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daSilva M, Dissanayake M, Sibbald SL. Beyond implementation: A collective case study exploring the conceptions and facilitators of sustainability in a quality improvement collaborative. EVALUATION AND PROGRAM PLANNING 2024; 102:102384. [PMID: 37948901 DOI: 10.1016/j.evalprogplan.2023.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of adult hospitalizations and imposes substantial burdens on patients and healthcare systems. Initiatives that support providers and patients in addressing needs at each stage of this illness are needed. The INSPIRED COPD Outreach Program™ was introduced in 2010 in Halifax, Nova Scotia, Canada to improve care for those with advanced COPD. The huge success of the program led to its expansion to various contexts and geographic locations through a pan-Canadian quality improvement collaborative (QIC). Our study explored early elements of program planning and practice with an aim to understand factors that influence program sustainability. We evaluated the implementation process of 19 teams across Canada; post-collaborative team reports, focus groups, interviews and self-ratings of progress were collected from all teams. Analysis of data revealed three phases important to fostering sustainability (facilitating implementation, keeping the momentum, and securing sustainability) and each phase had unique supporting themes. Not surprisingly, teams that planned for sustainability early in the implementation process were more likely to successfully achieve program sustainability. However, teams also benefited more broadly from sustainability planning; this included being better able to plan for program spread as well as skill retention and knowledge transfer. This was also seen for quality improvement skills introduced early in the program that were more likely to be maintained and used through other contexts when sustainability planning was present. This study highlights that a QIC can be effective in not only influencing program sustainability but also beyond program implementation through improving knowledge and skill acquisition.
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Affiliation(s)
- Madelyn daSilva
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada
| | - Melanie Dissanayake
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences at Western University, 1151 Richmond St., London, Ontario N6A 3K7, Canada; Department of Family Medicine and the Schulich Interfaculty Program in Public Health at the Schulich School of Medicine and Dentistry, 1151 Richmond St., London, Ontario N6A 3K7, Canada.
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Ferren MD, Von Ah D, Menachemi N. EBP champion responsibilities and sustainability: A scoping review. Nurs Manag (Harrow) 2022; 53:22-33. [PMID: 35913815 DOI: 10.1097/01.numa.0000853152.64293.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Melora D Ferren
- Melora D. Ferren is vice president and associate chief nurse executive at Indiana University Health in Indianapolis, Ind. Diane Von Ah is a distinguished professor of cancer research at the College of Nursing and the director of cancer research at The Ohio State University in Columbus. Nir Menachemi is the Fairbanks Endowed Chair, the Health Policy and Management department chair, and a professor at Indiana University in Indianapolis, Ind
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Kastner M, Makarski J, Mossman K, Harris K, Hayden L, Giraldo M, Sharma D, Asalya M, Jussaume L, Eisen D, Wintemute K, Rolko E, Shin P, Zadravec J, McRitchie D. Choosing Wisely: An idea worth sustaining. Health Serv Res 2022; 57:568-578. [PMID: 34859435 PMCID: PMC9108081 DOI: 10.1111/1475-6773.13917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 07/19/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To evaluate the sustainability potential of Choosing Wisely (CW) to address unnecessary medical care at Ontario community hospitals. DATA SOURCES/STUDY SETTING Ontario community hospitals and their affiliated family health teams (FHTs). STUDY DESIGN A mixed-methods study involving the administration of a validated sustainability survey to CW implementation teams followed by their participation in focus groups. DATA COLLECTION/EXTRACTION METHODS Survey data were collected using an Excel file with an embedded, automated scoring system. We collated individual survey scores and generated aggregate team scores. We also performed descriptive statistics for quantitative data (frequencies, means). Qualitative data were triangulated with quantitative assessments to support data interpretations using the meta-matrix method. PRINCIPAL FINDINGS Fifteen CW implementation teams across four Ontario community hospitals and six affiliated primary care FHTs participated. CW priority areas investigated were de-prescribing of proton pump inhibitors (PPIs) and reducing Pre-Op testing and BUN/Urea lab testing. Survey results showed steady improvements in sustainability scores from baseline to final follow-up among most implementation teams: 10% increase for PPI de-prescribing (six FHTs) and 2% increase (three hospital teams); 18% increase in BUN/Urea lab testing (three hospital teams). Regardless of site or CW priority area, common facilitators were fit with existing processes and workflows, leadership support, and optimized team communication; common challenges were lack of awareness and buy-in, leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge for which they co-designed and implemented a plan to maximize the sustainability potential of their CW initiative. CONCLUSIONS Evaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence implementation efforts and to realize positive outcomes for their health care services and patients.
