International Journal of Evidence-Based Healthcare最新文献

Background and aims: Postoperative nausea and vomiting (PONV) is a common surgical complication, affecting 30-50% of patients and 80% in high risk populations. Successful prevention and management of PONV relies on accurately assessing individual risk prior to surgery. A valid and reliable Apfel score is commonly used to assess patients' risk. It is however challenging to translate this evidence into clinical practice. This evidence-based project aimed to identify the current practice of assessing and documenting the risk factors of PONV prior to surgery, and to develop strategies to improve the practice.

Methods: The project had three phrases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up tool to assess the impact on compliance with best practice. A research team was formed. A baseline audit was conducted at a public hospital in Victoria in June 2016 to examine PONV risk assessment practice through checking medical files of surgical patients. A getting research into practice audit and feedback tool was used to identify barriers, implementation strategies, stakeholders and resources. After implementation, a second audit was conducted between June and October 2017. Audit criteria were based on a reliable and valid Apfel score.

Results: At baseline, accurate PONV risk could only be calculated from 8% of patient files with no file formally recording the risk factors. The proportion of patients with three risk factors preoperatively, indicating high PONV risk, was 5.3%. Barriers identified were the perceived lack of necessity to record the risk, time constraint and too much paperwork. A self-checklist for risk assessment was developed to enable patients to check their own level of risk. Its face validity, construct validity and accuracy were examined. The checklist was then implemented for patients to complete prior to surgery. A number of strategies were used to improve the implementation. The second audit of 1308 files showed that at the end of audit period, 74% of patients had risk assessment conducted and documented postimplementation. 16.8% of the patients were identified as having high PONV risk, nearly triple the number identified at baseline.

Conclusion: A simple self-checklist of PONV risk was implemented. It greatly improved PONV risk assessment and documentation in a public hospital in Australia and enabled the identification of patients at high risk.

Background: Comorbid physical and mental health problems are common across the age spectrum. However, services addressing these health concerns are typically siloed and disconnected. Over the past 2 decades efforts have been made to design integrated services to address the physical and mental health needs of the population but little is known about the characteristics of effective integrated care models. The aim of the review was to map the design of integrated care initiatives/models and to describe how the models were evaluated and their evaluation findings.

Method: Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined.

Results: The current review identified 43 studies, describing 37 models of integrated physical and mental healthcare. Although modest in terms of evaluation design, it is evident that models are well received by consumers and providers, increase service access, and improve physical and mental health outcomes. Key characteristics of models include shared information technology, financial integration, a single-entry point, colocated care, multidisciplinary teams, multidisciplinary meetings, care coordination, joint treatment plan, joint treatment, joint assessment/joint assessment document, agreed referral criteria and person-centred care. Although mostly modest in term of research design, models were well received by consumers and providers, increased service access and improved physical and mental health outcomes. There was no clear evidence regarding whether models of integrated care are cost neutral, increase or reduce costs.

Conclusion: Future research is needed to identify the elements of integrated care that are associated with outcomes, measure cost implications and identify the experiences and priorities of consumers and clinicians.

Background: In addition to numerous infections and frequent pain constantly affecting people living with HIV (PLWH), various risk factors might contribute to prescription drug diversion. The purpose of the study is to map existing evidence on risk factors contributing to prescription drug diversion among PLWH.

Methods: Arksey and O'Malley's framework and the recommendation by Levac et al. (2010) guided this study. We searched for relevant literature from the following databases: PubMed; Google Scholar; EBSCOhost (Academic Search Complete, MEDLINE and Newspaper Source), Cochrane, WHO, HIV, ScienceDirect and Open Access Theses and Dissertations. Studies reporting evidence on risk factors contributing to prescription drug diversion and published in the period January 1996 to July 2017 were included. Thematic content analysis was performed to summarize the findings.

Results: The search identified 734 studies. After full-text screening of the eligible studies, risk factors contributing to prescription drug diversion among PLWH were reported in 20 included studies. It was found that there is limited research on prescription drug diversion among PLWH in low-middle-income countries (LMICs). Risk factors contributing to prescription drug diversion were being a substance user or substance dependent; being male; young in age; being stigmatized; not disclosed HIV status; diagnosed with mental health problems; being HIV infected; poor health and well being; being White; being homeless or not owing a home; having low educational level; having history of diversion, misuse or abuse; in possession of addictive prescriptions; being unemployed and living in high neighbourhood disorder.

Conclusion: Evidence shows that there is limited research on prescription drug diversion among PLWH in LMICs. The study findings show that the risk factors contributing to prescription drug diversion are related with risk factors for HIV transmission and infection.

Prospero registration number: CRD42017074076.

Aim: To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia.

Methods: The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making.

Results: The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units.

Conclusions: Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.

Aim: The aim of this evidence implementation project was to improve the documentation of chemotherapy administration by nursing staff in a bone marrow transplant unit, to improve patient care and safety, as well as meet the legal and educational responsibilities of the nursing staff.

Methods: This evidence implementation project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback framework for the design and development of an evidence-based audit and feedback change project. A baseline audit was conducted to assess current practices against best practice and identify areas requiring improvement. Next, the project team reflected on the results of the audit to develop and implement strategies for documentation improvement. Lastly, a follow-up audit was conducted to assess changes in practice improvement.

Results: The baseline audit results revealed practice areas requiring improvement; facilitators of and barriers to nursing documentation and practice improvement were identified. A checklist, educational session, Nursing Documentation Guidelines for Chemotherapy Administration, was implemented to improve nursing documentation. The follow-up audit demonstrated improved adherence across all audit criteria.

Conclusion: The checklist implemented for nursing documentation and education contributed to improved practices. To promote additional improvements, nurses will continue to utilize the tools developed and receive continued education through formal training and staff meetings. Future auditing is planned to ensure sustainability.