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1.
J Subst Abuse Treat ; 144: 108929, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36402124

ABSTRACT

INTRODUCTION: Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. METHODS: We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. RESULTS: Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. CONCLUSIONS: Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.


Subject(s)
HIV Testing , Substance-Related Disorders , United States , Humans , Cross-Sectional Studies , Evidence-Based Practice , Analgesics, Opioid , Substance-Related Disorders/diagnosis , Substance-Related Disorders/therapy
2.
Curr Opin Psychiatry ; 36(1): 28-33, 2023 01 01.
Article in English | MEDLINE | ID: mdl-36302201

ABSTRACT

PURPOSE OF REVIEW: There are increasing calls for mental health treatments to be adapted for different groups to maximize their acceptability and benefit to patients. However, adaptations can be costly to develop and evaluate, difficult to implement in routine clinical practice and may reduce service capacity at a time when there is unprecedented unmet need. An alternative method is personalization on an individual level. This review provides an overview of the issues related to personalization and adaptation of mental health interventions. RECENT FINDINGS: Several terms have been used to describe changes to existing therapies, these reflect different extents to which existing treatments have been changed. Evidence-based practice and modular therapies allow a level of flexibility within intervention delivery without formal changes and not all changes to therapy should be considered as a new/adapted treatment but instead regarded as 'metacompetence'. Implementing existing interventions in new contexts is preferable to developing new interventions in many instances. New guidance outlines how researchers can adapt and transfer interventions to varied contexts. SUMMARY: The review provides proposed definitions of different changes to therapy. Modified and personalized treatments may improve acceptability to patients whilst maximizing implementation of evidence-based practice within clinical services.


Subject(s)
Evidence-Based Practice , Mental Health , Humans , Delivery of Health Care , Psychotherapy
3.
Crit Care Nurse ; 42(6): e1-e6, 2022 Dec 01.
Article in English | MEDLINE | ID: mdl-36453063

ABSTRACT

BACKGROUND: Pulse oximetry is commonly used in critical care settings to monitor oxygenation status and assist with decision-making regarding oxygen therapy. Although it is imperative that nurses follow manufacturer guidelines, off-label use is common and could affect patient safety. OBJECTIVE: To increase staff members' knowledge and reduce the frequency of off-label pulse oximeter placement in the critical care setting. METHODS: A preintervention audit was completed to assess the frequency of off-label use, and a preintervention survey was given to staff. Health care staff in the critical care units received an educational intervention. A postintervention survey for health care staff and a postintervention audit were completed to assess outcomes. With the support of hospital management, 90 ear probes were purchased for critical care settings to address supply barriers to the use of appropriate pulse oximetry sensors. RESULTS: In the preintervention audit (508 observations), a finger probe was used off label on the ear in 77 patients (15.2%). In the postintervention audit (365 observations), a finger probe was used on the ear in only 3 patients (0.8%). CONCLUSION: Providing a brief educational session and making ear pulse oximeter probes readily available in the critical care setting increased compliance with manufacturer guidelines and helped ensure safe pulse oximetry monitoring.


Subject(s)
Evidence-Based Practice , Patient Safety , Humans , Critical Care , Intensive Care Units , Oximetry
4.
5.
Diagn. tratamento ; 27(4): 157-63, out-dez. 2022. tab, tab
Article in Portuguese | LILACS | ID: biblio-1399070

