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Cobo-Sánchez JL, Cirera-Segura F, García-Martínez M, Vieira-Barbosa Lopes LM, Jaume-Riutort C, Hernando-García J, Marrero-Fernández P, Moreno García MÁ, González-García F, Larrañeta-Inda I, Ulzurrún-García A, Casas-Cuesta R, Ila-García A, Blanco-Mavillard I. Mapeo de la percepción individual y del entorno organizacional para la práctica clínica basada en la evidencia entre enfermeras renales en España. ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s2254-28842023002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influenyen esta percepción.
Material y Método: Estudio observacional transversal multiéntrico, en 15 servicios de nefrología de distitos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístio descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente.
Resultados: Se recibieron 397 encuestas (participación84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC:95% 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experiencia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC:95% 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado.
Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.
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Cobo-Sánchez JL, Cirera-Segura F, García-Martínez M, Vieira-Barbosa Lopes LM, Jaume-Riutort C, Hernando-García J, Marrero-Fernández P, Moreno García MÁ, González-García F, Larrañeta-Inda I, Ulzurrún-García A, Casas Cuesta R, Ila-García A, Blanco-Mavillard I. Mapeo de la percepción individual y del entorno organizacional para la práctica clínica basada en la evidencia entre enfermeras renales en España. ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s225428842023002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influenyen esta percepción.
Material y Método: Estudio observacional transversal multiéntrico, en 15 servicios de nefrología de distitos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístio descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente.
Resultados: Se recibieron 397 encuestas (participación84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC:95% 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experiencia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC:95% 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado.
Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.
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Fischbein AB. Improving Skin Care Protocol Use in the Intensive Care Unit to Reduce Hospital-Acquired Pressure Injuries. AACN Adv Crit Care 2023; 34:16-23. [PMID: 36877652 DOI: 10.4037/aacnacc2023806] [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: 03/07/2023]
Abstract
BACKGROUND Patients in the intensive care unit have the highest rate of hospital-acquired pressure injuries (HAPIs). In the United States, treatment of HAPIs costs an estimated $9.1 to $11.6 billion annually, with each occurrence adding an average of $10 708 to a patient's total hospital cost. In addition to their financial impact, pressure injuries negatively affect patients physically, socially, and psychologically and are associated with increased morbidity and mortality. OBJECTIVE An intensive care unit had 42 HAPIs during a single fiscal year, with 45% of them related to lack of adherence to the institution's established evidence-based skin care protocol. This project was conducted to increase adherence to the protocol and thus reduce the incidence of HAPIs in the unit. METHODS This quality improvement initiative featured an evidence-based multifaceted intervention to increase adherence to the skin care protocol. A review of medical records was used to determine general skin care protocol adherence and to measure the monthly incidence of HAPIs in the unit. RESULTS The number of HAPIs in the unit decreased from 33 in the preintervention period to 11 in the postintervention period, a reduction of 67%. The rate of general skin care protocol adherence improved to as high as 76% by the end of the postintervention period. CONCLUSION Use of an evidence-based multifaceted intervention can improve adherence to a skin care protocol in the intensive care unit, resulting in a reduced incidence of HAPIs and improved patient outcomes.
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Affiliation(s)
- Amanda B Fischbein
- Amanda B. Fischbein is Nurse Practitioner, Electrophysiology Group, Lexington Cardiology, 2728 Sunset Blvd #300, West Columbia, SC 29169
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The Spillover Effects of Quality Improvement Beyond Target Populations in Mechanical Ventilation. Crit Care Explor 2022; 4:e0802. [PMID: 36419635 PMCID: PMC9678568 DOI: 10.1097/cce.0000000000000802] [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: 12/13/2022] Open
Abstract
UNLABELLED To assess the impact of a mechanical ventilation quality improvement program on patients who were excluded from the intervention. DESIGN Before-during-and-after implementation interrupted time series analysis to assess the effect of the intervention between coronary artery bypass grafting (CABG) surgery patients (included) and left-sided valve surgery patients (excluded). SETTING Academic medical center. PATIENTS Patients undergoing CABG and left-sided valve procedures were analyzed. INTERVENTIONS A postoperative mechanical ventilation quality improvement program was developed for patients undergoing CABG. MEASUREMENTS AND MAIN RESULTS Patients undergoing CABG had a median mechanical ventilation time of 11 hours during P0 ("before" phase) and 6.22 hours during P2 ("after" phase; p < 0.001). A spillover effect was observed because mechanical ventilation times also decreased from 10 hours during P0 to 6 hours during P2 among valve patients who were excluded from the protocol (p < 0.001). The interrupted time series analysis demonstrated a significant level of change for ventilation time from P0 to P2 for both CABG (p < 0.0001) and valve patients (p < 0.0001). There was no significant difference in the slope of change between the CABG and valve patient populations across time cohorts (P0 vs P1 [p = 0.8809]; P1 vs P2 [p = 0.3834]; P0 vs P2 [p = 0.7672]), which suggests that the rate of change in mechanical ventilation times was similar between included and excluded patients. CONCLUSIONS Decreased mechanical ventilation times for patients who were not included in a protocol suggests a spillover effect of quality improvement and demonstrates that quality improvement can have benefits beyond a target population.
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Lindberg M, Skytt B, Lindberg M, Wijk K, Strömberg A. A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:236-246. [PMID: 36193881 PMCID: PMC10433968 DOI: 10.1108/lhs-05-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager's job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers' perceptions of, prerequisites for and experiences from the implementation of changes in their manager's work conditions. DESIGN/METHODOLOGY/APPROACH A grounded theory-based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis. FINDINGS Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers' descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process. ORIGINALITY/VALUE This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.
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Affiliation(s)
- Maria Lindberg
- Department of Caring Sciences, University of Gävle, Gävle, Sweden; Centre for Research and Development, Uppsala University, Uppsala, Sweden and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Bernice Skytt
- Department of Caring Sciences, University of Gävle, Gävle, Sweden and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Lindberg
- Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Katarina Wijk
- Centre for Research and Development, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden and Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Annika Strömberg
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden and Department of Business and Economics studies, University of Gävle, Gävle, Sweden
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Birrenbach T, Hoffmann M, Hautz SC, Kämmer JE, Exadaktylos AK, Sauter TC, Müller M, Hautz WE. Frequency and predictors of unspecific medical diagnoses in the emergency department: a prospective observational study. BMC Emerg Med 2022; 22:109. [PMID: 35705901 PMCID: PMC9199121 DOI: 10.1186/s12873-022-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Misdiagnosis is a major public health problem, causing increased morbidity and mortality. In the busy setting of an emergency department (ED) patients are diagnosed under difficult circumstances. As a consequence, the ED diagnosis at hospital admittance may often be a descriptive diagnosis, such as “decreased general condition”. Our objective was to determine in how far patients with such an unspecific ED diagnosis differ from patients with a specific ED diagnosis and whether they experience a worse outcome. Methods We conducted a prospective observational study in Bern university hospital in Switzerland for all adult non-trauma patients admitted to any internal medicine ward from August 15th 2015 to December 7th 2015. Unspecific ED diagnoses were defined through the clinical classification software for ICD-10 by two outcome assessors. As outcome parameters, we assessed in-hospital mortality and length of hospital stay. Results Six hundred eighty six consecutive patients were included. Unspecific diagnoses were identified in 100 (14.6%) of all consultations. Patients receiving an unspecific diagnosis at ED discharge were significantly more often women (56.0% vs. 43.9%, p = 0.024), presented more often with a non-specific complaint (34% vs. 21%, p = 0.004), were less often demonstrating an abnormal heart rate (5.0% vs. 12.5%, p = 0.03), and less often on antibiotics (32.0% vs. 49.0%, p = 0.002). Apart from these, no studied drug intake, laboratory or clinical data including change in diagnosis was associated significantly with an unspecific diagnosis. Unspecific diagnoses were neither associated with in-hospital mortality in multivariable analysis (OR = 1.74, 95% CI: 0.60–5.04; p = 0.305) adjusted for relevant confounders nor with length of hospital stay (GMR = 0.87, 95% CI: 0.23–3.32; p = 0.840). Conclusions Women and patients with non-specific presenting complaints and no abnormal heart rate are at risk of receiving unspecific ED diagnoses that do not allow for targeted treatment, discharge and prognosis. This study did not find an effect of such diagnoses on length of hospital stay nor in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00665-x.
