diabetes patients who received regular educational measures. Areas of non-compliance were identified and an improvement strategy was implemented. A follow-up audit was then conducted to evaluate the effectiveness of the improvement strategy. The project was conducted in Poland in 2021 in a tertiary referral unit that specializes in the diagnosis and treatment of diabetes.

Results: Substantial improvements were noted for all audit criteria after the implementation of strategies to address areas of non-compliance. Use of the education program improved from 0% to 100%. Compliance regarding patients receiving handouts and personalization of the program increased to 100%. We observed a significant improvement from 0% to 80% in the structuring of the program content.

Conclusions: This project successfully improved the quality of education provided for type 1 diabetes patients in all relevant areas. We devised an education program, covering important aspects of diabetes education, with the patients reporting increased satisfaction with the personalized educational measures during their hospital stay.

Spanish abstract: http://links.lww.com/IJEBH/A215.

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.

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.

Introduction: Evidence-informed decision-making (EIDM) plays a vital role in public health practice. Canada has invested in support for evidence-informed approaches in public health. Despite growing expectations for EIDM, evidence integration has not been thoroughly evaluated.

Objective: This study explores EIDM within Canadian public health organizations before the COVID-19 pandemic. A secondary objective is to explore how EIDM in public health was affected by the COVID-19 pandemic.

Methods: Using a qualitative descriptive approach, data were collected and analyzed from interviews with public health professionals across Canada.

Results: From interviews with 20 participants in four Canadian provinces and one territory, all participants noted that EIDM was valued, but there was considerable variation in implementation. Participants reported differences in consistency of evidence use, resources available at their public health organizations to support EIDM, and staff knowledge and skills in EIDM. Leadership emerged as a strong influencer of EIDM; however, leadership investment in EIDM varied. Changes in evidence use during the COVID-19 pandemic revealed an urgency for decision-making amidst an influx of evidence and reallocated staff roles.

Conclusions: Despite gains in the recognized value of EIDM, gaps remain in the integration of evidence into decision-making and adequate resource investment to support EIDM. Time, resources, and skills to adapt processes and implement EIDM are needed for public health organizations in Canada to fully integrate EIDM into all aspects of public health decision-making.

Spanish abstract: http://links.lww.com/IJEBH/A249.

Objectives: The project aimed to assess health visitors' concordance with evidence-based criteria regarding identification and support of postnatal depression in mothers receiving the health visiting service.

Introduction: Timely identification is critical to support mothers at risk of postnatal depression. Undetected and untreated postnatal depression can result in severe consequences for the mother's health, infant health and development, and well-being of the family as a whole. Due to their unique role of universal home visiting, health visitors are ideally placed to identify and support mothers, and evidence-based practice is key to positive outcomes.

Methods: A baseline audit was carried out using evidence-based audit and feedback informed by the JBI Model of Evidence-based Healthcare and guided by the seven-phase implementation framework, involving 12 health visitors and 60 health visiting records from one health board in Wales, UK. The first step involved project development and generating evidence. A baseline audit was completed and a training program on perinatal and infant mental health was implemented. Finally, a post-implementation audit was completed involving 6 health visitors and 30 health visiting records.

Results: Receiving training in perinatal and infant mental health resulted in an improvement in baseline audit results. Health visitor concordance with best practice guidelines increased, with three of the six criteria in the post-implementation audit reaching 100% concordance, and two other criteria increasing to 83% and 93%, respectively.

Conclusion: The implementation project achieved improvements in concordance with best practice recommendations for identifying and supporting mothers experiencing, or at risk of experiencing, postnatal depression.

Spanish abstract: http://links.lww.com/IJEBH/A293.

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.