ABSTRACT:Since its emergence in the 1990s, evidence-based healthcare (EBHC) has made great strides in locating, synthesizing, summarizing, and disseminating evidence, but sustainable mechanisms for getting trustworthy evidence into policy and practice continues to be less well understood. We propose that there is an EBHC 'Flywheel' that begins and ends with culture and the development of adaptive but disciplined approaches that generate new 'norms' in relation to EBHC. In mechanics, a flywheel is a device that uses momentum to create rotational energy. The concept of a 'flywheel effect' has been adopted in management fields to demonstrate how change in organizations or practices rarely happen in one fell swoop; rather, sustainable change requires energy and persistent effort.This energy might be exemplified by leadership to get the wheel moving, but it needs to be guided, channelled, harnessed and supported throughout the rest of the organization. To achieve sustainable momentum, it is necessary to communicate with transparency the EBHC principles, practices, and perspectives that are considered of broad organizational value to generate cohesion and understanding about practice expectations. With a common vision, cooperation and collective identity in place, true multidisciplinary collaboration underpinned by EBHC is possible. The final component in the EBHC flywheel, capacity, is self-generating (i.e. you do not need 'more time' or 'more resource' for EBHC as EBHC is embedded in the fabric and fibre of the organization). This shifts the notion of EBHC initiatives from being 'in addition to' or being singular one-off initiatives or projects to being part of the lifeblood of how the organization functions. EBHC is, ultimately, a human-to-human endeavour. It relates to individuals connecting and committing to a common purpose. The 'four C's' that underpin the JBI Model (culture, communication, collaboration, and capacity) are the organizational navigational instruments and roadmaps required to provide the human focus/lens that is needed.
OBJECTIVES:The main aim of the best practice implementation project was to enhance the use of pain assessment and the compliance with evidence-based criteria regarding pain assessment among incoming patients to emergency department. INTRODUCTION:Adequate approaches to pain assessment and documentation have been demonstrated beneficial for emergency department patients. Evidence-based recommendations establish a focus on education about the implications for evaluating and recording pain in order to improve outcome strategies and quality of care. METHODS:The implementation project was undertaken in the emergency department following JBI Implementation framework in order to seek whether pain assessment was taken and registered as per protocols. Random selection for 100 anonymized emergency department admission episodes, which had to meet the specified inclusion criteria, was carried out. RESULTS:The baseline audit showed low compliance in criterion 3 (C3) 'Pain was documented in each assessment' (6%), C4 'Pain was assessed after treatment' (9%) and C5 'Pain was assessed prior to discharge' (10%). In the follow-up audit, noticeable improvement was shown for four of the criteria; C3 (14%), C4 (22%) and for C5 (41%). C1 'Pain was assessed in a timely manner' improved from 81% up to 95%. C2 'Use of a validated scoring tool' had a compliance of 100% as the hospital's assessing system default has NRS-11 scale set up. CONCLUSION:We performed an audit of pain assessment documentation. Enhancing the use of pain assessment among emergency department nurses by means of specific training emphasizing the importance of documentation showed a positive impact on practice. Follow-up audit results justify the continuity of the implemented strategies.
OBJECTIVE:To describe how allied health professionals have used mentoring as a knowledge translation strategy to inform practice. INTRODUCTION:Mentoring has been reported to be used by nursing and medicine as a knowledge translation strategy. It is not known if allied health professionals have also used mentoring to improve their use of research in practice, or what the key mentoring characteristics are that guide its application in allied health settings. Improved understanding of the barriers and facilitators to mentoring in allied health settings may be used to guide the design of future mentoring programs to assist knowledge translation. INCLUSION CRITERIA:Eligible studies must have included allied health professionals, and used the concept of mentoring to support knowledge translation in the context of healthcare. Primary empirical and synthesized studies were eligible. METHODS:An a-priori protocol was followed to complete a search of six databases (MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCO], PsycInfo [OVID], PDQ-Evidence ( www.pdq-evidence.org ), and Cochrane on the 9 March 2021. Screening for eligibility was conducted by two authors at the title and abstract stage and the full text stage. Selection criteria and the data extraction tool were established prior to the search. Findings are presented in narrative and tabular formats. RESULTS:A total of 2053 studies met the inclusion criteria for screening and nine were determined to be eligible for inclusion. Mentoring has been used by allied health professionals to improve the translation of interventional research evidence by clinicians, and to establish clinician skills and knowledge relating to knowledge translation processes. Mentoring was predominantly used as part of a multifaceted knowledge translation strategy alongside educational strategies. Mentoring characteristics such as structure, context, goals, resourcing and dosage varied depending on the context of translation. The specific barriers reported to using mentoring were varied, whereas the facilitators to mentoring were primarily related to the mentor's approach and expertise. The impact of mentoring was primarily measured through the mentee's experience of mentoring. CONCLUSIONS:Allied health professionals have used mentoring as a knowledge translation strategy to enhance the use of research evidence in their practice and to learn the process of knowledge translation. Mentoring is mostly used in conjunction with other strategies in practice, such as education. The limited number of identified barriers and facilitators to using mentoring as a knowledge translation strategy supports the need for future research to deepen our understanding about the mentoring process.
