Jbi Evidence Implementation最新文献

Abstract: Inpatient diabetes management presents a complex challenge that is distinct from outpatient management. This is due to acute changes in physiology, medication regimens, and eating patterns associated with hospitalization, alongside the condition's prevalent and variable nature. The conventional systems for managing glycemic control in hospital have been found lacking, with gaps in data integration, decision support, and timely intervention. Queensland Health's development and adoption of the Glucose Management View and the Glucose Assessment for Inpatients (GAIN) dashboard represents a significant leap forward. The TIDieR checklist and guide have been used to report the implementation of these two interventions. The Glucose Management View, available within an individual's electronic medical record, provides an overview of demographics, relevant medication details, pathology data, and blood glucose levels. This cohesive and intuitive interface enhances individual patient trend visibility and facilitates diabetes medication prescribing. GAIN consolidates all diabetes-related patient data within the hospital into a single interface, enabling clinicians to monitor glycemic status across the whole cohort in near real-time, promoting a proactive approach to diabetes management. The future of inpatient diabetes care looks toward the incorporation of machine learning and artificial intelligence (AI) to predict adverse events and streamline care further. However, significant gaps remain in the deployment of these technologies, indicating a need for more comprehensive development and testing of all phases of the AI lifecycle, before integration into clinical practice.

Spanish abstract: http://links.lww.com/IJEBH/A308.

Introduction: Uptake of virtual care solutions in primary care settings has increased exponentially, and current evidence suggests high patient satisfaction but mixed clinician views.

Aims: This paper aimed to identify factors influencing its implementation to support delivery to the right patient, in the right clinical context, at the right time. Further, this paper evaluates how the updated Consolidated Framework for Implementation Research (CFIR) can be used to assess these factors that contribute to the uptake of virtual care innovations.

Methods: This systematic scoping review identified empirical research on factors influencing the uptake of virtual care solutions in the Australian primary care setting. Searches were undertaken in Embase, PubMed, Scopus, and Web of Science. The CFIR was used to code factors influencing the implementation of virtual care solutions. Inductive coding was used to generate new constructs where no appropriate CFIR construct could be identified.

Results: Fourteen eligible studies were identified as eligible for inclusion. Five common influencing factors were identified. Three are from the existing CFIR framework, and two are newly developed constructs. CFIR constructs included innovation relative advantage, capability, and IT infrastructure. New constructs included accessibility and suitability. A further six new constructs were identified (trust, privacy, governance, unintended consequences, preference, and choice) but these were not prominently mentioned.

Conclusions: Common factors influence virtual care uptake in Australian primary care. The CFIR assisted in conceptualizing these but was not sufficient for capturing factors unique to virtual care. Newly developed constructs are noted to be of importance in the literature, but further research is needed to understand whether they are applicable in multiple contexts.

Spanish abstract: http://links.lww.com/IJEBH/A286.

Introduction: Chronic obstructive pulmonary disease (COPD) is a complex health problem, with important repercussions for patients and their families. Interventions need to be improved to prevent exacerbations and reduce high readmission and mortality rates. Evidence suggests that including a telephone follow-up (TFU) call in discharge plans could improve outcomes in patients with a chronic disease.

Objectives: This project aimed to improve how primary care nurses in Gran Canaria, Spain, followed up COPD patients after hospital discharge.

Methods: This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) method. The JBI approach uses audit, feedback, and re-audit to promote evidence-based health care.

Results: A baseline audit was conducted to compare current practices against best practices. Five barriers to best practices were identified and improvement strategies were developed. The follow-up audit revealed 100% compliance for Criteria 1 and 2, which related to COPD patients having a discharge plan and that plan including TFU. There was a 4.88% improvement for both Criteria 3 and 4, which involved the TFU being prompt and using a validated clinical questionnaire. Following project implementation, the 30-day readmission rate increased from 2.78% to 4.88% but the 30-day emergency room presentation rate decreased from 25% to 9.76%.

Conclusions: The practice changes were partly achieved, but further strategies are needed to achieve full compliance. Educational programs are necessary when conducting improvement projects. Chances of success increase when decisions about hospital discharge involve both the hospital and the primary care service.

Spanish abstract: http://links.lww.com/IJEBH/A296.

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.

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.

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: 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.