ABSTRACT

Contextualização: A vitamina C (ácido ascórbico) é, sem dúvida, a mais popular dentre as vitaminas e a vedete de vendas na mídia, sobretudo no inverno, sob o slogan de que previne doenças. Objetivos: O estudo avaliou a efetividade da suplementação de vitamina C para tratamento e prevenção de sintomas e doenças, segundo as revisões sistemáticas da Colaboração Cochrane. Métodos: Trata-se de overview de revisões sistemáticas Cochrane. Procedeu-se à busca na Cochrane Library (2022), sendo utilizado o termo "Ascorbic Acid". O desfecho primário de análise foi a redução da incidência da doença ou a melhora clínica, mediante suplementação de vitamina C. Resultados: A estratégia de busca recuperou 26 revisões sistemáticas Cochrane, sendo oito estudos incluídos, seguindo critérios de inclusão. Foram avaliados 91 ensaios clínicos (n = 54.864 participantes). Condições/doenças fetais, pneumonia, resfriado comum, tétano, doença cardiovascular, asma e broncoconstrição por exercício, retinopatia diabética e Doença de Charcot-Marie-Tooth configuraram objetos de análise. Não foi evidenciada efetividade da vitamina C nas análises dessas condições. Discussão: Não há evidência de efetividade da vitamina C para as doenças analisadas. Embora a maioria dos estudos primários tenha limitações sérias e a evidência seja de baixa qualidade, não é possível recomendar a suplementação da vitamina C para essas condições nesse momento. Conclusão: Não há efetividade, nesse momento, da suplementação da vitamina C para prevenção e tratamento de doenças analisadas pela Cochrane, A evidência é bastante limitada e recomenda-se a realização de novos ensaios clínicos randomizados, utilizando-se o CONSORT (Consolidated Standards of Reporting Trials) Statement.


Subject(s)
Ascorbic Acid , Therapeutic Uses , Disease Prevention , Evidence-Based Practice , Systematic Review
6.
Diagn. tratamento ; 27(4): 150-6, out-dez. 2022. qdr, tab, tab
Article in Portuguese | LILACS | ID: biblio-1399065

ABSTRACT

Contexto: A Terapia Notch surgiu como estratégia promissora no controle do zumbido tonal. Trata-se de estratégia que utiliza a plasticidade neural para inibir as frequências laterais àquela do zumbido, equilibrando sinapses excitatórias e inibitórias e, por conseguinte, reduzindo a percepção e incômodo do zumbido. Objetivo: Avaliar a efetividade da Terapia Notch no controle do zumbido tonal. Material e métodos: Trata-se de sinopse baseada em evidências. Procedeu-se à busca por estudos que associavam zumbido e Terapia Notch em quatro bases eletrônicas de dados: Cochrane - Central de Registros de Ensaios Clínicos - CENTRAL (2022), PubMed (1966-2022), Portal BVS (1982-2022) e Embase (1974- 2022). Dois pesquisadores independentemente extraíram os dados e avaliaram a qualidade dos estudos para a síntese. O desfecho primário de análise envolveu a melhora clínica do zumbido. Resultados: Foram encontradas 538 referências. Seis estudos foram incluídos (n = 233 participantes). Discussão: A literatura apresenta poucos estudos clínicos de avaliação da terapia Notch para zumbido. Trata-se de ensaios clínicos com amostragem reduzida e heterogeneidade alta. Embora o nível de evidência seja ainda muito limitado, todos esses estudos concluem que a terapia Notch pode ser efetiva no controle do zumbido tonal. Conclusões: A terapia Notch pode trazer benefícios no controle do zumbido tonal, mas novos ensaios clínicos de qualidade e bom delineamento são necessários para maior robustez da evidência.


Subject(s)
Therapeutics , Tinnitus , Neurosciences , Evidence-Based Practice , Neuronal Plasticity
7.
Apuntes psicol ; 40(3): 117-125, 13 nov. 2022. ilus
Article in Spanish | IBECS | ID: ibc-ADZ-1023