'The right-hand does not know what the left does'. 'Patients are coming in insufficiently informed'. 'Some procedures and processes are performed in an uncoordinated manner and sometimes in duplicate'. 'Shifts planning is always stressfull'. Is at least one of these situations familiar to you? If yes, you are probably thinking about a solution, a CHANGE. However, how to do it? Who should be responsible? Where to start? Who can give me advice and help? Who should be involved in this process? Our team had to solve all of these questions 3 years ago at the beginning of the European ERASMUS+ project SPIDER (Strategic Partnership in Innovation and Development of Evidence-Based Healthcare). The SPIDER project is focused on increasing knowledge using the Evidence-Based Healthcare (EBHC) approach and improving participants' skills in translation/implementation and utilization of evidence in healthcare clinical practice. The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation led on this international project together with partners from four European countries: Portugal, the United Kingdom, Romania, and Spain. Every healthcare professional's decision should be taken according to the EBHC approach based on the best available up-to-date evidence, clinical expertise, and patient's preferences/wishes.1 This EBHC principle seems to be very simple; however, reality and everyday practice differs among different countries. There is high heterogeneity in the daily use of EBHC amongst regions and even amongst healthcare facilities within one country.2 Due to the enormous number of studies published every day, it is almost impossible for clinicians to orientate themselves and keep up-to-date. Everyday clinical practice can lag more than 15 years behind the science in many healthcare fields. In contrast, there are still some healthcare areas where there is a lack of research evidence, and healthcare decisions continue to be based on expert opinion alone. Healthcare professionals across Europe need to improve their experience and skills of getting research into practice.3 Implementing the best available evidence into practice is a crucial part of the whole EBHC approach, regardless of field, context or country. For this project, we decided to use our strong international cooperation within the JBI European collaboration and start the first action focused on exchange experiences and 'knowhow' in implementation science internationally. Europe is a unique multicultural part of the world involving various healthcare systems, so sharing experiences with the aim of changing clinical practice proved to be very beneficial. All the participating collaborating institutions are JBI centres, so all the educational and implementation activities followed the JBI Implementation model based on clinical audits and the 'Getting Research into Practice (GRiP) Framework', which consists of identifying obstacles and planning strategies to overcome them.4,5 This Supplement presents the results of the first 10 best practice implementation projects (BPIPs). As you can see, they impact on various areas of healthcare. There are six BPIPs in the nursing field, showing that even small and inexpensive changes in clinical practice can significantly improve patients' outcomes, comfort and level of care. Two of the projects dealt with pressure injury and ulcer prevention, one with medication administration, one with the importance of pain assessment at triage, one with the care of nasogastric tubes and one highlighted the benefits ofclinical supervision in primary and community care. In the midwifery area, one extensive BPIP showed the importance of professionally led midwifery consultations in caring for high-risk pregnancies from antenatal, through intrapartum, to postpartum care. In the psychological field, there were two BPIPs that focused on the importance of communication skills and their standardization in the medical lab and operating room. The last BPIP crossed the border between practice and policy-making processes and attempted to initiate changes in the process of clinical practice guidelines development on the level of medical associations and relevant stakeholders, including the Ministry of Health.6 During the course of this project, we have observed huge added value from the interaction and sharing of knowledge and expertise amongst our European participants. Our participants were from five different countries with different health systems and policies, from various backgrounds and working in different health settings. They shared the barriers and facilitators they experienced whilst working towards successful implementation strategies, each providing examples about what works, how, and for whom in their settings. In the case of each individual BPIP, there were different obstacles identified in the process of practice change; however, pandemic coronavirus disease 2019 (COVID-19) was common and significant for most of them. The majority of BPIPs experienced delays because of the pandemic; however, it was exciting to see that the solution of several BPIPs accelerated despite the impact of COVID-19. The biggest obstacle for all of us has been travel restrictions. which prevented face to face meetings and educational activities. So, we had to completely transform the whole several-month training program into an online format and all meetings organized virtually. Although it was not easy, in the end, the entire pandemic situation forced us to prepare better. On the basis of feedback from our participants, this resulted in a more beneficial educational program. Whilst the pandemic situation took a lot from us, it also taught us a lot, and in the end, the whole implementation process is about solving obstacles. Acknowledgements Conflicts of interest There are no conficts of interest.