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Affiliation(s)
- Monika Kastner
- Knowledge Translation and Implementation, Centre for Research and InnovationNorth York General HospitalTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Health Sciences BuildingTorontoOntarioCanada
| | - Julie Makarski
- Knowledge Translation and Implementation, Centre for Research and InnovationNorth York General HospitalTorontoOntarioCanada
| | - Kathryn Mossman
- Knowledge Translation and Implementation, Centre for Research and InnovationNorth York General HospitalTorontoOntarioCanada
| | - Kegan Harris
- Knowledge Translation and Implementation, Centre for Research and InnovationNorth York General HospitalTorontoOntarioCanada
| | - Leigh Hayden
- Knowledge Translation and Implementation, Centre for Research and InnovationNorth York General HospitalTorontoOntarioCanada
| | - Manuel Giraldo
- Pathology and Core LabsNorth York General HospitalTorontoOntarioCanada
| | - Deepak Sharma
- Decision Support, Health Information ManagementNorth York General HospitalTorontoOntarioCanada
| | - Marwan Asalya
- Decision Support, Health Information ManagementNorth York General HospitalTorontoOntarioCanada
| | - Linda Jussaume
- Department of SurgeryNorth York General HospitalTorontoOntarioCanada
| | - David Eisen
- Family and Community MedicineNorth York General HospitalTorontoOntarioCanada
| | - Kimberly Wintemute
- Family and Community MedicineNorth York General HospitalTorontoOntarioCanada
| | - Edith Rolko
- Department of PharmacyNorth York General HospitalTorontoOntarioCanada
| | - Phil Shin
- Department of MedicineNorth York General HospitalTorontoOntarioCanada
| | - Jennifer Zadravec
- Department of Medical ImagingNorth York General HospitalTorontoOntarioCanada
| | - Donna McRitchie
- Department of SurgeryNorth York General HospitalTorontoOntarioCanada
- Department of Medical and Academic AffairsNorth York General HospitalTorontoOntarioCanada
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Nadalin Penno L, Graham ID, Backman C, Fuentes-Plough J, Davies B, Squires J. Sustaining a nursing best practice guideline in an acute care setting over 10 years: A mixed methods case study. FRONTIERS IN HEALTH SERVICES 2022; 2:940936. [PMID: 36925887 PMCID: PMC10012662 DOI: 10.3389/frhs.2022.940936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
Background To improve patient outcomes many healthcare organizations have undertaken a number of steps to enhance the quality of care, including the use of evidence-based practices (EBPs) such as clinical practice guidelines. However, there is little empirical understanding of the longer-term use of guideline-based practices and how to ensure their ongoing use. The aim of this study was to identify the determinants and knowledge translation interventions (KTIs) influencing ongoing use of selected recommendations of an institutional pain policy and protocol over time from an organizational perspective and 10 years post implementation on two units within an acute care setting. Methods We conducted a mixed methods case study guided by the Dynamic Sustainability Framework of an EBP 10 years post implementation. We examined protocol sustainability at the nursing department and unit levels of a multi-site tertiary center in Canada. Data sources included document review (n = 29), chart audits (n = 200), and semi-structured interviews with nurses at the department (n = 3) and unit (n = 16) level. Results We identified 32 sustainability determinants and 29 KTIs influencing ongoing use of an EBP in acute care. Three determinants and eight KTIs had a continuous influence in all three time periods: implementation phase (0-2 yrs), sustained phase (>2-10 yrs.), and at the 10-year mark. Implementation of KTIs evolved with the level of application (e.g., department vs. unit) to fit the EBP within the context highlighting the need to focus on determinants influencing ongoing use. Sustainability was associated with continual efforts of monitoring and providing timely feedback regarding adherence to recommendations. KTIs used to embed recommendations into routine practices/processes positively influenced high adherence rates. Use of a participatory approach for implementation and sustainment and linking KTIs designed to incrementally address low adherence rates facilitated sustainment. Conclusion This research provides insight into the relationship between implementation and sustainability determinants and related KTIs during implementation and sustained use phases. Unique determinants identified by department and unit nurses reflect their different perspectives toward the innovation based on their respective roles and responsibilities. KTIs fostered changed behaviors and facilitated EBP sustainment in acute care. Findings confirm the concept of sustainability is a dynamic "ongoing process."