ABSTRACT

El importante esfuerzo que se está llevando a cabo por parte de las administraciones públicas para articular actuaciones de intervención y apoyo familiar dentro de los planes y estrategias estatales, autonómicos y locales, debe ir unido a procesos de innovación y mejora dirigidos a fomentar la calidad de los servicios y programas de atención a la infancia y las familias. En este sentido, hay un claro consenso entre responsables institucionales e investigadores en la necesidad de que las actuaciones de intervención familiar sean prácticas y programas basados en la evidencia. En este artículo se reflexiona sobre el papel central de las y los profesionales para la incorporación de buenas prácticas basadas en la evidencia en el ámbito de la intervención familiar, concluyendo sobre la necesidad de identificar y promover las competencias interprofesionales propias del trabajo con familias para garantizar la calidad de los servicios de atención familiar (AU)


he important effort that is being carried out by the public administrations to articulate family intervention and support actions within state, regional and local plans and strategies must be linked to innovation and improvement pro-cesses aimed at promoting the quality of services and programs for children and families. In this sense, there is a clear consensus between institutional managers and researchers on the need for family intervention actions to be practical and evidence-based programs. This article reflects on the central role of professionals for the incorporation of evidence-based best practices in the field of family intervention, concluding on the need to identify and promote the workforce skills in family intervention to guarantee the quality of family care services. (AU)


Subject(s)
Humans , Evidence-Based Practice , Organizational Innovation , Clinical Competence , Interprofessional Relations , Attitude of Health Personnel , Family Practice
8.
Apuntes psicol ; 40(3): 139-149, 13 nov. 2022. tab
Article in Spanish | IBECS | ID: ibc-ADZ-1025

ABSTRACT

A la hora de poner en marcha procesos de innovación en los servicios de intervención familiar que supongan la incorporación de programas basadas en la evidencia (PBE), es fundamental considerar el papel que desempeñan los/as profesionales, ya que de ellos depende en gran parte la fidelidad y calidad de la implementación de los programas. Este estudio se centra en analizar las actitudes de profesionales hacia las prácticas basadas en la evidencia, así como su percepción y valoración del Programa de Intervención Familiar (PIF), desarrollado en el Ayuntamiento de Pamplona (España) dentro de la cartera de servicios de preservación familiar. Los participantes fueron los/as 27 profesionales que aplican el PIF, que cumplimentaron la escala Evidence-Based Practice Attitude Scale (EBPAS) y la de Expectativas y Valoración Inicial del PIF (EVI-PIF). Los resultados obtenidos mostraron la relación existente entre las actitudes hacia las prácticas basadas en la evidencia y algunas características de los/as profesionales. Asimismo, también se encontró relación significativa entre una alta valoración del PIF y unas actitudes positivas hacia los PBE. Estos resultados avalan la importancia de las actitudes profesionales como elementos que pueden facilitar o dificultar los procesos de innovación y mejora en los servicios de atención e intervención familiar (AU)


When implementing innovation processes in family intervention services that involve the incorporation of eviden-ce-based programmes (EBP), it is essential to take into consideration the role played by professionals, since the fidelity and quality of the implementation of the programmes largely depends on them. This study focuses on analysing the attitudes of professionals towards EBP, as well as their perception and assessment of the Family Intervention Programme (FIP), developed in the family prevention services of Pamplona City Council (Spain). The participants in the study were the 27 professionals who implement the FIP, who completed the Evidence-Based Practice Attitude Scale (EBPAS) and he Expectations and Initial Assessment of the FIP (EVI-FIP). The results obtained showed the relationship between attitudes towards evidence-based practice and some characteristics of the professionals. A significant relationship was also found between a high valuation of the FIP and positive attitudes towards EBP. These results support the importance of professional attitudes as elements that can facilitate or hinder innovation and improvement processes in family care and intervention services. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , 36397 , Attitude of Health Personnel , Evidence-Based Practice , Professional Competence
9.
J Infus Nurs ; 45(6): 306-319, 2022.
Article in English | MEDLINE | ID: mdl-36322948

ABSTRACT

The objective of this study was to implement an evidence-based practice project to improve peripheral intravenous catheter (PIVC) insertion confidence and competence and to improve first-attempt success. The researcher used a blended online learning module and live simulation to increase PIVC insertion confidence and competence. Internal application of a blended curriculum model improved the first-attempt PIVC insertion success of nurses. A validated confidence assessment was completed by participants (n = 38) preintervention, immediately postintervention, and 30 days postintervention. A Mann-Whitney U test determined that nurses' confidence was significantly higher immediately following the intervention compared with preintervention (P = .003), and the increase was sustained 30 days after the intervention (P < .001). While placing a PIVC in simulation, the observer measured competence using a validated tool verifying 28 steps required, with a 76% success rate for all 28 steps. Nurses' self-reported first-attempt PIVC success increased significantly from the preintervention survey to the 30-day postintervention survey (P = .00004).


