Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline. / Mejora de la valoración del riesgo y la prevención de las lesiones por presión durante la implantación de una Guía de buenas prácticas clínicas.

OBJECTIVE: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses' Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. METHOD: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) "Risk Assessment and Pressure Injury Prevention" carried out by the Ontario Nurses' Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. RESULTS: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. CONCLUSIONS: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.

Implementation of best practice guidelines for ostomy care and management: Care outcomes. / Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados.

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications.

Implementation experience of a guideline on fall prevention in Centres Committed to Excellence in Care®. / Experiencia en la implantación de la Guía de prevención de caídas en Centros Comprometidos con la Excelencia en Cuidados®.

AIM: To describe the progress of implementing the «Preventing falls¼ Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). METHOD: A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. RESULTS: 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. CONCLUSIONS: Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice.

Mejora de la valoración del riesgo y la prevención de las lesiones por presión durante la implantación de una Guía de buenas prácticas clínicas / Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline

Objetivo: Evaluar los indicadores de calidad asistencial en lesiones por presión (LPP) antes y tras 6 meses de la implantación de la Guía de buenas prácticas clínicas de la Registered Nurses’ Association of Ontario en la unidad geriátrica del Hospital Universitario Santa María de Lleida. Método: Estudio observacional descriptivo longitudinal a lo largo de la implantación de la Guía de buenas prácticas clínicas Valoración del riesgo y la prevención de lesiones por presión realizada por la Asociación Profesional de Enfermeras de Ontario. De las historias clínicas electrónicas se extrajeron las principales variables —incidencia y categorización de LPP nosocomiales, valoración del riesgo de LPP durante las primeras 24horas de ingreso, valoración continuada según el riesgo de LPP y registro de una superficie especial para el manejo de la presión en el plan de cuidados en los pacientes con riesgo— para su posterior análisis descriptivo y contraste de hipótesis para la comparación de proporciones. Resultados: Se incluyeron un total de 154 sujetos, siendo mayoritariamente mujeres (57%), edad media de 86 años y estancia media de 8 días. Con la implantación de la guía globalmente se consiguió mejorar los indicadores de calidad, aunque no en todos los casos con significación estadística. Los indicadores de calidad: la incidencia de LPP disminuyó un 14,54%, las valoraciones del riesgo de LPP a las 24horas de ingreso aumentaron un 2,90% y las periódicas en función del riesgo un 280,35%, registrando un 48,19% frente al 12,67% de la situación basal, y el registro de superficies especiales en el manejo de la presión aumentó un 13,33%. Conclusiones: La implantación de la Guía de buenas prácticas clínicas de la Registered Nurseś Association of Ontario mejoró los resultados relacionados con la valoración y prevención de las LPP, repercutiendo positivamente en los indicadores de calidad asistencial.(AU)

Objective: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses’ Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. Method: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) “Risk Assessment and Pressure Injury Prevention” carried out by the Ontario Nurses’ Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. Results: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. Conclusions: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.(AU)

Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados / Implementation of best practice guidelines for ostomy care and management: Care outcomes

INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications

Experiencia en la implantación de la Guía de prevención de caídas en Centros Comprometidos con la Excelencia en Cuidados / Implementation experience of a guideline on fall prevention in Centres Committed to Excellence in Care

OBJETIVO: Describir la progresión del grado de adherencia a las recomendaciones de la Guía «Prevención de caídas» del Programa Best Practice Spotlight Organization (BPSO®) y resultados en caídas en los Centros Comprometidos con la Excelencia en Cuidados (CCEC®). MÉTODO: Estudio cuasiexperimental pretest-postest con carácter multicéntrico desarrollado entre 2012 y 2018. Se incluye a los pacientes ≥65 años, dados de alta en las unidades de implantación de la Guía, analizando variables sociodemográficas (sexo, edad); estancia hospitalaria; valoración del riesgo de caídas al ingreso y pacientes con riesgo; plan de cuidados para la prevención de caídas e incidencia de caídas. Se han comparado los indicadores del programa CCEC® medidos en los periodos: basal (T1), de candidatura en los 3 primeros años (T2) y de sostenibilidad (T3). Se ha realizado un análisis estadístico descriptivo e inferencial. RESULTADOS: Se ha evaluado a 31.486 pacientes de 7 centros hospitalarios (T1=465; T2=14.255; T3=16.766). El 51,87% fueron hombres, con una edad media de 79,06 años. La estancia hospitalaria fue 8,15 días. La valoración del riesgo al ingreso se realizó en el 81,96% (T1=44,30%; T2=81,11%; T3=83,73%), estando en riesgo un 52,31%. Tenían planificados cuidados para prevenir caídas un 47,75% (T1=24,73%; T2=42,43%; T3=52,90%). De las 423 caídas registradas, el 62,17% no tuvieron lesiones. CONCLUSIONES: A pesar de las diferencias entre hospitales, como las características estructurales, las estrategias, los instrumentos de valoración y el ritmo en la progresión de datos, el grado de adherencia a las recomendaciones está siendo exitoso mejorando de forma generalizada. La implantación de la Guía ha permitido abordar la problemática de las caídas, produciendo cambios positivos en el proceso y favoreciendo la implantación y sostenibilidad de prácticas basadas en la evidencia

AIM: To describe the progress of implementing the «Preventing falls» Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). METHOD: A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012-2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalization days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. RESULTS: 31,486 patients were evaluated in 7 centres (T1=465; T2=14,255; T3=16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalization was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1=44.30%, T2=81.11%, T3=83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1=24.73%, T2=42.43%, T3=52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. CONCLUSIONS: Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice