Experiencia en la generación de estrategias de monitorización y evaluación en la implantación de Guías de Práctica Clínica en España / Experience Generating Evaluation and Monitoring Strategies in the Implementation of Clinical Practice Guidelines in Spain / Experiência na geração de estratégias de monitoramento e avaliação na implementação de manuais de prática clínica na Espanha

Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud

Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article's objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care

Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde

Effectiveness of a best practice guideline to manage pain in surgical patients.

BACKGROUND: The prevention and control of acute postoperative pain is essential, not only to avoid unnecessary suffering, but to reduce postoperative morbidity, recovery time, hospital stay and associated costs. AIM: To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in surgical patients. METHODS: Prospective, observational, longitudinal study. SUBJECTS: Surgical patients over 14 admitted to the University Hospital Complex of Albacete, and discharged during the last working days of every month. VARIABLES: 1) demographic data, hospital stay. 2) The process indicators of BPG implementation. 3) Patient outcomes: prevalence and intensity of pain in the first 24 postsurgical hours, maximum intensity of pain during hospitalization. TOOLS: Scales of assessment of pain intensity (0-10). DATA COLLECTION: Database of BPSO/CCEC® Program. ETHICAL ASPECTS: Anonymous data. DATA ANALYSIS (SPSS® V12): Descriptive during four periods: baseline (T0: December 2012); initial (T1: June-December 2013); intermediate (T2: 2014-2015); consolidation (T3: 2016-2017). Measurements of central tendency and dispersion, absolute and relative frequencies, according to variables. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). STATISTICAL SIGNIFICANCE: p < 0.05. RESULTS: Included 3934 patients, 52.3% (2058) men. Daily intervention of pain detection was performed in 73.5% (2890) of patients (28% T0; 67.4% T1; 66.7% T2; 89.9% T3; p < 0.0001), assessment of pain with a scale in 65.2% (2567) (0% T0; 48.8% T1; 59.4% T2; 85.6% T3; p < 0.0001); 35.3% (1389) had a care plan for assessment and management of pain (0% T0; 34.6% T1; 32.3% T2; 42.3% T3; p < 0.0001). The percentage of patients who had serious pain (>5) during the first 24 h was reduced from 12.4% (T1) to 5.3% (T3) (p < 0.0001). CONCLUSION: Implementation of recommendations has led to a statistically significant improvement over the periods in the study. Pain intensity and the percentage of patients with severe pain have decreased in a significant way.

Implementation of the Best practice guideline: Stroke assessment across the continuum of care in hospitalised patients. / Implantación de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados.

INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. OUTCOME VARIABLES: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients.

[Hospitalisation as a risk for functional decline in older adults]. / Deterioro funcional asociado a la hospitalización en pacientes mayores de 65 años.

UNLABELLED: FUNCTIONAL DECLINE: (FD) is a risk associated with hospital admission in older people, due to its high prevalence (35-70%) and its serious consequences. AIM: To determine the incidence of FD in the elderly after hospital admission at the Geriatric and Internal Medicine wards of a tertiary teaching hospital (Albacete, Spain). METHOD: A cohort study has been designed, whose primary focus was FD, defined as the loss of independence to perform the activities of daily living between preadmission status and discharge. Demographic characteristics, comorbidity, length of hospital stay and cognitive status have been analysed. Data collection was performed by interviews with patients and caregivers during hospitalization and after discharge (by phone), as well as by revision of clinical records. RESULTS: 104 patients were evaluated, of which 51.9% were female; the average age was 79.97 years (dt=7.89) IC 95% [78.43, 81.5] and the average length of stay was 10.11 days (dt=7.65) IC 95% [8.62,11.6]. The proportion of patients who showed a normal cognitive status on the first in-hospital day was 41.4% (43 patients). FD was present in 60 (57.7%) patients in the first day of hospitalisation; when discharged, 32.6% of 92 patients who could be evaluated showed FD. 19% of patients who were previously independent in activities of daily living developed a serious dependence after discharge. FD was associated statistically with age and a history of previous falls. CONCLUSIONS: FD takes place in a high percentage of the elderly patients. Among the previously independent patients, 19% remains in a situation of dependence after discharge.