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Affiliation(s)
- Letitia Nadalin Penno
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Chantal Backman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Fuentes-Plough
- Business School and Leadership School, Anahuac-Mayab University, Mérida, Yucatan, Mexico
| | - Barbara Davies
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Janet Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Chiwaula CH, Kanjakaya P, Chipeta D, Chikatipwa A, Kalimbuka T, Zyambo L, Nkata S, Jere DL. Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2020.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Liaw YQ, Goh ML. Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:1709-1719. [PMID: 30113551 DOI: 10.11124/jbisrir-2017-003683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The main objective of this evidence-based utilization project was to improve the accuracy of fluid intake charting through patient involvement. INTRODUCTION The accurate documentation and maintenance of fluid balance charts constitute an integral part of nursing care. However, inaccuracies in fluid balance charting by nurses often occur. Inaccurate charting can result in delayed interventions, affecting the safety of patients. It has been found that fluid intake charting in an acute surgical inpatient ward is highly inaccurate. Many expressions of dissatisfaction are evident among medical healthcare professionals and patients regarding the accurate updating of the charts. Therefore, evidence-based measures need to be implemented in order to improve the safety of patient care through accurate recording of patients' fluid intake. METHODS The project took place in a 21-bed acute surgical ward which had 30 patients. The Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) tools were used to implement the evidence-based project. A pre- and post- audit methodology congruent with the framework was applied. The project was implemented in three phases from April to September 2016. The audit criteria obtained from JBI-PACES were used. The project's primary focus was to harness patient involvement in improving the accuracy of fluid intake charting. RESULTS Criteria 1 and 2 revealed low levels of compliance during the pre-implementation audit, 3% and 10%, respectively. There were significant improvements one month post-implementation for both Criteria 1 and 2, 100% and 87%, also respectively. Fisher's exact test was carried out and the statistical significance of the results was achieved (p < 0.001), compared to the pre-implementation audit. At six months post-implementation, the audit found that both criteria were adequately sustained as a practice in the ward (Criterion 1: 100%, Criterion 2: 83%). CONCLUSIONS This project has demonstrated the effectiveness of improving the accuracy of fluid intake charting through patient involvement. The use of JBI-PACES and GRiP has allowed the effective utilization of evidence in practice. It has also provided evidence that effective engagement of the ground nurses and stakeholders coupled with the commitment of change champions and ground nurses can contribute to improving practice in a highly demanding acute care setting and lead to healthcare success.