Subject(s)
Catheterization, Peripheral , Medical-Surgical Nursing , Humans , Curriculum , Evidence-Based Practice , Catheters
10.
JBI Evid Implement ; 20(S1): S15-S22, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372789

ABSTRACT

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.


Subject(s)
Evidence-Based Practice , Pain , Humans , Pain Measurement , Pain/diagnosis , Documentation , Emergency Service, Hospital
11.
JBI Evid Implement ; 20(S1): S32-S40, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372791

ABSTRACT

OBJECTIVES: The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes. INTRODUCTION: The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices. METHODS: The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient's monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline. RESULTS: There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice. CONCLUSION: Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses' increased level of knowledge and usage of appropriate preventative measures.


Subject(s)
Critical Care , Evidence-Based Practice , Humans
12.
JBI Evid Implement ; 20(S1): S41-S48, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372792

ABSTRACT

OBJECTIVES: This project aimed to improve communication skills of medical laboratory staff and the quality of health services. INTRODUCTION: Communication is the basis of all interpersonal actions; optimal and efficient communication needs permanent awareness and training in order to learn these skills. The healthcare industry is a constantly changing field, so communication becomes a very important tool that contributes to change. METHODS: This project has been conducted following the JBI framework to improve the communication process in a medical laboratory. A baseline audit involved 30 multidisciplinary healthcare providers (HCP). Using audit criteria provided by JBI, data for clinical audits were collected using a completed audit questionnaire based on direct observation and interview of participants, and checking the records. Once the information had been gathered, the team involved in the project implemented a three sessions workshop focused on communication to solve/improve identified barriers. A follow-up audit was conducted to assess the outcomes of the intervention. RESULTS: The implementation of the project resulted in the evolution of the participants and the cohesion of the healthcare team. The baseline compliance with best practice for audit criteria shows that only a part of those involved in the study benefited from training communication. Lack of time for team briefings and interactions led to different points of view. In the pandemic context, the implementation of the communication improvement strategy was conducted online, with all 30 HCP participating in training sessions. After the follow-up audit, the evolution was demonstrated by the improvement of the HCP compliance compared with the two audit criteria identified with the insufficient compliance in the basic audit. CONCLUSION: Effective communication is a necessity to meet patient needs and to provide high-quality services. The healthcare team received training for communication focused on interpersonal communication.


Subject(s)
Evidence-Based Practice , Health Personnel , Humans , Communication , Patient Care Team
13.
JBI Evid Implement ; 20(S1): S23-S31, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372790

ABSTRACT

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.


Subject(s)
Evidence-Based Practice , Preceptorship , Humans , Health Personnel
14.
JBI Evid Implement ; 20(S1): S3-S14, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372788

ABSTRACT

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.


Subject(s)
Evidence-Based Practice , Patient Safety , Humans , Hospitals, University , Health Personnel , Communication
15.
JBI Evid Implement ; 20(S1): S76-S87, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372796

ABSTRACT

OBJECTIVES: To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. INTRODUCTION: Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. METHODS: The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. RESULTS: Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). CONCLUSION: With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.


