Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project.

OBJECTIVES: This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward. INTRODUCTION: Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief. METHODS: This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit. RESULTS: The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced. CONCLUSIONS: The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

Delirium risk screening and assessment among older patients in general wards and the emergency department: a best practice implementation project.

OBJECTIVES: The aim of this project was to improve compliance with evidence-based criteria regarding risk of delirium and the assessment of delirium among older patients in the general hospitalization wards and the emergency department. INTRODUCTION: More than 50% of older hospitalized patients experience delirium. Some studies have highlighted the need to implement an orientation protocol in the emergency department and to continue this in the general wards, with the aim of decreasing the delirium rate among older patients admitted to hospital. METHODS: The project followed the JBI evidence implementation framework. We conducted a baseline audit, a half-way audit, and final audit of 50 patients at risk of delirium admitted to the emergency department and the general wards, respectively. The audits measured compliance with eight criteria informed by the available evidence. RESULTS: In the final audit, three of the eight criteria achieved more than 50% compliance in the general wards: pressure injury screening (96%); monitoring changes (74%); and performing interventions (76%). In the emergency department, worse results were reported because of the service conditions. The exception was the criterion on the training of nurses on the topic, with 98%. The integration of a tool to screen for delirium in older patients in the hospital's electronic clinical history records increased the percentage of compliance with audit criteria regarding the use of the scale and delirium detection (rising from 0% to 32% in the final audit in the general wards). CONCLUSION: Through the implementation of this project, validated and evidence-based evaluation will ensure that nurses are supported through appropriate measures to reduce patient confusion and aggression resulting from delirium.

Facilitation as a component of evidence implementation: a multinational perspective.

BACKGROUND: Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM: This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS: To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS: The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION: The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.

Prevalence of falls in noninstitutionalized people aged 65-80 and associations with sex and functional tests: A multicenter observational study.

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65-80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk-specific fall prevention programs to prevent disabilities in older people.

JBI series paper 3: The importance of people, process, evidence, and technology in pragmatic, healthcare provider-led evidence implementation.

In this paper, we describe and discuss evidence implementation as a venture in global human collaboration within the framework of "people, process, evidence, and technology" as a roadmap for navigating implementation. At its core implementation is not a technological, or theoretical process, it is a human process. That health professionals central to implementation activities may not have had formal training in implementation, highlights the need for processes and programs that can be integrated within healthcare organization structures. Audit with feedback is an accessible implementation approach that includes the capacity to embed theory, frameworks, and bottom-up change processes to improve the quality of care. In this third paper in the JBI series, we discuss how four overarching principals necessary for sustainability (Culture, Capacity, Communication, and Collaboration) are combined with evidence, technology, and resources for evidence-based practice change. This approach has been successfully used across hundreds of evidence implementation projects around the globe for over 15 years. We present healthcare practitioner-led evidence-based practice improvement as sustainable and achievable in collaborative environments such as the global JBI network as a primary interest of the practicing professions and provide an overview of the JBI approach to evidence implementation.

Cost-Effectiveness of an Exercise Programme That Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65-80: A Secondary Data Analysis.

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

[Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.] / Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico.

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses´Association of Ontario (RNAO). METODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p<0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado.

Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados / The implementation of Best practice guidelines in Spain through the Programme of the Best Practice Spotlight Organizations

La aplicación de Guías de Buenas Prácticas es efectiva en la mejora de la práctica clínica y en la disminución de la variabilidad clínica. En España se implantan desde 2012 las Guías de Buenas Prácticas de la Asociación de Enfermeras de Ontario a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®, siguiendo los principios del programa canadiense Best Practice Spotlight Organizations® (BPSO®). La Unidad de Investigación en Cuidados y Servicios de Salud (Investén-isciii) coordina dicho programa en España, tras ser nombrada BPSO Host por la Asociación de Enfermeras de Ontario. Se han seguido 4 estrategias: traducción de las Guías de Buenas Prácticas, difusión de las mismas y del programa, implantación de las GuÍas de Buenas Prácticas y evaluación de los resultados en centros seleccionados de forma competitiva, y, finalmente, desarrollo de mecanismos de sostenibilidad. La implantación se apoya en el modelo teórico Knowledge to Action, que establece un ciclo de 6 fases: identificación del problema y formación a Centros Comprometidos con la Excelencia en Cuidados® seleccionados; adaptación al contexto local; evaluación de los facilitadores y barreras; adaptación e implantación de las intervenciones; monitorización y evaluación de resultados, y sostenibilidad. En cada una de estas fases se incorporan aquellos elementos basados en la evidencia que favorecen la efectividad de la implantación, como son la concurrencia competitiva para ser seleccionado candidato a participar en el programa, la selección por la institución de las guías a implantar, el liderazgo por enfermeras con un enfoque multiprofesional, la planificación del proceso a partir de estructuras de trabajo no verticales, pero con apoyo de la institución, el uso de múltiples estrategias de forma simultánea, la evaluación continuada y la retroalimentación de resultados, todo ello tutorizado y apoyado desde el BPSO Host. Actualmente en España hay 27 instituciones de diferentes características que implantan en total 20 guías clínicas. Recientemente se ha ampliado el alcance y estructura del programa con centros coordinadores BPSO Host regionales, lo que ha ampliado el número de instituciones a 36 y el número de guías clínicas implantadas a 22. El programa ha tenido un impacto positivo a nivel de las organizaciones y el sistema, en los procesos de cuidados y en la salud de los pacientes. Se observa en el enriquecimiento de la práctica profesional basada en la evidencia, el fomento del trabajo colaborativo en red, así como en la mejora en los resultados de salud de los pacientes y en la calidad de los cuidados prestados