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Affiliation(s)
- Yi Qi Liaw
- University of Surgical Cluster, National University Hospital, Singapore
| | - Mien Li Goh
- Evidence Based Nursing Unit, National University Hospital, Singapore.,Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: a Joanna Briggs Institute Centre of Excellence
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Allen E, Williams A, Jennings D, Stomski N, Goucke R, Toye C, Slatyer S, Clarke T, McCullough K. Revisiting the Pain Resource Nurse Role in Sustaining Evidence‐Based Practice Changes for Pain Assessment and Management. Worldviews Evid Based Nurs 2018; 15:368-376. [DOI: 10.1111/wvn.12318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Allen
- Centre for Nursing ResearchSir Charles Gairdner Hospital Nedlands WA Australia
- School of Health ProfessionsMurdoch University Murdoch WA Australia
| | - Anne Williams
- Centre for Nursing ResearchSir Charles Gairdner Hospital Nedlands WA Australia
- School of Health ProfessionsMurdoch University Murdoch WA Australia
| | - David Jennings
- Centre for Nursing ResearchSir Charles Gairdner Hospital Nedlands WA Australia
- School of Nursing and MidwiferyEdith Cowan University Joondalup WA Australia
| | - Norman Stomski
- School of Health ProfessionsMurdoch University Murdoch WA Australia
| | - Roger Goucke
- Department of Pain ManagementSir Charles Gairdner Hospital Nedlands WA Australia
| | - Christine Toye
- Sir Charles Gairdner Hospital Nedlands WA Australia
- School of NursingMidwifery and ParamedicineCurtin University Bentley WA Australia
| | - Susan Slatyer
- Sir Charles Gairdner Hospital Nedlands WA Australia
- School of NursingMidwifery and ParamedicineCurtin University Bentley WA Australia
| | - Trish Clarke
- Department of Pain ManagementSir Charles Gairdner Hospital Nedlands WA Australia
| | - Kylie McCullough
- Centre for Nursing ResearchSir Charles Gairdner Hospital Nedlands WA Australia
- School of Nursing and MidwiferyEdith Cowan University Joondalup WA Australia
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Koh SY, Yeo HL, Goh ML. Prevention of heel pressure ulcers among adult patients in orthopaedic wards: an evidence-based implementation project. Int J Orthop Trauma Nurs 2018; 31:40-47. [PMID: 30316760 DOI: 10.1016/j.ijotn.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/14/2018] [Accepted: 08/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels. AIMS The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel pressure ulcers. METHODS The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and involved a sample consisting of 30 adult patients. RESULTS Nurses' compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project resulted in more than 50% reduction in stage one heel pressure ulcers. CONCLUSION The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
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Affiliation(s)
- Siew Yi Koh
- University of Orthopaedic Cluster, National University Hospital, Singapore
| | - Hui Ling Yeo
- University of Orthopaedic Cluster, National University Hospital, Singapore
| | - Mien Li Goh
- Evidence Based Nursing Unit, National University Hospital, Singapore.
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Kastner M, Sayal R, Oliver D, Straus SE, Dolovich L. Sustainability and scalability of a volunteer-based primary care intervention (Health TAPESTRY): a mixed-methods analysis. BMC Health Serv Res 2017; 17:514. [PMID: 28764687 PMCID: PMC5540508 DOI: 10.1186/s12913-017-2468-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/24/2017] [Indexed: 11/28/2022] Open
Abstract
Background Chronic diseases are a significant public health concern, particularly in older adults. To address the delivery of health care services to optimally meet the needs of older adults with multiple chronic diseases, Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) uses a novel approach that involves patient home visits by trained volunteers to collect and transmit relevant health information using e-health technology to inform appropriate care from an inter-professional healthcare team. Health TAPESTRY was implemented, pilot tested, and evaluated in a randomized controlled trial (analysis underway). Knowledge translation (KT) interventions such as Health TAPESTRY should involve an investigation of their sustainability and scalability determinants to inform further implementation. However, this is seldom considered in research or considered early enough, so the objectives of this study were to assess the sustainability and scalability potential of Health TAPESTRY from the perspective of the team who developed and pilot-tested it. Methods Our objectives were addressed using a sequential mixed-methods approach involving the administration of a validated, sustainability survey developed by the National Health Service (NHS) to all members of the Health TAPESTRY team who were actively involved in the development, implementation and pilot