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Just D, Tai S, Palmier-Claus J. A systematic review of policy and clinical guidelines on positive risk management. J Ment Health 2023; 32:329-340. [PMID: 34006184 DOI: 10.1080/09638237.2021.1922643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND National policies and guidelines advocate that mental health practitioners employ positive risk management in clinical practice. However, there is currently a lack of clear guidance and definitions around this technique. Policy reviews can clarify complex issues by qualitatively synthesising common themes in the literature. AIMS To review and thematically analyse national policy and guidelines on positive risk management to understand how it is conceptualised and defined. METHOD The authors completed a systematic review (PROSPERO: CRD42019122322) of grey literature databases (NICE, NHS England, UK Government) to identify policies and guidelines published between 1980 and April 2019. They analysed the results using thematic analysis. RESULTS The authors screened 4999 documents, identifying 7 eligible policies and 19 guidelines. Qualitative synthesis resulted in three main themes: i) the conflicting aims of positive risk management; ii) conditional positive risk management; and iii) responsible positive risk management. CONCLUSIONS Analysis highlighted discrepancies and tensions in the conceptualisation of positive risk management both within and between policies. Documents described positive risk management in different and contradictory terms, making it challenging to identify what it is, when it should be employed, and by whom. Five policies offered only very limited definitions of positive risk management.
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Affiliation(s)
- Daniela Just
- School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Sara Tai
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Jasper Palmier-Claus
- Spectrum Centre for Mental Health Research, University of Lancaster, Lancaster, UK.,Lancashire and South Cumbria, NHS Foundation Trust, Lancashire, UK
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Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center. CLIN NURSE SPEC 2023; 37:14-19. [PMID: 36508230 DOI: 10.1097/nur.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This article describes how a large urban medical center was able to enhance the integration of evidence-based practice in the clinical environment by reconfiguring its approach to policy and procedures documentation. PROJECT DESCRIPTION Leaders at a large urban medical center observed that numerous nursing practice documents lacked a base of evidence. No standard process existed for building staff awareness of the evidence-based underlying practice, and there was uneven knowledge of evidence-based practice in the milieu. To address the problem, a team of Clinical Nurse Specialists developed a novel policy establishing procedures for document review, formal structures for policy assignment, and rigorous standards for the development and sharing of evidence tables. OUTCOME The proportion of nursing guidance documents connected to evidence tables increased from 45% to 77% in the first year and a half following implementation. The change has enabled streamlining and consolidation of nursing practice guidance documents and has led to significant increases in engagement with clinical inquiry at the bedside. CONCLUSION A policy specifically requiring evidence to be incorporated into nursing practice guidance documents can help enhance the understanding and uptake of evidence-based practice in a complex clinical environment. Clinical Nurse Specialists played a vital role in facilitating this organizational culture change.
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Reeves N. Utilization and evaluation of a diabetes screening assessment tool (DSAT) in an interprofessional student-led community-based clinic. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wind LS, Knight TG, Auten JJ, Bates JS, Marucci L, Creedle CJ, Foster MC, Muluneh B. Evaluation and optimization of a clinical pharmacist driven transitions of care model for malignant hematology. J Oncol Pharm Pract 2020; 27:283-287. [PMID: 32290764 DOI: 10.1177/1078155220916516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To implement and optimize a pilot transitions of care model for scheduled chemotherapy admissions in patients with hematologic malignancies at our institution.Methodology: We utilized the plan-do-study-act (PDSA) quality improvement technique to prospectively measure success of interventions related to improving transitions of care processes that occurred in multiple stages including development of standardized operating procedures, electronic medical record documentation, and education to the malignant hematology multidisciplinary group. Chart review was performed retrospectively for at least nine patients per PDSA cycle. Areas of intervention addressed and measured regarding communication between the ambulatory care and acute care settings included: admission purpose, processes related to insurance benefits investigations for specialty medications required in the post-discharge setting, and plan for growth factors, prophylactic antimicrobials, and follow-up.Results and conclusions: We included 28 patients and performed a total of three PDSA cycles demonstrating specific improvements in: communication regarding status of benefits investigations performed for specialty medications prior to admission, resolution of these benefits investigations at various time points, improvement in efficient use of the electronic medical record for chemotherapy orders, and patient instructions for appropriate use of prophylactic antimicrobials. Although improvement was noted initially with prescribing of discharge antiemetics and antimicrobials, regression to baseline was noted with the third PDSA cycle.
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Affiliation(s)
- Lucas S Wind
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | - Jessica J Auten
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jill S Bates
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Leonardo Marucci
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Crista J Creedle
- Division of Nursing, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Matthew C Foster
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benyam Muluneh
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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