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided

Implantación de la valoración y el cuidado de los adultos en riesgo de ideación y comportamiento suicida: una Guía de la Registered Nurses' Association of Ontario (RNAO) / Implementation of the assessment and care of adults at risk for suicidal ideation and behaviour: A guideline of the Registered Nurses' Association of Ontario (RNAO)

OBJETIVO: Conocer la evolución de los cuidados tras la implantación de la Guía de buenas prácticas «Valoración y cuidado de adultos en riesgo de ideación y comportamiento suicida». MÉTODO: Se realizó un estudio descriptivo longitudinal en la Unidad de Hospitalización de Salud Mental del Hospital Universitario Virgen de las Nieves de Granada. Se incluyeron 1.471 pacientes, todos los ingresados entre 2016 y 2018. Se evaluaron el cumplimiento en indicadores del proceso de cuidados y la situación de riesgo suicida, y se obtuvo la tasa de suicidio por 100.000 habitantes. Se calcularon frecuencias absolutas y relativas de los indicadores y su evolución en el tiempo con el test chi-cuadrado de Pearson para p < 0,05. RESULTADOS: Se observó un incremento estadísticamente significativo en todos los procesos. El porcentaje de pacientes con valoración de riesgo suicida aumentó del 16% en 2016 al 45,25% en 2018. La aplicación de medidas de seguridad aumentó hasta el 100% en 2018, y la derivación a otros servicios comunitarios pasó del 70,31% al 90,50%. El porcentaje de pacientes en riesgo de ideación suicida se mantuvo estable. La tasa de suicidios por 100.000 habitantes en la provincia de Granada disminuyó un 24,50%. CONCLUSIONES: La mejora en los procesos de cuidados y la disminución de la tasa de suicidio en Granada desde la implantación son consistentes con los hallazgos de otros estudios y ofrecen una visión esperanzadora. Se deben potenciar las estrategias integrales de prevención y continuar con la evaluación de las iniciativas puestas en marcha

OBJECTIVE: To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour». METHOD: A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS: We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS: Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue

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

Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC) en España / Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO)

OBJETIVO: Analizar la evolución de la implantación de las recomendaciones de proceso de la guía RNAO Valoración y manejo del dolor y de los resultados en salud. MÉTODO: Estudio observacional, longitudinal, retrospectivo, realizado en 3hospitales de tercer nivel de España. Se incluyó a todos los pacientes dados de alta los últimos 5 días de cada mes de las unidades seleccionadas en el proceso de implantación. Se evaluaron datos estructurales, estancia media, estrategia de implantación y grado de implantación de recomendaciones de proceso según la guía RNAO durante los 3primeros años de implantación y resultados. Se realizó un análisis descriptivo mediante el cálculo de medias y frecuencias absolutas y relativas por periodos: basal (T0) y anual durante los 3primeros años de implantación (T1, T2 y T3, respectivamente) e inferencial. RESULTADOS: Se ha incluido a 8.128 pacientes. Se ha realizado contraste de hipótesis entre los diferentes periodos. La valoración inicial del dolor en las primeras 24h de ingreso o poscirugía se incrementó tras el periodo basal en todos los hospitales, especialmente en aquellos en los que no se cumplían los requisitos de la guía al inicio, y continuó creciendo de forma progresiva hasta a los 3 años de implantación (alcanzando un 94,6% en el hospital 2). En cambio, la implantación del plan de cuidados no ha llegado a superar el 37,5 o el 38,5% de los hospitales 1 y 3, respectivamente. Respecto a los indicadores de resultado, la prevalencia de dolor a las 24 h e intenso disminuyó en los 3hospitales de forma general desde T0 o T1 a T3; sin embargo, no se obtuvieron diferencias estadísticamente significativas concluyentes. CONCLUSIONES: La evolución de la implantación de las recomendaciones de proceso ha mejorado desde el inicio, al igual que los resultados sobre los pacientes, consiguiendo una disminución de la prevalencia y la intensidad del dolor, aunque no se obtuvieron datos concluyentes; todo esto conlleva una mejor práctica enfermera con mayores registros, continuidad asistencial y mejora de la gestión del dolor en los pacientes

