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Improving the quality of self-management in discharged patients with multiple sclerosis: a best practice implementation project. 提高多发性硬化症出院患者的自我管理质量:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000389
Yafang Xu, Lucylynn Lizarondo, Yan Zhao, Chao Quan, Yanpei Cao

Objectives: This project determined current compliance with best practice recommendations for self-management in patients with multiple sclerosis (MS) and used a web-based intervention to implement strategies to improve the quality of self-management in discharged patients with MS.

Methods: Guided by the JBI Evidence-based Model of Health care, this project applied the 7 phases of the JBI Evidence Implementation Framework to improve the quality of self-management in MS patients.

Results: After implementation, compliance significantly improved across all criteria compared with the baseline audit. All patients were assessed to determine their ability to self-manage (Criterion 1). All health care providers were trained to facilitate self-management and behavioral change (Criterion 2). All patients had self-management goals and action plans that were set together by both health care providers and patients (Criteria 3, 5, 6, 7). All patients received education through online patient education courses and were given an education handbook (Criterion 4). The agreed action plan was documented (Criterion 8). All members of the multidisciplinary team coordinated the services required by the patients (Criterion 9) and provided appropriate support to help patients achieve their goals and solve problems through a WeChat group and the communication module on the self-management online platform (Criterion 10).

Conclusion: This implementation project effectively promoted practice change by enhancing patients' knowledge of self-management and staff awareness of delivering self-management support to MS patients.

目的:该项目确定了目前多发性硬化症(MS)患者自我管理最佳实践建议的依从性,并使用基于网络的干预措施来实施策略,以提高MS出院患者的自我管理质量。方法:在JBI循证医疗模型的指导下,该项目应用了JBI证据实施框架的7个阶段,以提高MS患者的自我管理质量。结果:实施后,与基线审计相比,所有标准的合规性都显著提高。对所有患者进行评估,以确定他们的自我管理能力(标准1)。所有医疗保健提供者都接受了促进自我管理和行为改变的培训(标准2)。所有患者都有由医疗保健提供者和患者共同制定的自我管理目标和行动计划(标准3、5、6、7)。所有患者通过在线患者教育课程接受教育,并获得教育手册(标准4)。商定的行动计划已形成文件(标准8)。多学科团队的所有成员协调患者所需的服务(标准9),并通过微信群和自我管理在线平台上的沟通模块(标准10)提供适当的支持,帮助患者实现目标和解决问题。结论:该实施项目通过提高患者的自我管理知识和员工为MS患者提供自我管理支持的意识,有效地促进了实践的转变。
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引用次数: 0
Implementation science: a primer. 实现科学:入门。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000398
Craig S Lockwood, Noah M Ivers
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引用次数: 0
Antenatal and intrapartum care for women with gestational diabetes: a best practice implementation project. 妊娠期糖尿病妇女的产前和产时护理:最佳做法实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000392
Daniela Stan, Doina C Mazilu, Mariana Zazu, Viorica Nedelcu, Monica Teodor, Elvira Brătilă, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová

Objectives: This project aimed to improve the quality of antenatal and intrapartum care for women with gestational diabetes (GD) by increasing nursing and midwifery care compliance with best practice recommendations.

Introduction: GD is one of the most common diseases that can lead to several important maternal and fetal complications.

Methods: This project was based on JBI's evidence implementation approach and included a baseline audit, the implementation of strategies, and a follow-up audit. The project was conducted in an obstetrics-gynecology department of a hospital in Bucharest, and the sample included 30 pregnant women with GD from that ward.

Results: Regarding antenatal care, the baseline audit revealed low compliance (63%-87%) for criterion 2 (specific education), criterion 3 (multidisciplinary team), criterion 4 (individualized care plan), criterion 5 (training on self-monitoring), criterion 8 (dietician consultation), and criterion 10 (physical exercise program). Compliance with criterion 9 (physiotherapist consultation) was nil. Higher compliance (90%-100%) was reported for criterion 1 (screening for GD), criterion 6 (self-monitoring), and criterion 7 (maintenance of glycemic values). The intrapartum care audit criteria regarding maintaining blood glucose levels had compliance rates of 97% (criteria 13 and 14), 73% (criterion 11), and 67% (criterion 12). As a result of implementing the most appropriate strategies, maximum improvement was observed for all 12 audit criteria found to be deficient in the baseline audit.