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Affiliation(s)
- Tanja Birrenbach
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland. .,Faculty of Medicine, Centre for Health Sciences Education, University of Oslo, Oslo, Norway.
| | - Michele Hoffmann
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Stefanie C Hautz
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Juliane E Kämmer
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010, Bern, Switzerland
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Pit S, Ramsden R, Tan AJ, Payne K, Barr J, Eames B, Edwards M, Colbran R. Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help? JMIR Hum Factors 2022; 9:e35094. [PMID: 35499866 PMCID: PMC9112088 DOI: 10.2196/35094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health professionals' perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. OBJECTIVE This study aims to explore rural health professionals' perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. METHODS Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini's Principles of Persuasion. RESULTS Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific-based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. CONCLUSIONS Rural health professionals' perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability.
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Affiliation(s)
- Sabrina Pit
- New South Wales Rural Doctors Network, Hamilton, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
- University Centre for Rural Health, Faculty of Medicine and Health Sciences, University of Sydney, Lismore, Australia
| | - Robyn Ramsden
- New South Wales Rural Doctors Network, Hamilton, Australia
| | - Aaron Jh Tan
- New South Wales Rural Doctors Network, Hamilton, Australia
| | - Kristy Payne
- New South Wales Rural Doctors Network, Hamilton, Australia
| | - James Barr
- New South Wales Rural Doctors Network, Hamilton, Australia
| | - Benjamin Eames
- New South Wales Rural Doctors Network, Hamilton, Australia
| | - Mike Edwards
- New South Wales Rural Doctors Network, Hamilton, Australia
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Emond Y, Wolff A, Bloo G, Damen J, Westert G, Wollersheim H, Calsbeek H. Complexity and involvement as implementation challenges: results from a process analysis. BMC Health Serv Res 2021; 21:1149. [PMID: 34688287 PMCID: PMC8542304 DOI: 10.1186/s12913-021-07090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities. Methods An involvement rating measure was developed to express the extent to which the implementation programme was carried out in the hospitals. This measure reflects the number of IMPROVE-implementation activities executed and the estimated participation in these activities in all nine participating hospitals. These data were compared with prospectively collected field notes. Results Considerable variation between the hospitals was found with involvement ratings ranging from 0 to 6 (mean per measurement = 1.83 on a scale of 0–11). Major implementation challenges were respectively the study design (fixed design, time planning, long duration, repeated measurements, and data availability); the selection process of hospitals, departments and key contact person(s) (inadequately covering the entire perioperative team and stand-alone surgeons); the implementation programme (programme size and scope, tailoring, multicentre, lack of mandate, co-interventions by the Inspectorate, local intervention initiatives, intervention fatigue); and competitive events such as hospital mergers or the introduction of new IT systems, all reducing involvement. Conclusions The process analysis approach helped to explain the limited and delayed execution of the IMPROVE-implementation programme. This turned out to be very heterogeneous between hospitals, with variation in the number and content of implementation activities carried out. The identified implementation challenges reflect a high complexity with regard to the implementation programme, study design and setting. The involvement of the target professionals was put under pressure by many factors. We mostly encountered challenges, but at the same time we provide solutions for addressing them. A less complex implementation programme, a less fixed study design, a better thought-out selection of contact persons, as well as more commitment of the hospital management and surgeons would likely have contributed to better implementation results. Trial registration Dutch Trial Registry: NTR3568, retrospectively registered on 2 August 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07090-z.
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Affiliation(s)
- Yvette Emond
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands. .,Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands.
| | - André Wolff
- Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit Bloo
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Johan Damen
- Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Gert Westert
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
| | - Hub Wollersheim
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
| | - Hiske Calsbeek
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
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Barreto JOM, Bortoli MC, Luquine CD, Oliveira CF, Toma TS, Ribeiro AAV, Tesser TR, Rattner D, Vidal A, Mendes Y, Carvalho V, Neri MA, Chapman E. Implementation of national childbirth guidelines in Brazil: barriers and strategies. Rev Panam Salud Publica 2020; 44:e170. [PMID: 33417646 PMCID: PMC7778467 DOI: 10.26633/rpsp.2020.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the Implementation of the National Guidelines for Normal Childbirth in Brazil, as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as the basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote use of the Guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. Effective implementation of the Guidelines is important for improving the care provided during labor and childbirth in Brazil.
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Affiliation(s)
- Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz)Brasília, DFBrazilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brazil.
| | - Maritsa C. Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Cézar D. Luquine
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Cintia F. Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Tereza S. Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Aline A. V. Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Taís R. Tesser
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Daphne Rattner
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Avila Vidal
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Yluska Mendes
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Viviane Carvalho
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Mônica Almeida Neri
- Universidade Federal da Bahia (UFBa), Instituto de Saúde ColetivaSalvador (BA)BrazilUniversidade Federal da Bahia (UFBa), Instituto de Saúde Coletiva, Salvador (BA), Brazil.
| | - Evelina Chapman
- Fundação Oswaldo Cruz (Fiocruz)Brasília, DFBrazilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brazil.
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Barreto JOM, Bortoli MC, Luquine Jr CD, Oliveira CF, Toma TS, Ribeiro AAV, Tesser TR, Rattner D, Vidal A, Mendes Y, Carvalho V, Neri MA, Chapman E. [Implementation of the National Childbirth Guidelines in Brazil: barriers and trategiesObstáculos y estrategias para la aplicación de las Directrices Nacionales para el Parto Normal en el Brasil]. Rev Panam Salud Publica 2020; 44:e120. [PMID: 33346245 PMCID: PMC7745726 DOI: 10.26633/rpsp.2020.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the National Childbirth Guidelines in Brazil as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote the use of guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. An effective implementation of the Guidelines is relevant to improve the care provided during labor and childbirth in Brazil.
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Affiliation(s)
- Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz), BrasíliaDFBrasilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil.
| | - Maritsa C. Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Cézar D. Luquine Jr
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Cintia F. Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Tereza S. Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Aline A. V. Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Taís R. Tesser
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Daphne Rattner
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Avila Vidal
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Yluska Mendes
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Viviane Carvalho
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Mônica Almeida Neri
- Universidade Federal da Bahia (UFBa), Instituto de Saúde ColetivaSalvador (BA)BrasilUniversidade Federal da Bahia (UFBa), Instituto de Saúde Coletiva, Salvador (BA), Brasil.
| | - Evelina Chapman
- Fundação Oswaldo Cruz (Fiocruz), BrasíliaDFBrasilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil.
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11
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Blanco-Mavillard I, Parra-García G, Fernández-Fernández I, Rodríguez-Calero MÁ, Personat-Labrador C, Castro-Sánchez E. Care of peripheral intravenous catheters in three hospitals in Spain: Mapping clinical outcomes and implementation of clinical practice guidelines. PLoS One 2020; 15:e0240086. [PMID: 33007001 PMCID: PMC7531784 DOI: 10.1371/journal.pone.0240086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. Aim To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. Methods We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. Conclusions Our findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is.
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Affiliation(s)
- Ian Blanco-Mavillard
- Hospital Manacor, Manacor, Spain
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- * E-mail:
| | | | | | - Miguel Ángel Rodríguez-Calero
- Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Servei de Salut de les Illes Balears, Palma, Spain
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12
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Lee L, Hillier LM, Lumley-Leger K, Molnar FJ, Netwon D, Stirling L, Milne K, Kay K. Key Lessons Learned in the Strategic Implementation of the Primary Care Collaborative Memory Clinic Model: A Tale of Two Regions. ACTA ACUST UNITED AC 2020; 15:53-69. [PMID: 31629456 PMCID: PMC7008695 DOI: 10.12927/hcpol.2019.25938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Primary care collaborative memory clinics (PCCMCs) address existing challenges in dementia care by building capacity to meet the needs of persons living with dementia within primary care. This paper describes the strategic implementation of the PCCMC care model in two regions within Ontario. METHODS Evaluation of this initiative included the completion of individual interviews (N = 32) with key informants to identify impacts associated with the PCCMCs and tracking of all referrals and assessments completed in the first nine months of clinic implementation. RESULTS The qualitative analysis of interview transcripts generated five major themes: (1) earlier identification of dementia and intervention; (2) increased capacity for dementia care within primary care; (3) better patient and caregiver experience with care; (4) improved continuity, integration and coordination and improved care; and (5) system efficiencies. Across both regions, 925 patients were referred to PCCMCs, of which 631 (68%) had been assessed during the evaluation period. CONCLUSIONS Strategic, regional implementation of PCCMCs provides a significant opportunity to support better integrated and coordinated dementia care.