Objectives: The aim of this implementation project was to promote evidence-based best practice regarding effective communication and patient safety amongst nurses in perioperative settings. Introduction: One of the main causes of surgical errors is inadequate communication. To address this issue, published research has shown that effective communication among healthcare professionals (HCPs) within and between all phases of perioperative care, as well as the proper transfer of all patient information at all transition points, are essential for ensuring patient safety and quality of care. Methods: This best practice implementation project was conducted based on the JBI implementation model and included three phases of activity: a baseline audit, a strategies implementation stage and a follow-up audit. The audit criteria used were based on a JBI evidence summary and referred to: education, interdisciplinary team, conflict resolution, team communication, transfer of patient information and safety intraoperative processes. The project was carried out in the perioperative environment of a university hospital, and the sample included 52 nurses. Results: Eleven audit criteria were used in the baseline audit. For four of these criteria (on education and information transfer) the compliance was zero, for five criteria (on intraoperative processes) the compliance had values between 31 and 66% and for two criteria (on interdisciplinary team/conflict resolution documentation and team communication monitoring), the identified compliance was maximum (100%). Following the identification of four barriers to compliance and the implementation of targeted strategies, the follow-up audit showed complete compliance (100%) for all criteria except three, for which the identified compliance values were 96, 95 and 25%. Conclusion: The implementation of appropriate strategies in this project has led to a significant improvement in nurses' compliance with all audit criteria except one, regarding the verbal transfer of patient information. However, future audits and strategies are needed not only to support the improvements obtained but also to significantly increase the compliance rate for the audit criterion for which only a slight increase in compliance was recorded.
Objectives: The project aimed to assess compliance with evidence-based criteria regarding the use of clinical supervision amongst district nurses and to improve knowledge and engagement in clinical supervision activities within the workplace. Introduction: It is important to provide clinical support to all healthcare workers that provide opportunities to develop and be listened to in a supervised environment. Clinical supervision is seen as a key element to provide this support. It provides a professional working relationship between two or more members of staff where the reflection of practice and personal emotion can be discussed, which is outlined in many policies and guidelines. Methods: A baseline audit was carried out using the JBI Practical Application of Clinical Evidence System program involving 16 participants in one district nursing team in South Wales. The first step involved the development of the project and generating the evidence. Following this, a baseline audit was conducted, and educational training on clinical supervision was undertaken followed by clinical supervision sessions. A postimplementation re-audit was conducted following implementation. Results: A total of 16 participants enrolled on the project. Receiving basic training and participating in clinical supervision was much higher than the baseline audit with both increasing to 100% compliance. Furthermore, 94% of participants were aware of clinical supervision activities and 88% knew of existing records on clinical supervision. The project results show a large increase in compliance with all of the criteria. Conclusion: Overall the implementation project achieved an improvement in evidence-based practice regarding clinical supervision in primary care.
Objective:This project aimed to promote evidence-based practices regarding the promotion of sleep and rest using nonpharmacological interventions for infants in the neonatal intensive care unit (NICU) at Children's of Mississippi.Introduction:Sleep is a basic physiological need that plays a fundamental role in the growth and development of infants. Unfortunately, infants admitted to the NICU after birth may not receive adequate sleep and rest, especially when compared to infants discharged home after delivery.Methods:The project used the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research in Practice (GRiP) audit tool for promoting change in healthcare practice. A baseline audit of NICU staff and patient caregivers was conducted and measured against five best practice recommendations, followed by implementation of targeted strategies and a follow-up audit.Results:The project team discovered two barriers to sleep promotion and rest in the NICU at Children's of Mississippi: lack of nurse knowledge of evidence-based practices for promotion of sleep and rest for infants in the NICU and a lack of location in the electronic health record to document sleep quality of infants. Strategies were implemented to address these barriers and compliance improved in four of the five audit criteria.Conclusions:Implementation of an educational PowerPoint that focused on sleep promotion of infants in the NICU was developed and distributed to all of the nurses and resulted in average increased compliance from 43% to 53% for all audit criteria.