Conclusions: Strategies were identified and applied to successfully implement the best practices (educational programs and improved procedures). However, specific actions, such as regular targeted audits and continuous monitoring, are needed to maintain long-term results.

目的:本项目旨在通过提高护理和助产护理对最佳实践建议的依从性,提高妊娠期糖尿病(GD)妇女的产前和产中护理质量。GD是最常见的疾病之一,可导致几种重要的母体和胎儿并发症。方法:本项目基于JBI的证据实施方法,包括基线审计、策略实施和随访审计。该项目在布加勒斯特一家医院的妇产科进行,样本包括该病房30名患有GD的孕妇。结果:关于产前保健,基线审计显示标准2(特殊教育)、标准3(多学科团队)、标准4(个性化护理计划)、标准5(自我监测培训)、标准8(营养师咨询)和标准10(体育锻炼计划)的依从性较低(63%-87%)。对标准9(物理治疗师咨询)的依从性为零。标准1 (GD筛查)、标准6(自我监测)和标准7(维持血糖值)的依从性较高(90%-100%)。关于维持血糖水平的产时护理审计标准的依从率分别为97%(标准13和14)、73%(标准11)和67%(标准12)。由于执行了最适当的战略,在基线审计中发现的所有12项审计标准都得到了最大程度的改进。结论:确定了策略并应用于成功实施最佳实践(教育计划和改进的程序)。但是,需要采取具体行动,例如定期有目标的审计和持续监测,以保持长期结果。
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引用次数: 0
Delirium risk screening and assessment among older patients in general wards and the emergency department: a best practice implementation project. 普通病房和急诊科老年患者谵妄风险筛查和评估:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000393
Laura Lafarga-Molina, Laura Albornos-Muñoz, Esther González-María, Tereza Vrbová, María Teresa Moreno-Casbas, Miloslav Klugar, Jitka Klugarová

Objectives: The aim of this project was to improve compliance with evidence-based criteria regarding risk of delirium and the assessment of delirium among older patients in the general hospitalization wards and the emergency department.

Introduction: More than 50% of older hospitalized patients experience delirium. Some studies have highlighted the need to implement an orientation protocol in the emergency department and to continue this in the general wards, with the aim of decreasing the delirium rate among older patients admitted to hospital.

Methods: The project followed the JBI evidence implementation framework. We conducted a baseline audit, a half-way audit, and final audit of 50 patients at risk of delirium admitted to the emergency department and the general wards, respectively. The audits measured compliance with eight criteria informed by the available evidence.

Results: In the final audit, three of the eight criteria achieved more than 50% compliance in the general wards: pressure injury screening (96%); monitoring changes (74%); and performing interventions (76%). In the emergency department, worse results were reported because of the service conditions. The exception was the criterion on the training of nurses on the topic, with 98%. The integration of a tool to screen for delirium in older patients in the hospital's electronic clinical history records increased the percentage of compliance with audit criteria regarding the use of the scale and delirium detection (rising from 0% to 32% in the final audit in the general wards).

Conclusion: Through the implementation of this project, validated and evidence-based evaluation will ensure that nurses are supported through appropriate measures to reduce patient confusion and aggression resulting from delirium.

目的:该项目的目的是提高对普通住院病房和急诊科老年患者谵妄风险和谵妄评估的循证标准的依从性。导读:超过50%的老年住院患者经历谵妄。一些研究强调,有必要在急诊科实施一项指导协议,并在普通病房继续实施这项协议,目的是降低住院老年患者的谵妄率。方法:项目遵循JBI证据实施框架。我们分别对急诊和普通病房收治的50例有谵妄风险的患者进行了基线审计、中期审计和最终审计。审计根据现有证据衡量了八项标准的遵守情况。结果:在最终审核中,8项标准中有3项在普通病房达到50%以上的符合性:压伤筛查(96%);监测变化(74%);实施干预措施(76%)。在急诊科,由于服务条件,报告的结果更糟。唯一的例外是护士培训标准,为98%。在医院的电子临床病史记录中整合了一种筛查老年患者谵妄的工具,提高了关于使用量表和谵妄检测的审计标准的符合率(在普通病房的最终审计中从0%上升到32%)。结论:通过本项目的实施,经过验证和循证的评估将确保护士通过适当的措施得到支持,减少患者因谵妄而产生的混乱和攻击行为。
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引用次数: 0
Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities. 改善农村和/或低收入社区成人营养教育干预措施实施战略的有效性。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000371
Victoria M Gholar, Robin Christian

Objective: The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities.