Subject(s)
Clinical Competence , Intubation, Gastrointestinal , Humans , Portugal , Evidence-Based Practice
16.
JBI Evid Implement ; 20(S1): S67-S75, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372795

ABSTRACT

OBJECTIVES: The main aim of this project was to enhance compliance with the best available evidence in clinical practice guidelines (CPGs) development based on evidence-based healthcare (EBHC) and GRADE (grading of recommendations, assessment, development and evaluation) principles in healthcare professionals and healthcare providers. INTRODUCTION: In various healthcare fields, the quality of care provided in different healthcare settings may vary. Guidelines following the EBHC principles should help make the right decisions in healthcare by providing the best healthcare option and be available for all patients. The perspectives of all engaged stakeholders should be respected, however. Within the Czech Republic, there had been no standardized process of CPG development. METHODS: A baseline audit was conducted to demonstrate the status quo of the EBHC in the Czech Republic, which identified several barriers. Consequently, strategies (educational activities, methodological guidelines) to overcome the barriers were suggested and implemented. Two more audits followed (November 2017, November 2020). RESULTS: The baseline audit results showed no or very low compliance to the best available evidence in CPG development. After the implementation, an increased compliance in all audit criteria (national methodology guidelines, trustworthy CPGs, experienced methodologists, clinical summaries) has been reported. The project has helped to establish procedures of CPGs development, enhanced knowledge and skills on EBHC in healthcare professionals, and ignited patients' involvement in CPG development. CONCLUSIONS: The implementation project showed an increasing number of national methodology guidelines, CPGs being developed using EBHC and GRADE principles and HC professionals educated in EBHC. A national center for CPGs development within the Ministry of Health is being planned to sustain the project achievements.


Subject(s)
Delivery of Health Care , Evidence-Based Practice , Humans , Czech Republic , Health Personnel
17.
JBI Evid Implement ; 20(S1): S59-S66, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372794

ABSTRACT

OBJECTIVES: This project aimed to set up a control mechanism for the prevention of pressure injuries during surgery. INTRODUCTION: Structured and comprehensive risk assessment is effective in identifying individuals at risk for pressure injuries. The subsequent use of proper positioning aids (modern gel-filled positioning aids used to position the head and limbs: floating limb concept) reduces the incidence of surgery-related pressure injuries. METHODS: The best practice implementation project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in local healthcare practice. The study was carried out from January 2020 to February 2021 at the private clinic of aesthetic surgery (Brno, Czech Republic). A baseline audit involving 27 patients was undertaken and measured against six best practice recommendations. This step was followed by the implementation of targeted strategies and finally, a postimplementation follow-up audit was conducted. RESULTS: The baseline audit results showed significant deficits between current practice and best practice in all but two criteria. Barriers to implementation of nursing clinical handover best practice criteria were identified by the project team and an education strategy was implemented, documentation for recording possible risks of pressure injuries was created, and new positioning aids were purchased and introduced into clinical practice. There were significantly improved outcomes across all best practice criteria in the follow-up audit. CONCLUSION: Clinical audits were proved to promote best practice in healthcare. Focused education, provision, and use of relevant tools and aids can have an immediate and positive impact on clinical practice. Future audits are planned to ensure the sustainability of practice changes.


Subject(s)
Acquired Immunodeficiency Syndrome , Patient Handoff , Humans , Evidence-Based Practice/methods , Guideline Adherence , Documentation
18.
JBI Evid Implement ; 20(S1): S88-S97, 2022 Aug 01.
Article in English | MEDLINE | ID: mdl-36372797

ABSTRACT

OBJECTIVES: To promote evidence-based practices related to the prevention of adverse events associated with medication administration (only chemotherapy) in a hospital service. INTRODUCTION: The medication management process in a hospital setting is highly complex, going through multiple stages from drug selection, procurement and storage, to prescription, validation, dispensing, preparation, administration and monitoring. METHODS: An evidence implementation project based on an audit and feedback approach was conducted from December 2019 to April 2021 using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice. RESULTS: The results of the baseline audit showed that the 10 audit criteria were mostly met; however, two of the criteria (criterion 6: the expiry date of medication is checked before use and criterion 7: the nurse who prepares the medication administers the medication to the patient) had low compliance (respectively, 0 and 67.9%). After identifying the barriers and implementing strategies to deal with the identified barriers, we verified a significant improvement in compliance with best practices (criterion 6 improved to 64.3% and criterion 7 to 78.6%). CONCLUSION: This implementation project was a success, achieving a great improvement of the implementation of evidence-based guidelines concerning the prevention of adverse events associated with medication administration in a hospital in central Portugal. More such projects should be planned to sustain the implementation of evidence-based methods to improve health outcomes, patient safety, costs and health systems.