OBJECTIVES The aim of this implementation project was to promote evidence-based practices regarding hospital-acquired pressure injuries prevention practices among immobilized adult patients in a mental health department and to measure the level of compliance with the best practice in this field. INTRODUCTION Pressure injuries can have significant restrictions on the patient's quality of life; affect the patient physically, psychologically, and socially; lead to increased costs and length of hospital stay; and are closely linked to increased mortality. Thus, the best evidence practice implementation project was conducted in the mental health ward of a large teaching hospital in Bucharest. METHOD The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice. The best practices project was carried out in a mental health department with 70 beds at Bucharest's largest mental health hospital. This analysis of nursing practice included all immobile patients who were hospitalized in the ward. RESULTS Through the project to implement best practices for the prevention of pressure injuries, the activity of nurses was improved. If initially, the prevention of pressure injuries was a deficient activity in the hospital (compliance between 0 and 82%), after the implementation of the project, compliance with the recommendations of evidence-based practices was radically improved, obtaining a maximum percentage of 100% for all these activities: patient assessment, use of assessment tools, use of necessary devices, provision of high protein diet and patient education. CONCLUSION The current project contributed to the standardization and improvement of nurses' practice of pressure injuries prevention in patients with mental illness and immobility hospitalized in a psychiatric ward. The development of future audits will help identify the sustainability of the implemented prevention measures.
Introduction:Globally, there is an increasing incidence of chronic diseases, particularly, diabetes. Patient engagement in disease self-management is essential to improve outcomes and reduce consumption of health resources. Despite investment in this area, there is a need to improve nursing care practices.Aims:To increase compliance of Endocrinology nurses with best practice in promoting self-management of diabetes by patients.Methods:The project was conducted in an Endocrinology unit of a Portuguese central hospital. It was based on the JBI's model approach, considering three phases: baseline audit, strategy design and implementation, and follow-up audit. For the audits, 11 criteria were considered. The sample was composed of patients (15 in the baseline; 30 at the follow-up audit), and nurses (15 in both audits).Results:The baseline audit showed that there was poor compliance in some criteria. Four barriers were identified and the strategies/resources to mitigate them. There was improvement in all audit criteria as the project developed (100% compliance in seven criteria; two criteria increased from 0 to 100%).Conclusion:The evidence-based implementation project improved nursing practices for self-management planning of the person with diabetes. The adequacy of the strategies developed should be highlighted, namely the training and reflection on practices. The creation of the standardized discharge procedure has also improved compliance (criteria 7-10). The culture of patient-centred care, the desire to provide quality care, the involvement of the nurse manager, informal leaders, and the support office for information and documentation systems in nursing were facilitators in this process.
Objectives: To assess compliance with recommendations to alleviate nipple pain and/or trauma (NPT) and to reduce the rate of breastfeeding abandonment for this reason. Introduction: As a fundamental priority, health programmes encourage mothers to breastfeed exclusively for the first 6 months of the baby's life and to supplement breast milk with other foods up to the age of 2 years. However, the presence of NPT can reduce or prevent compliance with this recommendation. Methods: The project was designed and carried out using a framework based on the JBI Practical Application of Clinical Evidence System (JBI-PACES). Six audit criteria were used in preaudits and postaudits to observe any changes in compliance with the recommendations. Between audits, the Getting Research into Practice (GRiP) tool was used to identify stakeholders, barriers and facilitators of the project. Results: Two hundred and sixty-seven breastfeeding women were studied in the baseline phase and 275 during follow-up. Compliance in four criteria improved, and the rates of NPT decreased (pain: from 63.3 to 53.5%; P = 0.02; trauma: from 37.8 to 24.7%; P = 0.01). The proportion of women advised by qualified personnel increased from 63 to 88% whereas those who cited pain as the reason for abandoning exclusive breastfeeding decreased from 1.5 to 1.1%. Conclusion: This evidence-based implementation project achieved significantly improved compliance rates in most of the evidence-based criteria considered. In consequence, the prevalence of NPT fell significantly. Nevertheless, there was no significant impact on the proportion of mothers abandoning breastfeeding for this reason.