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Affiliation(s)
- Linda Lee
- Director, Primary Care Collaborative Memory Clinics, Centre for Family Medicine, Kitchener, ON
| | - Loretta M Hillier
- Research Affiliate, Geriatric Education and Research in Aging Sciences, Hamilton, ON
| | - Kelly Lumley-Leger
- Advanced Practice Nurse, Community Geriatrics, Regional Geriatric Program of Eastern Ontario, Ottawa, ON
| | - Frank J Molnar
- Medical Director, Regional Geriatric Program of Eastern Ontario, Ottawa, ON, Kelly Kay, MA, PhD Candidate, Executive Director, Seniors Care Network, Cobourg, ON
| | - Denyse Netwon
- Executive Director, Alzheimer Society of Durham, Whitby, ON
| | - Linda Stirling
- Cert Clin Lead, Project Manager, Primary Care Collaborative Memory Services, Alzheimer Society of Durham Region, Whitby, ON
| | - Kelly Milne
- Program Director, Regional Geriatric Program of Eastern Ontario, Ottawa, ON
| | - Kelly Kay
- PhD Candidate, Executive Director, Seniors Care Network, Cobourg, ON
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Lamoshi A, Gibbons A, Williams S, Ponsky T. Barriers to the implementation of new guidelines among pediatric surgeons: online survey. Pediatr Surg Int 2020; 36:1103-1109. [PMID: 32588118 DOI: 10.1007/s00383-020-04707-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify barriers that prevent pediatric surgeons from implementing updated practice guidelines. METHODS An online survey targeting pediatric surgeons was conducted on the StayCurrent MD Application (SCMA) and Pediatric Surgery Education Facebook page (PSE FBP). The survey results for pediatric surgeons of underdeveloped countries (PSUC) and pediatric surgeons of developed countries (PSDC) was compared and analyzed. RESULTS Based on the number of active members on PSE FBP and SCA, the response rate was 32.3% (174/539), 66.3% of responses were from PSUC. The majority of PSUC (73%) wanted to have convincing guidelines and the plurality of PSDC (46%) wanted to see approval by the American Pediatric Surgical Association (APSA) for implementation of new guidelines. Lack of resources was the number one response (78%) for PSUC not implementing the most up to date guidelines and about 40% of the PSDC responded "concerned about malpractice liability." CONCLUSIONS PSUC and PSDC identified very different barriers to implementation of new guidelines. It is reassuring that accessibility to treatment is not the primary issue, though resistance to implementation is a resounding concern. Identifying the barriers will highlight areas that need to be addressed, and awareness may help resolve some of the barriers.
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Affiliation(s)
- Abdulraouf Lamoshi
- Department of Pediatric Surgery, Kaleida Health Facility, John R. Oishei Children's Hospital, Conventus 5th Floor, 5324, 1001 Main Street, Buffalo, NY, 14202, USA.
| | - A Gibbons
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
| | - S Williams
- Department of Pediatric Surgery, Kaleida Health Facility, John R. Oishei Children's Hospital, Conventus 5th Floor, 5324, 1001 Main Street, Buffalo, NY, 14202, USA
| | - T Ponsky
- Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA
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14
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Pol-Castañeda S, Rodríguez-Calero MÁ, Zaforteza-Lallemand C, Villafáfila-Gomila CJ, Blanco-Mavillard I, Ferrer-Cruz F, De Pedro-Gómez J. Moving Evidence into Practice by Advanced Practice Nurses in Hospitalization Wards. Protocol for a Multicentre Quasi-Experimental Study in Three Hospitals in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103473. [PMID: 32429332 PMCID: PMC7277768 DOI: 10.3390/ijerph17103473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Abstract
Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses' perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice.
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Affiliation(s)
- Sandra Pol-Castañeda
- Hospital Son Llàtzer, 07198 Palma, Balearic Islands, Spain;
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Balearic Islands, Spain; (M.Á.R.-C.); (J.D.P.-G.)
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
| | - Miguel Ángel Rodríguez-Calero
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Balearic Islands, Spain; (M.Á.R.-C.); (J.D.P.-G.)
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
- Health Service of the Balearic Islands, 07003 Palma, Balearic Islands, Spain
| | - Concepción Zaforteza-Lallemand
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
- Hospital de Inca, 07300 Inca, Balearic Islands, Spain;
| | - Carlos Javier Villafáfila-Gomila
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
- Health Service of the Balearic Islands, 07003 Palma, Balearic Islands, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Balearic Islands, Spain; (M.Á.R.-C.); (J.D.P.-G.)
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
- Hospital Manacor, Quality, Teaching and Research Unit, Cra. de Manacor-Alcudia s/n, 07500 Manacor, Spain
- Correspondence: or ; Tel.: +34-971-847-147
| | | | - Joan De Pedro-Gómez
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Balearic Islands, Spain; (M.Á.R.-C.); (J.D.P.-G.)
- CurES Research Group, Balearic Islands Health Research Institute-IdISIBa, 07120 Palma, Balearic Islands, Spain; (C.Z.-L.); (C.J.V.-G.)
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15
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Lepard JR, Walters BC. In Reply: A Bibliometric Analysis of Neurosurgical Practice Guidelines. Neurosurgery 2020; 86:E405-E406. [PMID: 31814019 DOI: 10.1093/neuros/nyz539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacob R Lepard
- Department of Neurological Surgery The University of Alabama at Birmingham Birmingham, Alabama
| | - Beverly C Walters
- Department of Neurological Surgery The University of Alabama at Birmingham Birmingham, Alabama
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16
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Innis J, Barnsley J, Berta W, Daniel I. Do hospital size, location, and teaching status matter? Role of context in the use of evidence-based discharge practices. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1725716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Imtiaz Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Ontario Hospital Association, Toronto, Canada
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17
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Dryden-Palmer KD, Parshuram CS, Berta WB. Context, complexity and process in the implementation of evidence-based innovation: a realist informed review. BMC Health Serv Res 2020; 20:81. [PMID: 32013977 PMCID: PMC6998254 DOI: 10.1186/s12913-020-4935-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. Methods Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers’ Diffusion of Innovations theory (DOI) and Harvey and Kitson’s integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. Results A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. Conclusions The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.
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Affiliation(s)
- K D Dryden-Palmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Critical Care Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada. .,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada.
| | - C S Parshuram
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Critical Care Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - W B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Tegelberg A, Jangland E, Juhlin C, Muntlin Athlin Å. Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain. J Clin Nurs 2019; 28:3641-3650. [PMID: 31190406 DOI: 10.1111/jocn.14962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/13/2019] [Accepted: 05/26/2019] [Indexed: 01/30/2023]
Abstract
AIM AND OBJECTIVES To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. BACKGROUND Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high-quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high-quality fundamental care across the acute care chain. DESIGN Qualitative descriptive semi-structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. METHODS Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro- and macrolevels across the acute care chain. RESULTS The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. CONCLUSIONS The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. RELEVANCE TO CLINICAL PRACTICE Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence-based and high-quality care.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden.,Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
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Harrison-Blount M, Nester C, Williams A. The changing landscape of professional practice in podiatry, lessons to be learned from other professions about the barriers to change - a narrative review. J Foot Ankle Res 2019; 12:23. [PMID: 31015864 PMCID: PMC6469120 DOI: 10.1186/s13047-019-0333-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The delivery of healthcare is changing and aligned with this, the podiatry profession continues to change with evidence informed practice and extending roles. As change is now a constant, this gives clinicians the opportunity to take ownership to drive that change forward. In some cases, practitioners and their teams have done so, where others have been reluctant to embrace change. It is not clear to what extent good practice is being shared, whether interventions to bring about change have been successful, or what barriers exist that have prevented change from occurring. The aim of this article is to explore the barriers to changing professional practice and what lessons podiatry can learn from other health care professions. MAIN BODY A literature search was carried out which informed a narrative review of the findings. Eligible papers had to (1) examine the barriers to change strategies, (2) explore knowledge, attitudes and roles during change interventions, (3) explore how the patients/service users contribute to the change process (4) include studies from predominantly primary care in developed countries.Ninety-two papers were included in the final review. Four papers included change interventions involving podiatrists. The barriers influencing change were synthesised into three themes (1) the organisational context, (2) the awareness, knowledge and attitudes of the professional, (3) the patient as a service user and consumer. CONCLUSIONS Minimal evidence exists about the barriers to changing professional practice in podiatry. However, there is substantial literature on barriers and implementation strategies aimed at changing professional practices in other health professions. Change in practice is often resisted at an organisational, professional or service user level. The limited literature about change in podiatry, a rapidly changing healthcare workforce and the wide range of contexts that podiatrists work, highlights the need to improve the ways in which podiatrists can share successful attempts to change practice.
