[A multifaceted implementation strategy to enhance the uptake of evidence-based nursing recommendations in Spain: implementation project protocol]. / Estrategia de implantación multifacética para promover los cuidados basados en la evidencia: protocolo de investigación en implantación.

OBJECTIVE: It is necessary to facilitate the implementation of evidence-based practice in clinical practice to improve patients' health results. Sumamos Excelencia® is an implementation project led by nurses that aims to improve the evidence-based practice uptake. Building on the first edition, we have improved the project design and proposed new intervention topics. The objective is to evaluate the effects of the implementation of evidence-based recommendations through a multifaceted implementation strategy. METHODS: This study is an implementation research with a quasi-experimental, multicentre, before-and-after design and audits for data collection at baseline, 3, 6, and 12 months. It will be developed in hospital units, primary care centres, and nursing homes. Units choose to implement recommendations of one of these topics: assessment and management of pain, conservative management of urinary incontinence, prevention of childhood obesity, or breastfeeding promotion. All units will implement recommendations about hand hygiene. Audits will assess changes in process and patient outcomes, barriers and strategies, and evidence-based practice competencies through specific questionnaires and clinical records data. Analysis will be descriptive and inferential. CONCLUSIONS: Sumamos Excelencia® will aim to improve the use of evidence-based practice in the Spanish National Health System and to advance implementation science. This study will also provide important insight into the barriers that nurses face to implementing evidence-based practice in clinical practice and the strategies that they can use to overcome them. This generated knowledge can be used in other evidence-based practice implementation projects in a similar context to enhance adherence to evidence-based recommendations.

OBJECTIVE: Es necesario facilitar la implantación de la evidencia científica en la práctica clínica para mejorar los resultados de salud de los pacientes. Sumamos Excelencia® es un proyecto de implantación liderado por enfermeras para aumentar el uso de prácticas basadas en la evidencia en la práctica clínica. En base a la primera edición, se ha mejorado el diseño del proyecto y desarrollado nuevos paquetes de intervención clínica. El objetivo es evaluar los efectos de la implantación de recomendaciones basadas en evidencia en la práctica clínica mediante una estrategia de implantación multifacética. METHODS: Investigación en implantación con diseño cuasi-experimental multicéntrico antes-después sin grupo control, auditorías a los 0, 3, 6 y 12 meses. Realizado en unidades hospitalarias, centros de atención primaria y centros sociosanitarios. Las unidades eligen buenas prácticas sobre una intervención clínica: evaluación y manejo del dolor, manejo conservador de la incontinencia urinaria, prevención de la obesidad infantil o promoción de la lactancia materna. Todas implantarán recomendaciones sobre higiene de manos. Las auditorías evaluarán cambios en procesos y resultados, barreras y estrategias, y competencias de práctica basada en evidencia mediante cuestionarios específicos y registros clínicos. Análisis descriptivo e inferencial. CONCLUSIONS: Sumamos Excelencia® pretende mejorar el uso de la práctica basada en evidencia y aportar conocimiento a la ciencia de la implantación. Proporcionará información sobre las barreras para implantar prácticas basadas en evidencia en la práctica clínica y las estrategias para superarlas. El conocimiento generado puede utilizarse en otros proyectos de implantación para mejorar la adherencia a las recomendaciones basadas en evidencia.

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.