OBJECTIVES The aim of this project was to promote for the family caregivers of stroke patients the resilience evidence translation care model in the community. INTRODUCTION Stroke is the main cause of disability among many patients with chronic diseases. Resilience helps family caregivers facing the consequences of adversity and stress to have a positive outcome. METHODS The study utilized clinical audit strategies under the JBI Practical Application of Clinical Evidence System module. Three audit criteria for the caregivers of stroke patients were considered. A preimplementation audit was conducted with eight nurses and 30 caregivers to measure compliance between current practice and best practice. From that audit we identified barriers and facilitators to practice change by undertaking a Getting Research into Practice analysis. A postimplementation audit was conducted using the same number of samples at 8 weeks for the caregivers to evaluation, and the outcomes using follow-up audit. RESULTS The three criteria showed an improvement: nurses who received education about resilience care protocols, criterion 1 from 0 to 100%, criterion 2 from 0 to 100%, criterion 3 from 0 to 90%. The results showed that the average resilience of caregivers increased from 17.47 (SD ± 1.94) to 18.33 (SD ± 1.54). The resilience scale of pretest and posttest scores were significantly improved (P ≤ 0.001). CONCLUSION The implementation of best practice for enhancing resilience of the family caregivers of stroke patients on the resilience evidence translation care model: a best practice implementation project in community settings is possible. The results indicate that evidence-based practice is an effective method for enhancing the resilience of family caregivers. The strategies contributed to the success of this project, such as scenario simulation education, Objective Structured Clinical Examination, regular weekly audits, and collaboration with project leaders when carrying out caregiver case discussion during clinical practice.
Objectives: This study aims to assess compliance with evidence-based criteria regarding oral hygiene principle education provided for children and adolescents in the Tabriz Faculty of Dentistry. Introduction: Oral health problems might lead to lowering the quality of life amongst children and adolescents; so, providing education regarding oral health principles is of great importance. Methods: Eight audit criteria were assessed using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GriP) audit and feedback tool. Barriers were identified and dental students and staff were instructed by the team members and asked to educate children and adolescents referred to orthodontic department about oral hygiene practices. Changes in audit criteria were collected by direct observation and interview and reported using descriptive statistics. Results: In the follow-up phase, the percentage of patients who were advised to brush their teeth with fluoride toothpaste twice a day, floss daily, and seek regular dental check-ups increased, as compared with the baseline audit (37, 43 and 33%, respectively). Professional fluoride application, fissure sealant and individualized intervention and/ or prevention treatment plans increased by 30, 35 and 15%, respectively in the follow-up phase; while advice on diet and risks of alcohol, tobacco and smoking increased by 93%. Conclusion: The use of standard clinical audit tools in dentistry wards causes improvement in the compliance with providing oral hygiene principle instructions among dental students and staff. Standard tools can increase the effectiveness of corrective interventions by identifying weaknesses in patient care process.
Objectives:The aim of this project was to promote best practice in pressure injury prevention for patients during the intraoperative period in the main operating unit of a Swiss tertiary hospital, through improving risk assessment, safe positioning and documentation.Introduction:Pressure injury is a common and serious complication of surgery patients. Despite pressure injuries being mostly preventable, they are not a top priority of operating room professionals.Methods:A baseline audit was conducted using the JBI Practical Application of Clinical Evidence System, applying nine evidence-based criteria. The audit was followed by the implementation of multiple strategies to promote best practice in pressure injury prevention. A follow-up audit was conducted to determine the compliance with best practice recommendations.Results:The baseline audit indicated poor compliance with evidence-based practice in most audited criteria. The project team identified barriers to best practice and strategies implemented to improve practice, including tailored education, direct support in each surgery specialty, assignment of responsibilities regarding pressure injury prevention measures among the multidisciplinary team members and multiple channels of communication. Improvements in practice were observed in eight of nine criteria in the follow-up audit.Conclusion:The project demonstrated important positive changes in pressure injury prevention during the intraoperative period, despite a sharp slowdown in its implementation process. Continuing education for nursing and nonnursing practitioners has been systematized. Follow-up audits will need to be conducted in the future to maintain pressure injury prevention processes, and contribute to safety of care in adult patients during the perioperative period.