Subject(s)
Guideline Adherence , Hematology , Humans , Hospitalization , Evidence-Based Practice/methods , Patient Safety
19.
JBI Evid Implement ; 20(3): 209-217, 2022 Sep 01.
Article in English | MEDLINE | ID: mdl-36373359

ABSTRACT

INTRODUCTION: The first case of the novel coronavirus disease (COVID-19) in Iran was officially announced on February 19, 2020, in Qom city. The prevalence of COVID-19 is higher among frontline healthcare workers (HCWs) due to their occupational exposure. OBJECTIVE: The aim of this evidence implementation project was to improve the protection of nurses against COVID-19 in the emergency department of a teaching hospital in Tabriz, Iran. METHODS: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Ten audit criteria, representing the best practice recommendations for the protection of HCWs in the emergency department were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. RESULTS: The baseline audit results showed that the compliances for four (out of ten) audit criteria (criteria 4, 7, 8 and 9), were under 75%, which indicated poor and moderate compliance with the current evidence. After implementing plans such as running educational programs and meetings, major improvement was observed in 3 criteria, criterion 4 was improved from low to excellent (41-81%), criterion 7 was promoted from low to moderate (30-62%), criterion 8 was not promoted considerably (22-27%) and criterion 9 was improved from moderate to excellent (70-84%). CONCLUSION: The results of the audit process increased COVID-19 protection measures for nurses in the emergency department. It can be concluded that educational programs and tools, such as face-to-face training, educational pamphlets, workshops and meetings can facilitate the implementation of evidence into practice.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Evidence-Based Practice , Iran/epidemiology , Emergency Service, Hospital , Health Personnel , Hospitals, Teaching
20.
Am J Speech Lang Pathol ; 31(6): 2943-2958, 2022 Nov 16.
Article in English | MEDLINE | ID: mdl-36346976

ABSTRACT

PURPOSE: Two disparate models drive American speech-language pathologists' views of evidence-based practice (EBP): the American Speech-Language-Hearing Association's (2004a, 2004b) and Dollaghan's (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as clinical evidence, are an important part of EBP but lack consistent terminology and clear definitions in the literature. Our objective was to identify how clinical evidence is described in the field. METHOD: We conducted a scoping review to identify terms ascribed to clinical evidence and their descriptions. We searched the peer-reviewed, accessible, speech-language pathology intervention literature from 2005 to 2020. We extracted the terms and descriptions, from which three types of clinical evidence arose. We then used an open-coding framework to categorize positive and negative descriptions of clinical expertise and summarize the role of clinical evidence in decision making. RESULTS: Seventy-eight articles included a description of clinical evidence. Across publications, a single term was used to describe disparate concepts, and the same concept was given different terms, yet the concepts that authors described clustered into three categories: clinical opinion, clinical expertise, and practice-based evidence, with each described as distinct from research evidence, and separate from the process of clinical decision making. Clinical opinion and clinical expertise were intrinsic to the clinician. Clinical opinion was insufficient and biased, whereas clinical expertise was a positive multidimensional construct. Practice-based evidence was extrinsic to the clinician-the local clinical data that clinicians generated. Good clinical decisions integrated multiple sources of evidence. CONCLUSIONS: These results outline a shared language for SLPs to discuss their clinical evidence with researchers, families, allied professionals, and each other. Clarification of the terminology, associated definitions, and the contributions of clinical evidence to good clinical decision-making informs EBP models in speech-language pathology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21498546.


Subject(s)
Communication Disorders , Speech-Language Pathology , Humans , United States , Speech-Language Pathology/methods , Evidence-Based Practice , Clinical Decision-Making
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