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Nabelsi V, Croteau S. An Evidence-Based Health Care Knowledge Integration System: Assessment Protocol. JMIR Res Protoc 2019; 8:e11754. [PMID: 30855235 PMCID: PMC6431825 DOI: 10.2196/11754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/17/2018] [Accepted: 12/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rapid advancements in health care can make it difficult for general physicians and specialists alike to keep their knowledge up to date. In medicine today, there are deficiencies in the application of knowledge translation (KT) in clinical practice. Some medical procedures are not required, and therefore, no value is added to the patient's care. These unnecessary procedures increase pressures on the health care system's resources, reduce the quality of care, and expose the patients to stress and to other potential risks. KT tools and better access to medical recommendations can lead to improvements in physicians' decision-making processes depending on the patient's specific clinical situation. These tools can provide the physicians with the available options and promote an efficient professional practice. Software for the Evolution of Knowledge in MEDicine (SEKMED) is a technological solution providing access to high-quality evidence, based on just-in-time principles, in the application of medical recommendations for clinical decision-making processes recognized by community members, accreditation bodies, the recommendations from medical specialty societies made available through campaigns such as Choosing Wisely, and different standards or accreditive bodies. OBJECTIVE The main objective of this protocol is to assess the usefulness of the SEKMED platform used within a real working clinical practice, specifically the Centre intégré de santé et des services sociaux de l'Outaouais in Quebec, Canada. To achieve our main objective, 20 emergency physicians from the Hull and Gatineau Hospitals participate in the project as well as 20 patient care unit physicians from the Hull Hospital. In addition, 10 external students or residents studying family medicine from McGill University will also participate in our study. METHODS The project is divided into 4 phases: (1) orientation; (2) data synthesis; (3) develop and validate the recommendations; and (4) implement, monitor, and update the recommendations. These phases will enable us to meet our 6 specific research objectives that aim to measure the integration of recommendations in clinical practices, the before and after improvements in practices, the value attributed by physicians to recommendations, the user's platform experience, the educational benefits according to medical students, and the organizational benefits according to stakeholders. The knowledge gained during each phase will be applied on an iterative and continuous basis to all other phases over a period of 2 years. RESULTS This project was funded in April 2018 by the Fonds de soutien à l'innovation en santé et en services sociaux for 24 months. Ethics approval has been attained, the study began in June 2018, the data collection will be complete at the end of December 2019, and the data analysis will start in winter 2020. Both major city hospitals in the Outaouais region, Quebec, Canada, have agreed to participate in the project. CONCLUSIONS If results show preliminary efficacy and usability of the system, a large-scale implementation will be conducted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11754.
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Affiliation(s)
- Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Sylvain Croteau
- Hôpital de Gatineau, Centre intégré de santé et des services sociaux de l'Outaouais, Gatineau, QC, Canada
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Blanco-Mavillard I, Rodríguez-Calero MA, Castro-Sánchez E, Bennasar-Veny M, De Pedro-Gómez J. Appraising the quality standard underpinning international clinical practice guidelines for the selection and care of vascular access devices: a systematic review of reviews. BMJ Open 2018; 8:e021040. [PMID: 30344166 PMCID: PMC6196863 DOI: 10.1136/bmjopen-2017-021040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Catheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing number of guidelines exist worldwide. The purpose of the study was to assess clinical practice guidelines for peripheral and central venous access device care and prevention of related complications. DESIGN Systematic review of clinical practice guidelines: We conducted a search of the literature published from 2005 to 2018 using Medline/PubMed, Embase, CINAHL, Ovid, ScienceDirect, Scopus and Web of Science. We also evaluated grey literature sources and websites of organisations that compiled or produced guidelines. Guideline quality was assessed with the Appraisal of Guidelines for Research and Evaluation, Second Edition tool by three independent reviewers. Cohen's kappa coefficient was used to evaluate the concordance between reviewers. RESULTS We included seven guidelines in the evaluation. The concordance between observers was substantial, K=0.6364 (95% CI 0.0247 to 1.2259). We identified seven international guidelines, which scored poorly on crucial domains such as applicability (medium 39%), stakeholder involvement (medium 65%) and methodological rigour (medium 67%). Guidelines by Spanish Health Ministry and UK National Institute for Health and Care Excellence presented the highest quality. CONCLUSIONS It is crucial to critically evaluate the validity and reliability of clinical practice guidelines so the best, most context-specific document is selected. Such choice is a necessary prior step to encourage and support health organisations to transfer research results to clinical practice. The gaps identified in our study may explain the suboptimal clinical impact of guidelines. Such low adoption may be mitigated with the use of implementation guides accompanying clinical documents.
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Affiliation(s)
| | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
| | - Joan De Pedro-Gómez
- Evidence, Lifestyles and Health Research Group, Research Institute of Health Sciences, Universitat de les Illes Balears, Palma, Spain
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Rwabihama JP, Audureau E, Laurent M, Rakotoarisoa L, Jegou M, Saddedine S, Krypciak S, Herbaud S, Benzengli H, Segaux L, Guery E, Ambime G, Rabus MT, Perilliat JG, David JP, Paillaud E. Prophylaxis of Venous Thromboembolism in Geriatric Settings: A Cluster-Randomized Multicomponent Interventional Trial. J Am Med Dir Assoc 2018; 19:497-503. [PMID: 29580885 DOI: 10.1016/j.jamda.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the efficacy of an intervention on the practice of venous thromboembolism prevention. DESIGN A multicenter, prospective, controlled, cluster-randomized, multifaceted intervention trial consisting of educational lectures, posters, and pocket cards reminding physicians of the guidelines for thromboprophylaxis use. SETTINGS Twelve geriatric departments with 1861 beds total, of which 202, 803, and 856 in acute care, post-acute care, and long-term care wards, respectively. PARTICIPANTS Patients hospitalized between January 1 and May 31, 2015, in participating departments. MEASUREMENTS The primary endpoint was the overall adequacy of thromboprophylaxis prescription at the patient level, defined as a composite endpoint consisting of indication, regimen, and duration of treatment. Geriatric departments were divided into an intervention group (6 departments) and control group (6 departments). The preintervention period was 1 month to provide baseline practice levels, the intervention period 2 months, and the postintervention period 1 month in acute care and post-acute care wards or 2 months in long-term care wards. Multivariable regression was used to analyze factors associated with the composite outcome. RESULTS We included 2962 patients (1426 preintervention and 1536 postintervention), with median age 85 [79;90] years. For the overall 18.9% rate of inadequate thromboprophylaxis, 11.1% was attributable to underuse and 7.9% overuse. Intervention effects were more apparent in post-acute and long-term care wards although not significantly [odds ratio 1.44 (95% confidence interval 0.78;2.66), P = .241; and 1.44 (0.68, 3.06), P = .345]. Adequacy rates significantly improved in the postintervention period for the intervention group overall (from 78.9% to 83.4%; P = .027) and in post-acute care (from 75.4% to 86.3%; P = .004) and long-term care (from 87.0% to 91.7%; P = .050) wards, with no significant trend observed in the control group. CONCLUSIONS/IMPLICATIONS This study failed to demonstrate improvement in prophylaxis adequacy with our intervention. However, the intervention seemed to improve practices in post-acute and long-term care but not acute care wards.
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Affiliation(s)
- Jean Paul Rwabihama
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Joffre-Dupuytren, Draveil, France.
| | - Etienne Audureau
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Hôpital Henri Mondor, Créteil, France
| | - Marie Laurent
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Albert Chenevier-Henri Mondor, Créteil, France
| | - Lalaina Rakotoarisoa
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital George Clemenceau, Champceuil, France
| | - Marc Jegou
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Emile Roux, Limeil Brévannes, France
| | - Sofiane Saddedine
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Emile Roux, Limeil Brévannes, France
| | - Sébastien Krypciak
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Henri Mondor, Créteil, France
| | - Stéphane Herbaud
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Henri Mondor, Créteil, France
| | - Hind Benzengli
- Assistance Publique-Hôpitaux de Paris, Service de Pharmacie, Hôpital Joffre-Dupuytren, Draveil, France
| | - Lauriane Segaux
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Hôpital Henri Mondor, Créteil, France
| | - Esther Guery
- Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Hôpital Henri Mondor, Créteil, France
| | - Gabin Ambime
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Joffre-Dupuytren, Draveil, France
| | - Marie-Thérèse Rabus
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Joffre-Dupuytren, Draveil, France
| | - Jean-Guy Perilliat
- Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Joffre-Dupuytren, Draveil, France
| | - Jean-Philippe David
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Emile Roux, Limeil Brévannes, France
| | - Elena Paillaud
- Université Paris-Est, UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology and Aging Unit), Créteil, France; Assistance Publique-Hôpitaux de Paris, Service de Gériatrie, Hôpital Henri Mondor, Créteil, France
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Wiggers J, McElwaine K, Freund M, Campbell L, Bowman J, Wye P, Wolfenden L, Tremain D, Barker D, Slattery C, Gillham K, Bartlem K. Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial. Implement Sci 2017; 12:105. [PMID: 28830568 PMCID: PMC5567434 DOI: 10.1186/s13012-017-0636-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. METHODS A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. RESULTS A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. CONCLUSIONS The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.
