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JBI Database System Rev Implement Rep ; 16(8): 1720-1736, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30113552


OBJECTIVES: The main objective of this project was to reduce the incidence and harm from falls that occur among patients admitted in the acute Internal Medicine Unit and Intensive Care Unit in a public teaching hospital in São Paulo, Brazil. INTRODUCTION: Falls are a challenge for health professionals and healthcare services as they may result in high-impact outcomes for patients, such as functional decline, increase in length of hospital stay, increase in the cost of healthcare services, and death. In an attempt to promote safe care the World Health Organization (WHO) launched the World Alliance for Patient Safety in 2004 that encourages the adoption of best practice to reduce adverse events in healthcare services. METHODS: The project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in health practice. A baseline audit was conducted measuring eight best practice criterias, followed by the implementation of target strategies and a follow-up audit. RESULTS: The results of the baseline audit identified large gaps between current practice and overall compliance with best practice. The GRiP module helped identify strategies related to education programs for patients, families and nursing teams, and a falls risk assessment with an accurate tool to address the gaps in compliance. The follow-up audit cycle was satisfactory as all best practice audit criteria showed an improvement as an aggregated result. CONCLUSIONS: The project used the audit and feedback strategy to translate evidence into practice. Some of the measured criteria improved to moderate-high compliance with best practice. The results showed that implementation of evidence-based practice leads to an improvement in falls prevention. Future audits are required to sustain improvements.

Acidentes por Quedas/prevenção & controle , Hospitalização , Hospitais Universitários , Segurança do Paciente , Guias de Prática Clínica como Assunto , Adulto , Brasil , Cuidados Críticos , Prática Clínica Baseada em Evidências , Fidelidade a Diretrizes , Humanos , Medicina Interna , Recursos Humanos de Enfermagem no Hospital , Educação de Pacientes como Assunto , Medição de Risco
JBI Database System Rev Implement Rep ; 16(6): 1454-1473, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29894411


OBJECTIVES: This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice. INTRODUCTION: Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream. METHODS: This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital. RESULTS: The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing. CONCLUSIONS: Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.

Cateteres Venosos Centrais/efeitos adversos , Implementação de Plano de Saúde , Unidades de Terapia Intensiva , Guias de Prática Clínica como Assunto , Adulto , Brasil , Infecções Relacionadas a Cateter/prevenção & controle , Enfermagem Baseada em Evidências , Hospitais Universitários , Humanos , Recursos Humanos de Enfermagem no Hospital/educação