Introduction: Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided.

Methods: The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels.

Results: The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance.

Conclusion: Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

目的:该项目的目的是促进循证实践,并确定如何最好地实施农村和/或低收入社区成年人的营养教育干预措施。导言:生活在农村和/或低收入社区的成年人患营养不良和慢性疾病的风险增加。患者被转介到EversCare诊所(ECC),这是美国密西西比州一家学术医疗中心的门诊诊所,以接受社会需求方面的援助。除了生活在农村和/或低收入社区之外,在ECC就诊的90%以上的患者都是粮食不安全的,但营养教育却没有得到持续的提供。方法:采用JBI临床证据系统(pace)的实际应用和get Research into Practice (GRiP)的审核和反馈工具。ECC小组对30名患者电子健康记录进行了基线审计,设计和实施了最佳做法营养教育战略,并完成了对30名患者电子健康记录的后续审计。对农村和/或低收入社区成人营养教育的四项循证标准进行了审核,并采用了多种干预措施来解决多个层面的问题。结果:基线审计显示患者没有接受推荐的营养教育干预。在实施之后,在遵守所有四个最佳实践标准方面有64.2%的改进。让护生参与是提高依从性的有效方法。结论:实施营养教育干预的最佳实践的依从性是令人满意的,80%的患者在个人、人际、社区和社会层面接受了干预。计划未来的审计以确保可持续性。
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引用次数: 0
Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project. 捷克共和国新生儿病房的母乳喂养支持和避免不适当的母乳代用品营销:最佳做法实施项目
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000388
Lucia Kantorová, Andrea Poloková, Michal Sýkora, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová

Objectives: The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).

Introduction: The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.

Methods: We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.

Results: Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).

Conclusions: Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.

目标:该实施项目的目的是改善对母乳喂养的支持,更具体地说,是加强对爱婴医院倡议(BFHI)和《国际母乳代用品销售守则》(《守则》)要求的遵守。导言:该计划的成功母乳喂养的十个步骤已被证明可以改善目标医院的母乳喂养结果。《守则》是管理与母乳喂养支持有关的营销做法的最低标准。方法:我们使用JBI证据实施模型确定了捷克共和国一家医院的一组利益相关者,并于2021年1月至2022年5月开展了最佳实践实施项目。在进行基线审计后,临床小组和外部母乳喂养专家讨论了挑战,并利用JBI将研究付诸实践框架制定了实施计划。后续审计分别于2021年1月至12月和2022年5月进行。结果:所有审计标准的合规性得到改善,即完全符合准则(0%至100%);有书面的婴儿喂养政策(0% - 100%);确保工作人员具备支持母乳喂养的技能(0%至100%);与孕妇讨论母乳喂养(0%至100%);便于皮肤接触(67.86% ~ 83.58%);支持和帮助母乳喂养(67.86% ~ 82.09%);不提供母乳以外的液体(50%至58.21%);实行同住制(57.14% ~ 61.19%);对婴儿提示有反应(50% ~ 64.18%);提供社区支持服务信息(32.14% ~ 62.69%);并协调出院和持续护理(0%至100%)。结论:母乳喂养支持需要持续的长期努力才能完全建立。国家一级决策者的参与是必要的。
{"title":"Breastfeeding support and avoiding inappropriate breast milk substitute marketing in a neonatal ward in the Czech Republic: a best practice implementation project.","authors":"Lucia Kantorová, Andrea Poloková, Michal Sýkora, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová","doi":"10.1097/XEB.0000000000000388","DOIUrl":"10.1097/XEB.0000000000000388","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this implementation project was to improve breastfeeding support, and more specifically, to increase compliance with the Baby-Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).</p><p><strong>Introduction: </strong>The Ten Steps to Successful Breastfeeding of the BFHI have been shown to improve breastfeeding outcomes at target hospitals. The Code is a minimum standard for the regulation of marketing practices related to breastfeeding support.</p><p><strong>Methods: </strong>We used the JBI evidence implementation model to identify a group of stakeholders in a hospital in the Czech Republic and carried out a best practice implementation project from January 2021 to May 2022. After conducting a baseline audit, the clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the JBI Getting Research into Practice framework. Follow-up audits were undertaken from January to December 2021 and in May 2022.</p><p><strong>Results: </strong>Compliance improved across all audited criteria, namely, to fully comply with the Code (0% to 100%); to have a written infant feeding policy (0% to 100%); to ensure staff have skills to support breastfeeding (0% to 100%); to discuss breastfeeding with pregnant women (0% to 100%); to facilitate skin-to-skin contact (67.86% to 83.58%); to support and provide help with breastfeeding (67.86% to 82.09%); to not provide fluids other than breast milk (50% to 58.21%); to practice rooming-in (57.14% to 61.19%); to respond to infant cues (50% to 64.18%); to provide information about community support services (32.14% to 62.69%); and to coordinate discharge and ongoing care (0% to 100%).</p><p><strong>Conclusions: </strong>Breastfeeding support requires a sustained long-term effort before it can become fully established. The involvement of national-level policy makers is needed.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463735","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}
引用次数: 0
Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project. 妇科病房成年患者疼痛评估与管理:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000387
Leticia Bernués-Caudillo, Laura Albornos-Muñoz, M Paz Fernández Rodrigo, Marta Álvarez García, Marta De Rioja Benito, María Jesús Ruano Serrano, Paloma García Navarro, Patricia Ledesma Pérez, Sonia González Sotelo, M Teresa Moreno-Casbas, Tereza Vrbová, Miloslav Klugar, Jitka Klugarová, Esther Gonzalez-María