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Affiliation(s)
- John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kathleen McElwaine
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Libby Campbell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danika Tremain
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Daniel Barker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | | | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia
| | - Kate Bartlem
- Hunter New England Population Health, Wallsend, Australia
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Cidoncha-Moreno MÁ, Ruíz de Alegría-Fernandez de Retana B. Barriers to the implementation of research perceived by nurses from Osakidetza. ENFERMERIA CLINICA 2017; 27:286-293. [PMID: 28456492 DOI: 10.1016/j.enfcli.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. METHODS Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). RESULTS According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence. CONCLUSIONS The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care.
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Smeulers M, Dolman CD, Atema D, van Dieren S, Maaskant JM, Vermeulen H. Safe and effective nursing shift handover with NURSEPASS: An interrupted time series. Appl Nurs Res 2016; 32:199-205. [PMID: 27969028 DOI: 10.1016/j.apnr.2016.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022]
Abstract
AIM Implementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover. METHODS A mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process. RESULTS We observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated. CONCLUSION Use of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed.
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Affiliation(s)
- Marian Smeulers
- Department of Quality Assurance and Process Innovation, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
| | - Christine D Dolman
- Department of Cardiothoracic Surgery, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Danielle Atema
- Department of Internal Medicine, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Jolanda M Maaskant
- Emma Children's Hospital, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Hester Vermeulen
- Department of Surgery, Amsterdam, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands; Department of Nursing, the Amsterdam School of Health Professions, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
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26
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McElwaine KM, Freund M, Campbell EM, Bartlem KM, Wye PM, Wiggers JH. Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians. Implement Sci 2016; 11:50. [PMID: 27052329 PMCID: PMC4823902 DOI: 10.1186/s13012-016-0409-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/16/2016] [Indexed: 01/11/2023] Open
Abstract
Background Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primary care setting. Methods A search of Medline, Embase, PsycInfo, and CINAHL databases was undertaken to locate controlled intervention trials published between 1992 and May 2014 that provided practice change interventions to primary care nurses and/or allied health professionals to increase preventive care. The effect of interventions aimed at increasing the provision of any of the five care elements for any of the four behavioural risks was examined. A narrative synthesis was utilised. Results From 8109 articles, seven trials met the inclusion criteria. All trials bar one, assessed multi-strategic practice change interventions (three to five strategies) focused on care by nurses (six trials) or mixed nursing/allied health clinicians. One trial examined care provision for all four risks, five trials examined care for smoking only, and one trial examined care for alcohol consumption only. For the six trials reporting significance testing (excludes one smoking care trial), significant effects favouring the intervention group were reported in at least one trial for smoking risk assessment (2/4 trials reported an effect for at least one analysis of an assessment outcome), brief advice (2/3), assistance (2/2), and arranging referral (2/3); alcohol risk assessment (1/2) and brief advice (1/2); inadequate nutrition risk assessment (1/1); and physical inactivity risk assessment and brief advice (1/1). When the number of analyses undertaken within trials focusing on smoking care was considered, the results were less promising (e.g. of the 15 analyses conducted on brief advice variables across three trials, four showed a positive effect). Conclusions Evidence for the effect of practice change interventions on preventive care by primary care nurses or allied health providers is inconclusive given the small number of trials and inconsistency of results between and within trials. Systematic review registration number None Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0409-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,, Postal address: Locked Bag 10, Wallsend, NSW, 2287, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Bartlem K, Bowman J, Ross K, Freund M, Wye P, McElwaine K, Gillham K, Doherty E, Wolfenden L, Wiggers J. Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision. BMC Psychiatry 2016; 16:57. [PMID: 26935328 PMCID: PMC4776348 DOI: 10.1186/s12888-016-0763-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/24/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preventive care for chronic disease risk behaviours by mental health clinicians is sub-optimal. Little research has examined the association between clinician attitudes and such care delivery. This study aimed to explore: i) the attitudes of a multi-disciplinary group of community mental health clinicians regarding their perceived role, perception of client interest, and perceived self-efficacy in the provision of preventive care, ii) whether such attitudes differ by professional discipline, and iii) the association between these attitudes and clinician provision of such care. METHOD A telephone survey was conducted with 151 Australian community mental health clinicians regarding their attitudes towards provision of assessment, advice and referral addressing smoking, nutrition, alcohol, and physical activity, and their reported provision of such care. Logistic regression was used to examine the association between attitudes and care delivery, and attitudinal differences by professional discipline. RESULTS Most clinicians reported that: their manager supported provision of preventive care; such care was part of their role; it would not jeopardise their practitioner-client relationships, clients found preventive care acceptable, and that they had the confidence, knowledge and skills to modify client health behaviours. Half reported that clients were not interested in changing their health behaviours, and one third indicated that the provision of preventive care negatively impacted on time available for delivery of acute care. The following attitudes were positively associated with the provision of preventive care: role congruence, client interest in change, and addressing health risk behaviours will not jeopardise the client-clinician relationship. CONCLUSIONS Strategies are required to translate positive attitudes to improved client care and address attitudes which may hinder the provision of preventive care in community mental health.
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Affiliation(s)
- Kate Bartlem
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Kate Ross
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Megan Freund
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,School of Psychology, Faculty of Science and Information Technology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Kathleen McElwaine
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
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Abstract
Venous thromboembolism (VTE) is a major cause of morbidity and mortality and is associated with substantial healthcare costs. Identification of patients at risk of developing VTE enables appropriate thromboprophylaxis to be implemented. Although no predisposing risk factors can be identified in many patients in whom VTE develops, most have at least one underlying risk factor which can be categorized according to whether it confers low, moderate, or high risk. Clinical trials have demonstrated the effectiveness of thromboprophylaxis, both non-pharmacological and pharmacological, in a host of medical settings and there is sufficient evidence to support routine prophylaxis in many groups of patients. The implementation of decision making tools based on risk factor assessment improves the prescription of appropriate VTE prophylaxis. Nonetheless, thromboprophylaxis is often inadequate, with haphazard risk assessment and application of guidelines, leading to easily preventable instances of VTE. The most commonly used agents for pharmacological thromboprophylaxis of VTE are low dose unfractionated heparin; a low molecular weight heparin such as dalteparin, enoxaparin or tinzaparin; fondaparinux; warfarin; or aspirin. However, these have a number of drawbacks, principally the need for parenteral administration (with heparins) and frequent coagulation monitoring (with warfarin). The optimal anticoagulant would be orally administered, with a wide therapeutic window, rapid onset of action, predictable pharmacodynamics and pharmacokinetics, minimal interactions with food and other drugs, an ability to inhibit free and clot-bound coagulation factors, low, non-specific binding, and no requirement for routine coagulation monitoring or dose adjustment. A number of novel, single-target oral anticoagulants have been developed that appear to fulfill many of these requirements. This narrative review discusses the use of guidelines and risk assessment tools to identify patients at risk of VTE; it provides an overview of appropriate prophylaxis strategies in these patients with a summary of clinical trial results with novel oral anticoagulants.
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Urquhart R, Jackson L, Sargeant J, Porter GA, Grunfeld E. Health System-Level Factors Influence the Implementation of Complex Innovations in Cancer Care. Healthc Policy 2015; 11:102-18. [PMID: 26742119 PMCID: PMC4729286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The movement of new knowledge and tools into healthcare settings continues to be a slow, complex and poorly understood process. In this paper, we present the system-level factors important to the implementation of synoptic reporting tools in two initiatives (or cases) in Nova Scotia, Canada. METHODS This study used case study methodology. Data were collected through interviews with key informants, document analysis, non-participant observation and tool use/examination. Analysis involved production of case histories, analysis of each case and a cross-case analysis. RESULTS The healthcare system's delivery and support structure, information technology infrastructure, policy environment and history of collaboration and inter-organizational relationships influenced tool implementation in the two cases. CONCLUSIONS The findings provide an in-depth, nuanced understanding of how healthcare system components can influence the implementation of a new tool in clinical practice.
