BACKGROUND:Diabetic foot ulcers are a severe complication of diabetes. Despite international guidelines, preventive risk assessment remains inconsistent in outpatient settings. OBJECTIVES:The project aimed to improve early identification and risk stratification of diabetic foot in a plastic surgery outpatient department in Taiwan through the implementation of evidence-based practices. METHODS:This best practice implementation project utilized the JBI Evidence Implementation Framework. A baseline audit of 30 patient records was conducted to evaluate current practice against best practice recommendations. Barriers were identified using JBI's GRiP (Getting Research into Practice) tool. Improvement strategies included developing a standard operating procedure, embedding risk assessment forms in the electronic health record, and staff training. A follow-up audit of 38 records evaluated post-implementation compliance. RESULTS:Baseline compliance was 0% for standardized risk classification and staff training. Following the implementation of targeted strategies over 5 months, compliance improved to 100% across all six audit criteria. However, short-term clinical outcomes revealed persistent adverse events, including one death, four hospitalizations, and two amputations, highlighting a gap between process compliance and immediate outcome improvement. CONCLUSIONS:The project successfully established a high-reliability preventive process for diabetic foot care in an outpatient setting. However, the persistence of adverse outcomes suggests that process improvement must be coupled with longitudinal follow-up and robust post-assessment care pathways to effectively reduce amputation rates. SPANISH ABSTRACT:https://links.lww.com/IJEBH/A696.
AIMS:The aim of this overview is to provide a roadmap for the organization-wide implementation of evidence-based medicine (EBM) by synthesizing evidence across three key implementation process steps: outcome measurement, contextual analysis, and strategy selection. METHODS:A systematic overview of reviews was conducted following an a priori protocol (osf.io/65zn2). Reviews that provided information on EBM implementation, published from 2013 to 2023, were retrieved from MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCOhost). An implementation process model, a conceptual framework for organizational readiness, and a taxonomy for implementation strategies were used to synthesize the findings. RESULTS:The overview screened 8,726 reviews, of which 100 were included. Reviews related to outcome measurement (n = 50) all reported provider-level outcomes (e.g., knowledge and skills) and identified up to 204 instruments. Four instruments were consistently recommended: EBPQ, EPIC, Fresno Test, and HS-EBP. The results of reviews on contextual analysis (n = 57) were structured according to five Organizational Readiness concepts and 22 themes. Organizational (n = 51) and personal factors influencing EBM implementation (n = 48) were discussed most. Reviews reporting implementation strategies (n = 40) mainly investigated educational strategies (n = 38). Other strategies, such as infrastructure changes, were less commonly evaluated. CONCLUSIONS:This overview of reviews identifies actionable insights for the organization-wide implementation of EBM, including validated provider-level measurement instruments, a comprehensive overview of contextual factors, and effective strategies to support implementation. Critical evidence gaps concerned non-educational strategies as well as the assessment of organizational and patient-level outcomes. By connecting insights across all stages of the implementation process, our synthesis offers health care organizations a structured roadmap to design, implement, and evaluate sustainable EBM initiatives. SPANISH ABSTRACT:https://links.lww.com/IJEBH/A692.
INTRODUCTION:Chronic obstructive pulmonary disease (COPD) remains a leading global cause of morbidity and mortality. Although evidence-based self-management programs are well established, their implementation in routine hospital care is often limited by contextual and behavioral barriers, resulting in suboptimal compliance with recommended practices. OBJECTIVES:This project aimed to improve patients' COPD self-management through the implementation of evidence-based practices in a hospital in Taiwan. METHODS:The project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) tool. A baseline audit was conducted to compare current practices with recommended practices. Participants included 32 ward nurses and 30 patients. Factors hindering compliance were identified and educational and workflow strategies were implemented, including staff training, bedside micro-teaching, and digital reinforcement through the ward's official messaging platform. A follow-up audit measured changes in compliance. RESULTS:Compliance improved across all criteria, increasing from 16.7%-56.7% at baseline to above 90% at follow-up. Nurses' knowledge and perception scores increased from 57.7 to 95.6 points and mean patient COPD Assessment Test scores improved from 6.6 to 4.9, indicating reduced symptom burden. No 30-day emergency department revisits occurred. CONCLUSIONS:This project improved adherence to evidence-based COPD self-management practices and strengthened nurses' capacity for evidence-based education. Repeated bedside micro-teaching sessions (each < 5 min) and digital reinforcement effectively supported patient learning and confidence. Embedding these approaches into staff training and ongoing audits demonstrates a feasible and transferable model for sustaining evidence-based COPD care in acute care settings. SPANISH ABSTRACT:https://links.lww.com/IJEBH/A688.
INTRODUCTION:Pain is a frequent complaint in emergency departments (ED), particularly among polytrauma patients, who often experience high levels of pain. The Advanced Trauma Life Support protocol is widely used to assess such patients, prioritizing life-threatening conditions through the ABCDE approach. However, pain documentation is often insufficient, and analgesia administration is frequently delayed, even in conscious patients able to report their pain. OBJECTIVES:This project aimed to promote evidence-based practices for pain assessment and management in an emergency trauma room. METHODS:The project followed the seven-phase JBI Evidence Implementation Framework. A baseline audit assessed 211 patient records against seven audit criteria and barriers to best practices were identified. After the implementation of improvement strategies, a follow-up audit measured changes in compliance with best practices. RESULTS:Key barriers included lack of pain documentation, absence of a reliable assessment scale, no reassessment after analgesia or before ED discharge, and delays in analgesic administration. To address these, a protocol for systematic pain evaluation was implemented, ensuring analgesia aligned with recorded scores, alongside training for medical and nursing teams. The follow-up audit demonstrated marked improvement across all criteria. Compliance exceeded 70% for pain documentation upon arrival in the ED using a validated tool and for analgesia administration based on recorded scores. Reassessment after analgesia and prior to discharge remained below 60%, likely reflecting structural challenges within the ED. Time to first analgesic dose was reduced, indicating progress in timely administration. CONCLUSION:The implementation strategies proved effective, improving the systematic care provided in the emergency trauma room of the ED, in alignment with best practices for the assessment and management of pain in polytrauma patients. SPANISH ABSTRACT:https://links.lww.com/IJEBH/A674.