Objectives: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward.

Introduction: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief.

Methods: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit.

Results: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced.

Conclusions: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

目的:本项目旨在提高妇科病房疼痛评估和管理的循证实践依从性。引言:有效的疼痛控制对于预防管理不善的疼痛的负面后果很重要。然而,它仍然被低估,得不到充分的治疗。应用循证实践来正确评估和管理疼痛是改善疼痛缓解的必要条件。方法:本项目遵循JBI证据实施框架。对41名入住妇科病房的妇女进行了基线审计,并根据5项最佳实践标准进行了测量,同时进行了患者满意度问卷调查。然后实施有针对性的策略,并使用与基线审计相同的标准、方法和样本量进行后续审计。结果:基线审计揭示了当前和最佳实践之间的差距。确定实施的障碍,并设计和实施解决障碍的策略(护士教育、信息材料、电子病历系统改进)。全面的疼痛评估,包括动态和静态疼痛评估,有效工具的使用,以及向患者和护理人员提供的教育,在后续审计中得到改善。患者满意度没有变化;然而,护士测量的疼痛与患者测量的疼痛之间的差异减小了。结论:JBI方法有助于提高循证实践标准的依从性。它还促进了对新障碍的适应,例如COVID-19大流行。提高护士对疼痛评估的认识可以使评估更加准确。不完善的记录系统也使记录所提供的护理变得困难。随后的审计将评估可持续性,并将项目升级到其他地区。
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引用次数: 0
Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review. 促进证据实施-经验,挑战和感知有效性的决定因素:定性系统回顾。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000399
Lucylynn Lizarondo, Alexa McArthur, Demetrius Porche, Marleen Corremans, Beatrice Perrenoud, Rogério Rodrigues, Craig Lockwood

Introduction: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness.

Methods: A systematic review of qualitative studies was conducted using the JBI methodology.

Results: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators.

Conclusion: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior.

Review registration number: PROSPERO CRD42023402496.