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Affiliation(s)
- Robin Urquhart
- Assistant Professor, Department of Surgery, Dalhousie University, Halifax, NS
| | - Lois Jackson
- Professor, School of Health and Human Performance, Dalhousie University, Halifax, NS
| | - Joan Sargeant
- Acting Head and Professor, Division of Medical Education Dalhousie University, Halifax, NS
| | | | - Eva Grunfeld
- Giblon Professor and Vice Chair, Research, Department of Family and Community Medicine, University of Toronto Toronto, ON
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Borgert MJ, Goossens A, Dongelmans DA. What are effective strategies for the implementation of care bundles on ICUs: a systematic review. Implement Sci 2015; 10:119. [PMID: 26276569 PMCID: PMC4536788 DOI: 10.1186/s13012-015-0306-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 08/05/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Care bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles. METHODS The databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers. RESULTS In total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as 'fair' in 77 %, and the remaining as 'good' (13 %) and 'poor' (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible. CONCLUSIONS The three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.
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Affiliation(s)
- Marjon J Borgert
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Astrid Goossens
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, Day NPJ, Graves N, Cooper BS. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015; 351:h3728. [PMID: 26220070 PMCID: PMC4517539 DOI: 10.1136/bmj.h3728] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014); studies selected by the same search terms in previous systematic reviews (1980-2009). REVIEW METHODS Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels. RESULTS Of 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I(2)=81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days. CONCLUSION Promotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate.
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Affiliation(s)
- Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Maliwan Hongsuwan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Andie S Lee
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Stephan Harbarth
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas Graves
- School of Public Health, Queensland University of Technology, Brisbane, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Zaforteza C, Gastaldo D, Moreno C, Bover A, Miró R, Miró M. Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research. Nurs Inq 2015; 22:336-47. [PMID: 26189487 DOI: 10.1111/nin.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 01/06/2023]
Abstract
This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.
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Affiliation(s)
| | | | | | - Andreu Bover
- University of Balearic Islands, Balearic Islands, Spain
| | - Rosa Miró
- University of Balearic Islands, Balearic Islands, Spain
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González-Valderrama A, Mena C, Undurraga J, Gallardo C, Mondaca P. Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction? Front Psychiatry 2015; 6:51. [PMID: 25926800 PMCID: PMC4396081 DOI: 10.3389/fpsyt.2015.00051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alfonso González-Valderrama
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile ; Facultad de Medicina, Universidad Finis Terrae , Santiago , Chile
| | - Cristián Mena
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
| | - Juan Undurraga
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile ; Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo , Santiago , Chile
| | - Carlos Gallardo
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
| | - Pilar Mondaca
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
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Lugtenberg M, Burgers JS, Han D, Westert GP. General practitioners' preferences for interventions to improve guideline adherence. J Eval Clin Pract 2014; 20:820-6. [PMID: 24953439 DOI: 10.1111/jep.12209] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Interventions aimed at improving guideline adherence should take into account the specific features of the target users; however, it is unclear how general practitioners (GPs) evaluate the different types of interventions. The aim of this paper was to identify GPs' preferences for interventions to improve guideline adherence in practice and whether these differ across key guideline recommendations. METHOD An electronic survey was conducted among 703 GPs working in the south-western part of the Netherlands. Each survey focused on two of four guidelines: cerebrovascular accident, eye inflammation, thyroid disorders and urinary tract infection. GPs were asked to rate potential interventions in terms of their usefulness in improving guideline adherence in general and for specific key guideline recommendations. RESULTS 264 GPs (38%) completed the questionnaire. In general, GPs preferred interactive small group meetings (84% rated this as much or very much encouraging), audit and feedback (53%), organizational interventions (50%) and the use of local opinion leaders (50%) as methods for improving guideline adherence. Financial interventions (24%), distribution of educational materials (22%) and big group educational meetings (21%) were of least interest. Some interventions were preferred by GPs irrespective of the specific key recommendations (e.g. audit and feedback), while ratings for other interventions differed across key recommendations (reminders/computer support). CONCLUSIONS To implement guidelines, interventions need to be identified that are acceptable and appealing to the target group. GPs seem to have general and recommendation-specific preferences regarding interventions, these should be taken into account when developing plans for guideline implementation to encourage the uptake of guidelines in practice.
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Affiliation(s)
- Marjolein Lugtenberg
- Scientific Center for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands; Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Bazarbashi SN. Saudi Oncology Society clinical management guidelines development. Saudi Med J 2014; 35:1524-6. [PMID: 25491222 PMCID: PMC4362167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/13/2014] [Indexed: 02/08/2023] Open
Affiliation(s)
- Shouki N Bazarbashi
- Oncology Center, King Faisal Specialist Hospital and Research Center, PO Box 3354 (MBC 64), Riyadh 11211, Kingdom of Saudi Arabia. Tel. +966 (11) 4423935. E-mail.
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37
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McElwaine KM, Freund M, Campbell EM, Knight J, Bowman JA, Wolfenden L, McElduff P, Bartlem KM, Gillham KE, Wiggers JH. Increasing preventive care by primary care nursing and allied health clinicians: a non-randomized controlled trial. Am J Prev Med 2014; 47:424-34. [PMID: 25240966 DOI: 10.1016/j.amepre.2014.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 05/13/2014] [Accepted: 06/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally. PURPOSE To assess the effectiveness of a practice change intervention in increasing primary care nursing and allied health clinician provision of preventive care for four health risks. DESIGN Two-group (intervention versus control), non-randomized controlled study assessing the effectiveness of the intervention in increasing clinician provision of preventive care. SETTING/PARTICIPANTS Randomly selected clients from 17 primary healthcare facilities participated in telephone surveys that assessed their receipt of preventive care prior to (September 2009-2010, n=876) and following intervention (October 2011-2012, n=1,113). INTERVENTION The intervention involved local leadership and consensus processes, electronic medical record system modification, educational meetings and outreach, provision of practice change resources and support, and performance monitoring and feedback. MAIN OUTCOME MEASURES The primary outcome was differential change in client-reported receipt of three elements of preventive care (assessment, brief advice, referral/follow-up) for each of four behavioral risks individually (smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, physical inactivity) and combined. Logistic regression assessed intervention effectiveness. RESULTS Analyses conducted in 2013 indicated significant improvements in preventive care delivery in the intervention compared to the control group from baseline to follow-up for assessment of fruit and vegetable consumption (+23.8% vs -1.5%); physical activity (+11.1% vs -0.3%); all four risks combined (+16.9% vs -1.0%) and for brief advice for inadequate fruit and vegetable consumption (+19.3% vs -2.0%); alcohol overconsumption (+14.5% vs -8.9%); and all four risks combined (+14.3% vs +2.2%). The intervention was ineffective in increasing the provision of the remaining forms of preventive care. CONCLUSIONS The intervention's impact on the provision of preventive care varied by both care element and risk type. Further intervention is required to increase the consistent provision of preventive care, particularly referral/follow-up.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia.
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Jenny Knight
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Patrick McElduff
- Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Wallsend; Faculty of Health, Faculty of Science and Information Technology, The University of Newcastle, Callaghan; Hunter Medical Research Institute (McElwaine, Freund, Campbell, Knight, Bowman, Wolfenden, McElduff, Bartlem, Gillham, Wiggers), Clinical Research Centre, New Lambton Heights, New South Wales, Australia
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Gamst-Jensen H, Vedel PN, Lindberg-Larsen VO, Egerod I. Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines. Burns 2014; 40:1463-9. [PMID: 25277698 DOI: 10.1016/j.burns.2014.08.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/17/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain management addresses and alleviates these complications. The aim of our study was to compare clinical guidelines for pain management in burn patients in selected European and non-European countries. We included pediatric guidelines due to the high rate of children in burn units. METHOD The study had a comparative retrospective design using combined methodology of instrument appraisal and thematic analysis. Three investigators appraised guidelines from burn units in Denmark (DK), Sweden (SE), New Zealand (NZ), and USA using the AGREE Instrument (Appraisal of Guidelines for Research & Evaluation), version II, and identified core themes in the guidelines. RESULTS The overall scores expressing quality in six domains of the AGREE instrument were variable at 22% (DK), 44% (SE), 100% (NZ), and 78% (USA). The guidelines from NZ and USA were highly recommended, the Swedish was recommended, whereas the Danish was not recommended. The identified core themes were: continuous pain, procedural pain, postoperative pain, pain assessment, anxiety, and non-pharmacological interventions. CONCLUSION The study demonstrated variability in quality, transparency, and core content in clinical guidelines on pain management in burn patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn patients in the clinic, to unify guideline construction, and to enable interdepartmental comparison of treatment and outcomes.