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients

Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España / Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain

OBJETIVO: Identificar elementos favorecedores y barreras de implantación en el Programa de Centros Comprometidos con la Excelencia en Cuidados® que instauran guías de práctica clínica de la Registered Nurse' Association of Ontario, con el fin de que experiencias futuras pudieran beneficiarse de las apreciaciones expuestas. MÉTODO: Estudio de investigación evaluativa del proceso de implantación de guías en instituciones que componen las dos primeras cohortes del programa en España, mediante análisis de contenido de memorias de implantación y proceso inductivo, lectura, interpretación, codificación y categorización según estructura DAFO: debilidades, amenazas, fortalezas y oportunidades. RESULTADOS: Se han analizado memorias e informes de 18 centros de 12 Comunidades Autónomas, entre los cuales implantan 22 guías distintas. Como debilidades, destacan por frecuencia e intensidad, problemas relacionados con sistemas de información y su explotación. Se exponen otros elementos relacionados con difusión de resultados, profesionales, cuidados y factores relativos a la institución. Sobresalen como amenazas, la inestabilidad de plantillas y cambios continuados en la alta dirección o políticas corporativas. Entre las fortalezas, se distinguen la dedicación exclusiva de personal al proyecto y su vinculación a objetivos institucionales. Y por último, se identifica como oportunidades, destacan la posibilidad de comparación estandarizada de resultados propios con ajenos, así como la difusión de resultados. CONCLUSIÓN: Se configura un patrón útil para el abordaje de implantación en otras realidades, donde el cambio en la cultura profesional, su formación, comunicación y liderazgo, así como alinear intereses de gestores y políticos, facilitan unas condiciones ideales para la práctica basada en la evidencia

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice

Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain. / Evaluación de estrategias de implantación del Proyecto Centros Comprometidos con la Excelencia en Cuidados en España.

OBJECTIVE: To identify favourable elements and barriers to implementation in the Program of Best Practice Spotlight Organization® that establish clinical practice guidelines of the Registered Nurse' Association of Ontario, so that future experiences could benefit from the assessments presented here. METHOD: Evaluation research study of the process of implementing guidelines in institutions that make up the first two cohorts of the programme in Spain, through analysis of contents of implantation reports and inductive process, reading, interpretation, coding and categorized according to SWOT structure: Strengths, weaknesses, opportunities and threats. RESULTS: Reports from 18 centres in 12 Autonomous Communities have been analyzed, including 22 different guidelines. As weaknesses, problems related to information systems and their exploitation stand out for frequency and intensity. Other elements related to dissemination of results, to professionals, care and factors related to the institution are presented. Standing out as threats are the instability of staff and continued changes in Senior Management or corporate policies. Among the strengths, the exclusive dedication of personnel to the project and its link to institutional objectives are distinguished. As opportunities, the possibility of standardized comparison of own results with others, as well as the dissemination of results are highlighted. CONCLUSION: A useful pattern is set up to approach implementation in other scenarios, where changes in professional culture, training, communication and leadership, as well as aligning interests of managers and politicians, facilitate ideal conditions for Evidence-Based Practice.

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.

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). / Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC®) en España.

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.

Implementation of the assessment and care of adults at risk for suicidal ideation and behaviour: A guideline of the Registered Nurses' Association of Ontario (RNAO). / Implantación de la valoración y el cuidado de los adultos en riesgo de ideación y comportamiento suicida: una Guía de la Registered Nurses' Association of Ontario (RNAO).

