Jbi Evidence Implementation最新文献

Introduction and objectives: Basic life support (BLS) is foundational to the care delivered to cardiac arrest victims. This study evaluated current practices and implemented best practices related to BLS training for intensive care unit (ICU) nurses in a general hospital in Tabriz, Iran.

Methods: This interventional before-and-after study was informed by the JBI Evidence Implementation Framework. An audit, feedback, and re-audit strategy was used to measure baseline compliance with best practices, develop an implementation strategy to address gaps in compliance, and undertake a final evaluation to measure changes in compliance. The JBI Practical Application of Clinical Evidence System (JBI PACES) and situational analysis Getting Research into Practice (GRiP) tool were used to support data collection and implementation planning. There were 13 evidence-based criteria and a sample of 9 ICU nurses.

Results: The baseline audit revealed gaps between current practice and best practice in 9 of the 13 criteria. Barriers included insufficient education tools and programs, insufficient supervision, lack of skills laboratories, and a lack of continuous BLS education. Improvement strategies included providing a human stimulator manikin, developing an education program for nurses, as well as establishing a cardiopulmonary-cerebral resuscitation department, a skills laboratory, and continuous BLS education based on the American Heart Association guidelines. The follow-up audit revealed improvement of 100% across all criteria.

Conclusions: This project indicates that a clinical audit is effective for assessing evidence-based BLS education for ICU nurses, thereby improving resuscitation performance and patient outcomes.

Spanish abstract: http://links.lww.com/IJEBH/A213.

Introduction: Falls are the main cause of disability among psychiatric patients, as well as being the most common adverse event in hospitals.

Aim: The aim of this evidence implementation project was to improve fall prevention and management among psychiatric patients in a neurology ward in an Iranian tertiary psychiatric hospital.

Methods: This project used the JBI Evidence Implementation Framework, which recommends an audit, feedback, and re-audit strategy. A baseline audit was conducted to evaluate current fall prevention practices among 50 psychiatric patients and 20 health care professionals. The baseline audit was used to identify gaps in compliance. After the implementation of improvement strategies, a follow-up audit was conducted to measure any changes in practice.

Results: The baseline and follow-up audits revealed that compliance with best practices improved in ward transfer fall risk assessment (Criterion 2: 87% to 90%), patient participation in fall risk assessment (Criterion 3: 95% to 96%), revising patient fall risk status (Criterion 9: 50% to 86%), and person-centered education of health care providers (Criterion 11: 78% to 96%). Other audit criteria remained unchanged. However, for Criterion 6 on patient engagement in goal-setting and treatment planning, compliance dropped from 100% at baseline to 94% at follow-up.

Conclusions: This project successfully increased evidence-based practices regarding fall prevention and management, as well as providing mechanisms for sustaining the practice changes. Future audits are required to further improve outcomes.

Spanish abstract: http://links.lww.com/IJEBH/A267.

Introduction: Evidence-based self-management strategies in chronic disease management are associated with increased self-efficacy and improved health-related quality of life. Physiotherapists feel unprepared to promote these strategies in patients with chronic musculoskeletal pain conditions.

Objective: The objective of this best practice implementation project was to assess and promote exercise-centered self-management strategies in physiotherapy care.

Methods: JBI's Evidence Implementation Framework, Practical Application of Clinical Evidence System (PACES) audit tool, and Getting Research into Practice (GRiP) method were used. The project was conducted in Germany at the University Hospital of the Brandenburg Medical School in the Department of Physiotherapy. Barriers and facilitators to implementation were identified through qualitative interviews with musculoskeletal pain experts in the team (N  =  5). All team members (N  =  16) completed a 31-item standardized questionnaire to determine compliance with seven audit criteria. The results of the baseline audit informed the implementation strategy. A post-implementation audit was conducted to measure improvements in practice.

Results: Baseline compliance with audit criteria ranged from 0% to 89%. Barriers to implementation included lack of knowledge on self-management facilitation (e.g., assessment of patient capabilities, pain education, goal-setting, self-monitoring, action plan development) and no standardized documentation. The implementation strategy combined interactive educational training with the introduction of two standardized assessment and documentation forms. Moreover, a short-form exercise diary was created to facilitate patient self-monitoring. In the follow-up audit, five of the seven audit criteria improved.