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Affiliation(s)
- Hejdi Gamst-Jensen
- Department of Anesthesiology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
| | - Pernille Nygaard Vedel
- Department of Orthopedic Surgery, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | | | - Ingrid Egerod
- Faculty of Health & Medical Sciences, University of Copenhagen, Denmark; Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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Sesé-Abad A, De Pedro-Gómez J, Bennasar-Veny M, Sastre P, Fernandez-Dominguez JC, Morales-Asencio JM. A multisample model validation of the evidence-based practice questionnaire. Res Nurs Health 2014; 37:437-46. [PMID: 25043842 DOI: 10.1002/nur.21609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/07/2022]
Abstract
Evidence-based practice may be implemented more successfully if the barriers to its implementation have been previously identified. Many of the available instruments to measure these barriers have been validated in single samples or without confirmatory analyses. The objective of the study was to contrast the goodness of fit of two measurement models (24 items and 19 items) for the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ) in a sample of 1,673 full-time registered nurses in 10 hospitals and 57 primary health care centers in the Spanish Public Health Service. The 19-item model performed better in all four subsamples. A hypothesis of strict invariance, with equal factor loadings, intercepts, and error variance in all contexts in which it was evaluated, was supported. Goodness-of-fit indices provided strong evidence of good fit according to standard cut-off criteria in a multisample confirmatory factor analysis.
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Affiliation(s)
- Albert Sesé-Abad
- Faculty of Psychology, Balearic Islands University, Palma, Spain
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van Schoten SM, Kop V, de Blok C, Spreeuwenberg P, Groenewegen PP, Wagner C. Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: results of a national patient safety programme in the Netherlands. BMJ Open 2014; 4:e005075. [PMID: 24993761 PMCID: PMC4091260 DOI: 10.1136/bmjopen-2014-005075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/23/2014] [Accepted: 06/02/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To prevent wrong surgery, the WHO 'Safe Surgery Checklist' was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim of this study is to evaluate the extent to which hospitals carry out the TOP before anaesthesia in the operating room, whether compliance has changed over time, and to determine factors that are associated with compliance. DESIGN Evaluation study involving observations. SETTING Operating rooms of 2 academic, 4 teaching and 12 general Dutch hospitals. PARTICIPANTS A random selection was made from all adult patients scheduled for elective surgery on the day of the observation, preferably involving different surgeons and different procedures. RESULTS Mean compliance with the TOP was 71.3%. Large differences between hospitals were observed. No linear trend was found in compliance during the study period. Compliance at general and teaching hospitals was higher than at academic hospitals. Compliance decreased with the age of the patient, general surgery showed lower compliance in comparison with other specialties and compliance was higher when the team was focused on the TOP. CONCLUSIONS Large differences in compliance with the TOP were observed between participating hospitals which can be attributed at least in part to the type of hospital, surgical specialty and patient characteristics. Hospitals do not comply consistently with national guidelines to prevent wrong surgery and further implementation as well as further research into non-compliance is needed.
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Affiliation(s)
| | - Veerle Kop
- NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Carolien de Blok
- NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Faculty Economics and Business, Department Operations, University of Groningen, Groningen, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter P Groenewegen
- NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Departments of Sociology and Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Cordula Wagner
- NIVEL—Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Vrije Universiteit Medical Center (VUmc), Amsterdam, The Netherlands
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Pericas-Beltran J, Gonzalez-Torrente S, De Pedro-Gomez J, Morales-Asencio J, Bennasar-Veny M. Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. Int Nurs Rev 2014; 61:90-8. [DOI: 10.1111/inr.12075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Pericas-Beltran
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
| | | | - J. De Pedro-Gomez
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
| | - J.M. Morales-Asencio
- Faculty of Nursing, Physiotherapy, Podology and Occupational Therapy; University of Malaga; Malaga Spain
| | - M. Bennasar-Veny
- Nursing Department, Evidence, Lifestyles and Health Research Group Members; Universitat de les Illes Balears; Palma Spain
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McElwaine KM, Freund M, Campbell EM, Knight J, Bowman JA, Doherty EL, Wye PM, Wolfenden L, Lecathelinais C, McLachlan S, Wiggers JH. The delivery of preventive care to clients of community health services. BMC Health Serv Res 2013; 13:167. [PMID: 23642238 PMCID: PMC3656789 DOI: 10.1186/1472-6963-13-167] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/23/2013] [Indexed: 11/22/2022] Open
Abstract
Background Smoking, poor nutrition, risky alcohol use, and physical inactivity are the primary behavioral risks for common causes of mortality and morbidity. Evidence and guidelines support routine clinician delivery of preventive care. Limited evidence describes the level delivered in community health settings. The objective was to determine the: prevalence of preventive care provided by community health clinicians; association between client and service characteristics and receipt of care; and acceptability of care. This will assist in informing interventions that facilitate adoption of opportunistic preventive care delivery to all clients. Methods In 2009 and 2010 a telephone survey was undertaken of 1284 clients across a network of 56 public community health facilities in one health district in New South Wales, Australia. The survey assessed receipt of preventive care (assessment, brief advice, and referral/follow-up) regarding smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, and physical inactivity; and acceptability of care. Results Care was most frequently reported for smoking (assessment: 59.9%, brief advice: 61.7%, and offer of referral to a telephone service: 4.5%) and least frequently for inadequate fruit or vegetable consumption (27.0%, 20.0% and 0.9% respectively). Sixteen percent reported assessment for all risks, 16.2% received brief advice for all risks, and 0.6% were offered a specific referral for all risks. The following were associated with increased care: diabetes services, number of appointments, being male, Aboriginal, unemployed, and socio-economically disadvantaged. Acceptability of preventive care was high (76.0%-95.3%). Conclusions Despite strong client support, preventive care was not provided opportunistically to all, and was preferentially provided to select groups. This suggests a need for practice change strategies to enhance preventive care provision to achieve adherence to clinical guidelines.
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Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia.
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Abstract
The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.
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Basey AJ, Krska J, Kennedy TD, Mackridge AJ. Challenges in implementing government-directed VTE guidance for medical patients: a mixed methods study. BMJ Open 2012; 2:e001668. [PMID: 23135540 PMCID: PMC3533008 DOI: 10.1136/bmjopen-2012-001668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/03/2012] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Implementing venous thromboembolism (VTE) risk assessment guidance on admission to hospital has proved difficult worldwide. In 2010, VTE risk assessment in English hospitals was linked to financial sanctions. This study investigated possible barriers and facilitators for VTE risk assessment in medical patients and evaluated the impact of local and national initiatives. SETTING Acute Medical Unit in one English National Health Service university teaching hospital. METHODS This was a mixed methods study; National Research Ethics Service approval was granted. Data were collected over four 1-week periods; November 2009 (1), January 2010 (2), April 2010 (3) and April 2011 (4). Case notes for all medical patients admitted during these periods were reviewed. Thirty-six staff were observed admitting 71 of these patients; 24 observed staff participated in a structured interview. RESULTS 876 case notes were reviewed. In total, 82.1% of patients had one or more VTE risk factors and 25.3% one or more bleeding risks. VTE risk assessment rose from a baseline of 6.9-19.6%, following local initiatives, and to 98.7% following financially sanctioned government targets. A similar increase in appropriate prescribing of prophylaxis was seen, but inappropriate prescribing also rose. No staff observed in period 1 conducted VTE risk assessment, risk-assessment forms were largely ignored or discarded during period 2; and electronic recording systems available during period 3 were not accessed. Few patients were asked any VTE-related questions in periods 1, 2 or 3. Interviewees' actual knowledge of VTE risk was not related to perceived knowledge level. Eight of the 24 staff interviewed were aware of national policies or guidance: none had seen them. Principal barriers identified to risk assessment were: involvement of multiple staff in individual admissions; interruptions; lack of policy awareness; time pressure and complexity of tools. CONCLUSIONS National financial sanctions appear effective in implementing guidance, where other local measures have failed.