Objectives:The aim of this implementation project was to improve compliance with best practice regarding nonpharmacological interventions used to promote sleep and rest in hospitalized pediatric patients in a nonintensive care setting.Introduction:Hospitalized children endure numerous hindrances to sleep and rest, including, but not limited to, noise, pain, anxiety, and interruptions for nursing care. Evidence suggests that a multifaceted approach to sleep promotion can reduce the length of time to sleep onset and the length of nighttime awakenings. It is widely accepted, however, rarely practiced, that proven, low-cost, and noninvasive strategies exist to promote sleep and restoration of hospitalized pediatric patients, which fosters healing and recovery.Methods:This project used the JBI Evidence Implementation framework. A baseline audit of 22 nurses' and 31 patients'/parents'/caregivers' receipt of education on strategies to promote sleep and rest was obtained via survey; baseline data were also obtained from nurses regarding whether or not a multifaceted approach to sleep promotion is utilized and/or if an evidence-based protocol regarding sleep promotion is in place. Targeted strategies, including a protocol and nurse/patient education of multifaceted approaches to sleep, were then implemented, and a follow-up audit of 25 nurses and 32 patients/caregivers was completed.Results:Overall, postimplementation audits revealed 93% compliance with best practice, a 78% increase from baseline audits of 15%. Baseline data revealed poor knowledge of and/or compliance with each of the four audit criteria: nurse education on strategies to promote sleep and rest, the use of an evidence-based protocol regarding sleep promotion, a multifaceted approach to sleep promotion, and patient and/or caregiver education regarding sleep promotion. Postimplementation data, however, showed improvement in each of these areas.Conclusion:Deficiencies in best practice recommendations for the promotion of sleep and rest in pediatric patients admitted to general wards were identified, interventions were implemented, and results were beneficial. Further investigation could be taken to assess the long-term effectiveness of interventions and/or sleep quality of patients while hospitalized. Moreover, postimplementation audits should be administered to parents near the end of their stay, after they have had time to implement optional interventions, if they choose.
INTRODUCTION AND AIMS:Substance use is a significant global concern. Strengthening parenting in families with adolescents has been shown to reduce substance use initiation. The ¡Vamos por Más! (¡VxM!) program is a positive-parenting program developed in Chile to improve family relations and reduce adolescent substance use that combines in-person school workshops, multimedia messaging and personalized support. This manuscript reports a mixed-methods evaluation of the pilot implementation of the ¡VxM! program utilizing the Consolidated Framework for Implementation Research and Proctor's taxonomy for process outcomes.METHODS:An explanatory sequential design was used. Quantitative methods evaluated program use, acceptability, appropriateness, and fidelity, and were followed by qualitative focus groups (FGs) to assess the implementation process and understand these outcomes. Thirteen FGs stratified by school and role, including school leaders, program facilitators, participants, and researchers, were conducted.RESULTS:The program was implemented in three schools, reaching 253 families with in-person workshops (40.5% of potential participants), 257 parents who viewed on average 72.1% of sent multimedia messages, and 2 families who used the personalized support (0.3%). Overall, the program was viewed as acceptable and appropriate by participants and implementers due to the high quality of program materials, targeted content, and activities. Implementation differed by schools. Key implementation factors were the outer context, inner school setting, and implementation processes.CONCLUSIONS:This comprehensive evaluation, including both intervention implementers and participants, identified implementation facilitators, barriers, and outcomes. Future ¡VxM! implementations should alter program components of schools with lower engagement to improve program implementation and outcomes.
INTRODUCTION:Proper bowel preparation is essential to successful colonoscopies. The quality of bowel preparation is often poorer in the inpatient settings compared with outpatient settings. This can result in repeat procedures and increased hospital length of stay. OBJECTIVE:The aim of this evidence implementation project was to assess and improve compliance with best practice recommendations for bowel preparation prior to colonoscopy. METHODS:The project was done in three phases for patients hospitalized at a tertiary adult hospital: the initial audit; clinical practice change that included providing patients with both oral and written education about bowel preparation; and a follow-up audit. RESULTS:The baseline audit showed that the hospital was already fully compliant with two out of four best practice criteria. For two criteria with poor compliance rates at baseline, we improved compliance for criterion 1 (giving patients both oral and written education about bowel preparation) from 8 to 40%, while compliance rate for criterion 4 [using 2 l polyethylene glycol - (PEG) or adding ascorbic acid to 4 l PEG] remained at 0% at the end of the intervention. CONCLUSION:The JBI evidence implementation program provided a structured approach to analyze colonoscopy bowel preparation practices and develop strategies to align policies with the best practice recommendation of providing written education about bowel preparation. However, there is need for more conclusive evidence to identify the most ideal inpatient bowel preparation formulation.