OBJECTIVE: To establish the evolution of the care process after the implementation of the Best Practices Guideline «Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour¼. METHOD: A descriptive longitudinal study was carried out at the Mental Health Hospitalization Unit in Hospital Universitario Virgen de las Nieves, Granada. All patients admitted to the Unit between 2016 and 2018, 1471 in total, were included. Compliance of care process indicators and suicidal risk were evaluated; in addition, suicide rates per 100,000 inhabitants were obtained. Absolute and relative frequencies of the indicators were calculated, as well as the change during the study period by the chi-square Pearson test, for P<.05. RESULTS: We observed a statistically significant increase in the entire care process. The percentage of patients with suicidal risk assessment improved from 16% in 2016 to 45.25% in 2018. The application of safety measures grew reaching 100% in 2018, and community services referral went from 70.31% to 90.50%. The percentage of patients at risk of suicidal ideation remains stable. Suicide rates per 100,000 inhabitants in Granada decreased by 24.50%. CONCLUSIONS: Improvement in the care process and the decrease in the suicide rate in Granada since the implementation of the guideline are consistent with the results of other research and offer a hopeful vision. Comprehensive strategies for suicide prevention must be promoted, and the evaluation of initiatives undertaken must continue.

The implementation of Best practice guidelines in Spain through the Programme of the Best Practice Spotlight Organizations®. / Implantación de Guías de buenas prácticas en España a través del Programa de Centros Comprometidos con la Excelencia en Cuidados®.

The implementation of Best practice guidelines is effective in improving clinical practice and reducing clinical variability. The Best Practice Guidelines of the Ontario Nurses Association have been implemented in Spain since 2012 following the principles of the Canadian programme of the Best Practice Spotlight Organisations® (BPSO®). The Nursing and Healthcare Research Unit (Investén-isciii) coordinates this programme in Spain, having been nominated BPSO Host by the Ontario Nurses Association. Four strategies were followed: translation of the Best Practice Guidelines, dissemination of same and of the programme, implementation of the Best Practice Guidelines and assessment of the results in competitively selected centres, and, finally, the development of sustainability mechanisms. Implementation is based on the theoretical Knowledge to Action model, which establishes a cycle of 6 phases: identification of the problem and training of selected BPSO®; adaptation to the local context; assessment of facilitators and barriers; adaptation and implementation of interventions; monitoring and evaluation of results, and sustainability. Each of these phases incorporate evidence-based elements that promote the effectiveness of implementation, such as the competitive selection of candidates to participate in the programme, selection by the institution of the guidelines to be implemented, leadership by nurses with a multi-professional approach, planning of the process from work structures that are non-vertical but with the support of the institution, the simultaneous use of multiple strategies, ongoing assessment and feedback of results. All of which is mentored and supported by the BPSO Host. There are currently 27 institutions in Spain of different characteristics that implement a total of 20 clinical guidelines. The scope and structure of the programme has recently been extended with regional BPSO Host coordinating centres, which has brought the number of institutions to 36 and the number of implemented clinical guidelines to 22. The programme has had a positive impact on organisations and the system, on care processes and on patient health. This is evidenced by enriched evidence-based professional practice, the promotion of collaborative networking and by improved patient health outcomes and the quality of care provided.

Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico / Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses'Association of Ontario (RNAO). MÉTODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p < 0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p < 0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high

Getting guidelines into practice: lessons learned as Best Practice Spotlight Organization host.

BACKGROUND: The Spanish Best Practice Guidelines (BPG) Implementation Project is part of the Best Practice Spotlight Organizations international program, coordinated by the Registered Nurses' Association of Ontario (RNAO). AIMS: To influence the uptake of nursing BPG across healthcare organizations, to enable practice excellence and positive client outcomes. METHODS: After translating the RNAO's BPG into Spanish, the Host Organization published a formal call for proposals to select healthcare settings in Spain to implement the RNAO's BPG and evaluate the results. The approach is nursing-led and multidisciplinary; context specific; and involving a wide range of stakeholders. The implementation of BPG Toolkit guides the process: cascade training, selection of recommendations to be implemented, 3 years of planned implementation activities, monitoring of process and outcome results for patients discharged 60 days every year. The Host Organization supports healthcare settings selected. RESULTS/DISCUSSION: The first call was launched in 2012. Eight healthcare settings (11 sites), serving 1.3 million people, were selected (hospitals and primary healthcare centers). They chose 10 BPG, according to their needs. In 2015 and 2018, 16 more healthcare settings have joined the program with a total of 263 sites. And in 2019, three complete regions will join the program as a regional host. Currently, more than 3200 nurses and 40 other healthcare professionals have been trained, evidence-based protocols have been developed or updated, patient education has been promoted, and international Best Practice Spotlight Organizations indicators have been evaluated in an electronic platform. CONCLUSION: The results obtained acknowledge that the RNAO implementation method could be replicated with success internationally. The strategies based on local context have worked and we have consolidated a network that shares knowledge and strategies and promotes evidence-based culture among Spanish healthcare settings and evidence-based care to patients.