导言:促进是证据实施的关键要素。虽然已经进行了定量系统审查,以检查其组成部分和有效性,但没有尝试综合定性证据,审查促进者在如何实施促进、与之相关的挑战以及可能影响其感知有效性的因素方面的经验。方法:采用JBI方法对定性研究进行系统回顾。结果:共有36项定性研究被纳入系统评价,其中大多数被评价为高质量。对调查结果进行了摘录和进一步综合,强调促进工作涉及向卫生专业人员提供技术和非技术支助,以及高强度合作和建立关系。促进效果感知的决定因素包括促进者获得资源和学习支持的机会;他们的技能、特点/态度和促进的方法;以及实现发生的组织环境。工作需求、情绪压力、角色和职业发展不清晰,都可能给引导者带来挑战。结论:为了最大限度地提高证据实施中的促进效果,应仔细选择促进者团队,以确保他们具有正确的技能、特征/态度和促进方法。他们还应该有专门的时间来进行促进,并有机会获得资源、培训和指导支持。未来的研究应着眼于考察获得促进者支持的“实施者”的观点,以更好地理解哪些促进策略对临床实践行为有影响。审核注册号:PROSPERO CRD42023402496。
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引用次数: 0
Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project. 心血管外科慢性病患者出院后电话随访:最佳实践实施项目
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000380
Pedro Sousa, Daniela Cardoso, Tereza Vrbová, João Apóstolo, Margarida Santos, Gracinda Manso, Daniel Mourão, Goreti Ferreira, Manuela Monteiro, Jacinta Manata, Alexandre Vaz, Jitka Klugarová, Miloslav Klugar

Objectives: To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service.

Introduction: Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates.

Methods: The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up.

Results: Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2).

Conclusions: This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.

目的:改善血管外科慢性病(外周动脉疾病)的出院后电话随访。慢性疾病(如外周动脉疾病)患者出现并发症的风险更高,并且在坚持治疗方面受到更大的限制,导致死亡率上升和功能下降。综合出院计划加上出院后电话随访可降低30天再住院率。方法:该项目采用JBI审计和反馈方法,将可获得的最佳证据付诸实践。采用两项审计标准:是否有全面的出院计划和及时的电话随访。进行了基线审计,然后分析了障碍,从而实施了几项战略,即有针对性的培训计划,开发出院过程的教育资源和标准化程序,以及出院后的电话随访。结果:基线和第一次随访审计的结果显示两项标准均有改善。标准1(综合出院计划,包括出院后电话随访)的依从性从0%增加到40.7%,标准2(出院后2周内电话随访)的依从性从0%增加到44.4%。这两个标准在第二次随访审计中持续改善:依从性增加到45%(标准1)和60%(标准2)。结论:该实施项目有助于优化慢性病管理,包括提高出院计划的依从性和出院后早期电话随访。
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引用次数: 0
Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project. 授权护士增加参与医疗过渡护理单位的预先护理计划:最佳实践实施项目。
IF 2.3 4区 医学 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1097/XEB.0000000000000373
Philip Garcia, Hannah Jang Kim, Susan Barbour, Adam S Cooper

Introduction and objective: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP.

Methods: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability.

Results: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences.

Conclusions: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

前言和目的:预先护理计划(ACP)的沟通和文件往往不足,导致护理不符合患者的偏好和家庭成员的道德困境。护士是病人的倡导者,最适合发起ACP,但许多人觉得他们缺乏引导这些对话的培训和技能。该项目的目标是提高护士参与ACP的能力。方法:本项目采用JBI审计和反馈方法,将证据落实到实践中。采用JBI临床证据系统的实际应用和将研究转化为实践的审计工具,将ACP纳入护理工作流程。根据JBI证据摘要制定了八项审计标准。通过审查电子健康记录和在线调查回复中的ACP记录来衡量依从性。在基线审计之后,进行了教育介绍和编制张贴材料。三次后续审计审查了可持续性。结果:护士参与ACP讨论的最佳实践建议依从性从55%增加到80%。从基线时的0个ACP记录(0%依从性)改善到最终审计时的12个ACP记录。在这些记录中,42%包括所有最佳实践要素,92%包括患者的治疗偏好。结论:为ACP制定一个综合护理教育计划,使护士能够参与重要的对话。告知护士他们的执业范围,定义术语和期望,并鼓励他们尝试和记录对话将有利于患者。今后的倡议将受益于纳入不涉及现实生活的实际机会,并继续向群组提供支助。
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Jbi Evidence Implementation
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