INTRODUCTION AND AIMS:Postoperative urinary retention (POUR) is a complication that often leads to adverse outcomes and prolonged hospital stay if treatment is delayed. The aim of this project was to improve the competence of nurses in the provision of preoperative POUR education and ensure all patients received preoperative POUR education, and hence reduce the incidence of POUR.METHODS:The evidence-based quality improvement project utilized JBI's Practical Application of Clinical Evidence System and Getting Research into Practice module, adopting two POUR best practice recommendations and two audit criteria. The first criterion was for nurses to conduct preoperative education on POUR and the second criterion was to initiate early ambulation of postoperative patients. The project was implemented in three phases from June 2019 to August 2020 in short-stayer and day surgery wards.RESULTS:Criteria 1 and 2 revealed low compliance of 0 and 30%, respectively, during preimplementation audit. There were significant improvements in the first and second cycles of postimplementation audit for both criteria 1 and 2. Our results indicated that most of the patients who were ambulated early were able to void urine. However, there were a few incidents of urinary retention reported despite early ambulation. Following the audit of the third cycle of postimplementation, the compliance for both criteria were found to be satisfactory (criteria 1: 87%, criteria 2: 82%).CONCLUSION:The implementation of the evidence-based quality improvement project reduced the incidence of POUR. A standardized management would enable nurses to provide consistency in care and effective management and hence prevent the occurrence of POUR.
INTRODUCTION:Behavioural and psychological symptoms of dementia are very common in acute care. Agitation and aggressive behaviours are the most common symptoms and are challenging to manage. Early detection and a nonpharmacological approach are recommended.OBJECTIVES:To implement evidence-based recommendations for the prevention and management of aggression/agitation in patients with dementia in an acute geriatric care unit.METHODS:The project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted with seven audit criteria based on evidence summaries. It was followed by the implementation of an action plan and a follow-up audit.RESULTS:Results showed moderate improvements in compliance with best practice recommendations. The second audit indicated an improvement up to 46% with the identification of factors/triggers that precipitate aggression/agitation and completion of a risk assessment. The highest improvement was the training of the nursing team (79%). Compliance with the involvement of patients and their families in the care planning improved slightly (14%). The lowest improvement was for the development and implementation of individualized care plans (10%).CONCLUSION:The project implementation achieved some positive changes. A formalized process for preventing aggression/agitation is in place. The interprofessional collaboration, the support given to the nursing team and the basket of nonpharmacological interventions were strengthened. The electronic documentation and a limited collaboration of the nursing team were challenging. As further strategies were implemented, further audit would be required to assess achievement in change and/or demonstration of improved care provided for this vulnerable population.
Objectives: The purpose of this project was to improve the compliance of patients' pain management process after surgery using evidence-based criteria at the Al-Zahra Educational Hospital in Tabriz. Introduction: Reducing and relieving pain are among the basic rights of patients, and the management of this component should be one of the basic goals of the patient care team. Inadequate pain control can have many unpleasant consequences for the patient and increase hospital costs. Due to the importance of pain control and a gap in this area, it was decided to implement a project to improve pain control in postoperative patients grounded in evidence-based recommendations. Method: This project was carried out at a Level III hospital in Iran from December 2019 to June 2020. A baseline audit, based on the JBI Practical Application of Clinical Evidence-Based System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool was conducted with 40 patients in the surgery ward of the hospital. After developing the GRiP table (barriers, strategy, resources and outcome), a follow-up audit was done three times. The different stages of the audit were centered in evidence-based criteria. At each stage of follow-up, 40 patients were randomly selected in the postoperative stage. Results: At the baseline audit, out of a total of eight criteria, only criterion 2 corresponded to the audit criteria where there was no pain assessment tool or protocol for pain or for training patients and nurses. Over the three follow-up audits, 100% improvement was achieved in half of the criteria through preparing visual analogue scale pain instruments, and development of a pain protocol and a pain self-care protocol, and a 63% improvement was observed in one of the criteria. Patients' pain decreased from very severe to mild/moderate in the first few hours in 70% of patients after surgery. Conclusion: The use of this best practices implementation project led to the improvement of the postoperative pain management process of patients and the improvement of patient care quality. The use of the JBI Method is recommended to address other current or defective hospital processes.
Objectives: The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. Introduction: Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. Methods: Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. Results: Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. Conclusion: The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.
