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Kelly Y, O'Rourke N, Flynn R, O'Connor L, Hegarty J. Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary. BMJ Qual Saf 2023; 32:750-762. [PMID: 37290917 PMCID: PMC10803983 DOI: 10.1136/bmjqs-2022-015287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/15/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation. METHODS Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers. RESULTS 4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%). CONCLUSIONS The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.
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Affiliation(s)
- Yvonne Kelly
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
- Catherine McAuley School of Nursing and Midwifery and School of Public Health (SPHeRE programme), University College Cork, Cork, Ireland
| | - Niamh O'Rourke
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Laura O'Connor
- Health Information and Standards Directorate, Health Information and Quality Authority (HIQA), Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Garrido MA, Alvarez EA, Ponce DP, Salech F, Tobar DI, Tobar EA. Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non-pharmacological delirium prevention program. Int J Geriatr Psychiatry 2021; 36:302-313. [PMID: 32892410 DOI: 10.1002/gps.5425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the contribution of applying the theoretical framework of implementation science for adherence to non-pharmacological interventions to prevent delirium. METHODS A quasi-experimental prospective design was conducted from March 2017 to October 2018 in a teaching hospital. Participants included 149 healthcare staff and 72 elderly inpatients. A non-pharmacological delirium prevention program was designed, applied and evaluated in accordance with the consolidated framework for advancing implementation research (CFIR). The primary outcome was the global adherence rate to 12 predefined indicators, comparing measurements at baseline (O1), after training (O2) and at a 6-month follow-up (O3) assessed by an external reviewer. Staff knowledge and beliefs about delirium were assessed using a validated tool, and delirium incidence was evaluated using the confusion assessment method. RESULTS Overall adherence increased from 58.2% (O1) to 77.9% (O2) and 75.6% (O3) (O2 vs. O1: p < 0.001 and O3 vs. O1: p < 0.001). Staff perceptions regarding implementation of non-pharmacological interventions increased from 74.8% to 81.9% (p = 0.004). Delirium incidence was non-significantly reduced from 20% (O1) to 16% (O3) (p = 0.99). CONCLUSIONS Implementation of a delirium prevention program using a CFIR model was useful in improving adherence to activities included in this program, as well as improving the knowledge and beliefs regarding delirium by healthcare workers. The impact of this implementation strategy on the incidence of delirium should be evaluated in a larger scale multicenter trial.
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Affiliation(s)
- Maricel A Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile.,Departamento de Ciencias de la Ocupación y Terapia Ocupacional, Universidad de Chile, Santiago, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Chile.,Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Chile.,Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
| | - Daniel I Tobar
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Eduardo A Tobar
- Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Chile
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Alvarez EA, Garrido M, Ponce DP, Pizarro G, Córdova AA, Vera F, Ruiz R, Fernández R, Velásquez JD, Tobar E, Salech F. A software to prevent delirium in hospitalised older adults: development and feasibility assessment. Age Ageing 2020; 49:239-245. [PMID: 31957783 DOI: 10.1093/ageing/afz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND non-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions. METHODS a transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study. RESULTS a software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software's usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation. CONCLUSION a highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.
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Affiliation(s)
- Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Metropolitana, Chile
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Maricel Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Gaspar Pizarro
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Andres A Córdova
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Vera
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Rocio Ruiz
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Raul Fernández
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Juan D Velásquez
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Eduardo Tobar
- Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
- Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
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The Design and validation of a Nursing Plan for Elderly Patients with Postoperative Delirium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224504. [PMID: 31731593 PMCID: PMC6888289 DOI: 10.3390/ijerph16224504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022]
Abstract
Delirium is the sudden alteration of the state of consciousness and perception, fluctuating over hours or days. It predominates in older adults and is associated with the aging process. The incidence of delirium increases between 10% and 15% in surgical interventions. The objective of this study was the design and validation of a nursing care plan for elderly patients with postoperative delirium. This study was based on the Delphi method and applied to nursing professionals at the Hospital Universitario del Caribe, Cartagena. The sample consisted of 36 nurses with knowledge of the taxonomy of nursing diagnoses. The care plan was applied in two rounds. For the analysis, measures of central tendency and dispersion were used, as well as frequency and percentages. The participants were women (90.9%) from the hospitalization service (51.5%), with training in Nursing Diagnosis (NANDA), Nursing interventions classification (NIC) and Nursing Outcome Classifications (NOC) (78.8%). The validated care plan has eight diagnostic features. Highlights include “Risk for Ineffective Cerebral Tissue Perfusion” and “Disturbed Sleep Pattern” (in 98.1%; 11 results), with the highest score in the first round being “Vital Signs” (with 100%) and “Sleep” (100%) and “Mobility” (100%) in the second round. Forty-four interventions and 18 suggested activities were identified. This care plan offers the nursing professionals reliable and pertinent tools in clinical practice for the management of patients with postoperative delirium.
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Haley MN, Casey P, Kane RY, Dārziņš P, Lawler K. Delirium management: Let's get physical? A systematic review and meta‐analysis. Australas J Ageing 2019; 38:231-241. [DOI: 10.1111/ajag.12636] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022]
Affiliation(s)
| | - Penelope Casey
- Eastern Health and Eastern Health Clinical SchoolFaculty of Medicine, Nursing and Health SciencesMonash University Melbourne Victoria Australia
| | - Richard Youlten Kane
- Eastern Health and Eastern Health Clinical SchoolFaculty of Medicine, Nursing and Health SciencesMonash University Melbourne Victoria Australia
| | - Pēteris Dārziņš
- Eastern Health and Eastern Health Clinical SchoolFaculty of Medicine, Nursing and Health SciencesMonash University Melbourne Victoria Australia
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