Conclusions: A combination of interactive educational training, standardized physiotherapy assessment and documentation, and a short-form exercise diary may be appropriate strategies to increase compliance for exercise-related self-management facilitation.

Spanish abstract: http://links.lww.com/IJEBH/A345.

Introduction: Prior studies have shown that about half of critically ill patients in intensive care units (ICUs) have abnormal blood glucose. Both hyperglycemia and hypoglycemia increase the risk of death in critically ill patients; therefore, controlling blood glucose in such patients is crucial. There is a significant gap between clinical practice and the current best evidence regarding glycemic control in ICU.

Aim: This best practice implementation project aimed to improve glycemic control for critically ill patients in a tertiary hospital in China by promoting best practices.

Methods: This project was conducted according to the JBI Evidence Implementation Framework, which is based on an audit and feedback strategy. Four audit criteria were developed for the baseline and follow-up audits. An implementation protocol was designed based on the barriers and facilitators identified in the baseline audit. Nursing documentation from patients' medical records and interviews with nurses were used to assess the baseline and follow-up audit compliance rates.

Results: The results showed improved compliance with the four criteria in the follow-up audit. Except for only slight improvement in Criterion 2 (increasing from 15.3% to 26.6%), the three other criteria all achieved significant improvements. The compliance rate for Criterion 1 increased from 43.8% to 70.0%, Criterion 3 increased from 0% to 100%, and Criterion 4 increased from 46.8% to 65.8%.

Conclusions: This evidence-based implementation project successfully increased nurses' compliance with best practice recommendations for glycemic control in critically ill patients.

Spanish abstract: http://links.lww.com/IJEBH/A338.

Introduction: Oral hygiene is crucial in palliative care, as it directly affects patient comfort and quality of life.

Aim: This study aimed to enhance oral hygiene practices in hospice wards by aligning them with evidence-based guidelines, evaluating current practices, identifying barriers, and implementing targeted interventions.

Methods: This study was conducted at Changhua Christian Hospital in Taiwan and involved 18 nurses and 30 unique patients. Using the JBI Evidence Implementation Framework, the project followed a structured methodology to assess and improve compliance with oral hygiene practices by conducting baseline and follow-up audits. An Oral Assessment Guide (OAG) was used to track and analyze oral health status.

Results: The baseline audit revealed significant deficiencies: 0% compliance for denture care, 10% compliance for twice-daily cleaning of natural teeth, and 50% compliance for assessing mouthwash options for patients with swallowing difficulties. Post-intervention, the follow-up audit revealed that compliance for all nine audit criteria was 100%. Notably, the OAG scores improved from an average of 14.1 to 11.7, indicating enhanced oral health and patient quality of life.

Conclusions: This study demonstrated that targeted educational interventions and adherence to best practice guidelines can significantly improve oral hygiene in hospice settings. Achieving full compliance across all criteria, including those initially at full compliance, underscores the importance of continuous improvement in care practices. These findings advocate for the integration of evidence-based practices to enhance the quality of patient care in palliative settings.

Spanish abstract: http://links.lww.com/IJEBH/A332.

Introduction: Rising mental health issues among university students in the United States may significantly affect their academic progress, contributing to a variety of negative outcomes, ranging from poor academic performance to forced attrition.

Objective: This study evaluated the implementation of an evidence-based practice (EBP) interdisciplinary approach to universal proactive mental health screening and triage at a university student health center (SHC).

Methods: Using the Knowledge to Action framework, a comprehensive program was developed to identify and triage university undergraduate students at risk of mental health conditions, to address a gap between current practice and emerging EBP. Potential barriers to implementation were identified and strategies were developed to improve the translation of knowledge to practice. A retroactive chart audit was used to evaluate the effectiveness of practice improvements.

Results: EBP interventions were implemented to proactively identify and triage mental health concerns in students, with positive results. Provider compliance with assessment and referral was 100%. Further studies are needed to assess long-term effectiveness.

Conclusion: Our results confirm the usefulness of a comprehensive, proactive mental health program for detecting and triaging undergraduate students at risk of anxiety and/or depression. This interdisciplinary approach has the potential to address mental health issues among college students in a timely fashion and to best steward limited campus resources.

Spanish abstract: http://links.lww.com/IJEBH/A327.

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.