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Affiliation(s)
- Avril Janette Basey
- Pharmacy Department, Royal Liverpool University Hospital, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Janet Krska
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, Kent, UK
| | - Tom D Kennedy
- Acute Medical Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Adam John Mackridge
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
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Sullivan KM, Suh S, Monk H, Chuo J. Personalised performance feedback reduces narcotic prescription errors in a NICU. BMJ Qual Saf 2012; 22:256-62. [PMID: 23038410 PMCID: PMC3594935 DOI: 10.1136/bmjqs-2012-001089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective Neonates are at high risk for significant morbidity and mortality from medication prescribing errors. Despite general awareness of these risks, mistakes continue to happen. Alerts in computerised physician order entry intended to help prescribers avoid errors have not been effective enough. This improvement project delivered feedback of prescribing errors to prescribers in the neonatal intensive care unit (NICU), and measured the impact on medication error frequency. Methods A front-line multidisciplinary team doing multiple Plan Do Study Act cycles developed a system to communicate prescribing errors directly to providers every 2 weeks in the NICU. The primary outcome measure was number of days between medication prescribing errors with particular focus on antibiotic and narcotic errors. Results A T-control chart showed that the number of days between narcotic prescribing errors rose from 3.94 to 22.63 days after the intervention, an 83% improvement. No effect in the number of days between antibiotic prescribing errors during the same period was found. Conclusions An effective system to communicate mistakes can reduce some types of prescribing errors.
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Affiliation(s)
- Kevin M Sullivan
- Department of Pediatrics, Nemours Neonatology, AI duPont Hospital for Children, Wilmington, Delaware, USA
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Wiechula R, Kitson A, Marcoionni D, Page T, Zeitz K, Silverston H. Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit. INT J EVID-BASED HEA 2012; 7:283-95. [PMID: 21631868 DOI: 10.1111/j.1744-1609.2009.00145.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities with sufficient flexibility to meet the individual needs of the teams. Conclusions The range of tools in the KT Toolkit were found to be helpful, but not all tools needed to be used to achieve successful results. Facilitation of the teams was a central feature of the KT Toolkit and allowed clinicians to retain control of their projects; however, finding the balance between structuring the process and enabling teams to maintain ownership and control was an ongoing challenge. Clinicians may not have the requisite skills and experience in basic standard setting, audit and evaluation and it was therefore important to address this throughout the project. In time this builds capacity throughout the organisation. Identifying evidence to support practice is a challenge to clinicians. Evidence-based guidelines often lack specificity and were found to be difficult to assimilate easily into everyday practice. Evidence to inform practice needs to be provided in a variety of forms and formats that allow clinicians to easily identify the source of the evidence and then develop local standards specific to their needs. The work that began with this project will continue - all teams felt that the work was only starting rather than concluding. This created momentum, motivation and greater ownership of improvements at local level.
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Affiliation(s)
- Rick Wiechula
- Discipline of Nursing, School of Population Health and Clinical Practice, University of Adelaide, Green Templeton College, University of Oxford, Oxford, UK, Nursing, Anaesthesia, Allied Health and General Services, Patient Journey Redesign and Clinical Leadership Programme in Australia™, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Wulff I, Könner F, Kölzsch M, Budnick A, Dräger D, Kreutz R. Interdisziplinäre Handlungsempfehlung zum Management von Schmerzen bei älteren Menschen in Pflegeheimen. Z Gerontol Geriatr 2012; 45:505-44. [DOI: 10.1007/s00391-012-0332-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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González-Torrente S, Pericas-Beltrán J, Bennasar-Veny M, Adrover-Barceló R, Morales-Asencio JM, De Pedro-Gómez J. Perception of evidence-based practice and the professional environment of primary health care nurses in the Spanish context: a cross-sectional study. BMC Health Serv Res 2012; 12:227. [PMID: 22849698 PMCID: PMC3444388 DOI: 10.1186/1472-6963-12-227] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 07/17/2012] [Indexed: 12/04/2022] Open
Abstract
Background The study of the factors that encourage evidence-based clinical practice, such as structure, environment and professional skills, has contributed to an improvement in quality of care. Nevertheless, most of this research has been carried out in a hospital context, neglecting the area of primary health care. The main aim of this work was to assess the factors that influence an evidence-based clinical practice among nursing professionals in Primary Health Care. Methods A multicentre cross-sectional study was designed, taking the 619 Primary Care staff nurses at the Balearic Islands’ Primary Health Care Service, as the study population. The methodology applied consisted on a self-administered survey using the instruments Evidence-Based Practice Questionnaire (EBPQ) and Nursing Work Index (NWI). Results Three hundred and seventy seven surveys were received (60.9% response rate). Self-assessment of skills and knowledge, obtained 66.6% of the maximum score. The Knowledge/Skills factor obtained the best scores among the staff with shorter professional experience. There was a significant difference in the Attitude factor (p = 0.008) in favour of nurses with management functions, as opposed to clinical nurses. Multivariate analysis showed a significant positive relationship between NWI and level of evidence-based practice (p < 0,0001). Conclusions Institutions ought to undertake serious reflection on the lack of skills of senior nurses about Evidence-Based Clinical Practice, even when they have more professional experience. Leadership emerge as a key role in the transferral of knowledge into clinical practice.
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Nilsson Kajermo K, Böe H, Johansson E, Henriksen E, McCormack B, Gustavsson JP, Wallin L. Swedish translation, adaptation and psychometric evaluation of the Context Assessment Index (CAI). Worldviews Evid Based Nurs 2012; 10:41-50. [PMID: 22647076 DOI: 10.1111/j.1741-6787.2012.00252.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The strength of and relationship between the fundamental elements context, evidence and facilitation of the PARIHS framework are proposed to be key for successful implementation of evidence into healthcare practice. A better understanding of the presence and strength of contextual factors is assumed to enhance the opportunities of adequately developing an implementation strategy for a specific setting. A tool for assessing context-The Context Assessment Index (CAI)-was developed and published 2009. A Swedish version of the instrument was developed and evaluated among registered nurses. This work forms the focus of this paper. PURPOSE The purpose of this study was to translate the CAI into Swedish, adapt the instrument for use in Swedish healthcare practice and assess its psychometric properties. METHODS The instrument was translated and back-translated to English. The feasibility of items and response scales were evaluated through think aloud interviews with clinically active nurses. Psychometric properties were evaluated in a sample of registered nurses (n = 373) working in a variety of healthcare organisations in the Stockholm area. Item and factor analyses and Cronbach's alpha were computed to evaluate internal structure and internal consistency. RESULT Sixteen items were modified based on the think aloud interviews and to adapt the instrument for use in acute care. A ceiling effect was observed for many items and the originally identified 37 item five-factor model was not confirmed. Item analyses showed an overlap between factors and indicated a one-dimensional scale. DISCUSSION The Swedish version of the CAI has a wider application than the original instrument. This might have contributed to the differences in factor structure. Different opportunities for further development of the scale are discussed. CONCLUSIONS Further evaluation of the psychometric properties of the CAI is required.
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Archambault PM, Bilodeau A, Gagnon MP, Aubin K, Lavoie A, Lapointe J, Poitras J, Croteau S, Pham-Dinh M, Légaré F. Health care professionals' beliefs about using wiki-based reminders to promote best practices in trauma care. J Med Internet Res 2012; 14:e49. [PMID: 22515985 PMCID: PMC3376518 DOI: 10.2196/jmir.1983] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/19/2012] [Accepted: 02/22/2012] [Indexed: 11/13/2022] Open
Abstract
Background Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis. Objectives To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs’ and AHPs’ beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants’ gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs—that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. Results Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs mentioned a disadvantage (the wiki added stress). The most frequently reported favorable referent was nurses for EPs (n = 16) and EPs for AHPs (n = 19). The most frequently reported unfavorable referents were people resistant to standardized care for EPs (n = 8) and people less comfortable with computers for AHPs (n = 11). The most frequent facilitator for EPs was ease of use (n = 19); for AHPs, it was having a bedside computer (n = 20). EPs’ most frequently reported barrier was irregularly updated wiki-based reminders (n = 18); AHPs’ was undetermined legal responsibility (n = 10). Conclusions We identified EPs’ and AHPs’ salient beliefs about using a wiki-based reminder. We will draw on these beliefs to construct a questionnaire to measure the importance of these determinants to EPs’ and AHPs’ intention to use a wiki-based reminder promoting evidence-based care for traumatic brain injuries.
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Affiliation(s)
- Patrick Michel Archambault
- Centre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis), Lévis, QC, Canada.
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