evaluation of the intervention (Phase 1: n = 38). Mean sustainability scores were calculated to identify the best potential for improvement across sustainability factors. Phase 2 was a qualitative study of interviews with purposively selected Health TAPESTRY team members to gain a more in-depth understanding of the factors that influence the sustainability and scalability Health TAPESTRY. Two independent reviewers coded transcribed interviews and completed a multi-step thematic analysis. Outcomes were participant perceptions of the determinants influencing the sustainability and scalability of Health TAPESTRY. Results Twenty Health TAPESTRY team members (53% response rate) completed the NHS sustainability survey. The overall mean sustainability score was 64.6 (range 22.8–96.8). Important opportunities for improving sustainability were better staff involvement and training, clinical leadership engagement, and infrastructure for sustainability. Interviews with 25 participants (response rate 60%) showed that factors influencing the sustainability and scalability of Health TAPESTRY emerged across two dimensions: I) Health TAPESTRY operations (development and implementation activities undertaken by the central team); and II) the Health TAPESTRY intervention (factors specific to the intervention and its elements). Resource capacity appears to be an important factor to consider for Health TAPESTRY operations as it was identified across both sustainability and scalability factors; and perceived lack of interprofessional team and volunteer resource capacity and the need for stakeholder buy-in are important considerations for the Health TAPESTRY intervention. We used these findings to create actionable recommendations to initiate dialogue among Health TAPESTRY team members to improve the intervention. Conclusions Our study identified sustainability and scalability determinants of the Health TAPESTRY intervention that can be used to optimize its potential for impact. Next steps will involve using findings to inform a guide to facilitate sustainability and scalability of Health TAPESTRY in other jurisdictions considering its adoption. Our findings build on the limited current knowledge of sustainability, and advances KT science related to the sustainability and scalability of KT interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2468-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - Radha Sayal
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Abstract
OBJECTIVE This study examined a 6-month follow-up of a regional evidence-based practice (EBP) fellowship program and the predictors of EBP adoption at hospital units. BACKGROUND The immediate beneficial effects of a regional EBP program are known, but the medium-term effects are not certain. METHODS A matched pretest/posttest study was conducted using a mailed questionnaire 6 months after the completion of a 9-month regional EBP fellowship program among 3 annual cohorts of participants. RESULTS Statistically significant improvements in the mean scores of EBP beliefs, EBP implementation, and group cohesion were found (P < .05). Of the 47 participants who completed their EBP projects, more than three-quarters reported EBP adoption at their own hospital units, and EBP beliefs were a positive predictor of EBP adoption (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P = .017). CONCLUSIONS The outcome improvements continued 6 months after the fellowship program, and strong EBP beliefs predicted EBP adoption in the participants' units.
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Patient-centred hand hygiene information in orthopaedics units: an evidence-based implementation project. INT J EVID-BASED HEA 2016; 15:22-29. [PMID: 27875344 DOI: 10.1097/xeb.0000000000000094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This project aimed to improve patients' knowledge on the importance of hand hygiene. It involved providing patients with a patient and family education on the importance of hand hygiene using a patient information leaflet that introduces the rationale of hand hygiene, possible consequences of poor hand hygiene, and the seven steps of hand hygiene. METHODS This projected used a preimplementation and postimplementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. The implementation occurred in three phases over a period of 6 months from January 2014 to June 2014. The audits took place in two orthopaedic wards in a large acute care setting tertiary hospital in Singapore and involved a sample size of 54 patients. It involved going through the medical records of the cases, assessment of patient knowledge based on the audit criteria, and checking if the patients received the patient information leaflet on hand hygiene. RESULTS The postimplementation audit found significant improvements in all three audit criteria. The percentage of patients who demonstrated knowledge in the importance of hand hygiene saw an improvement of 48.1%. There was an improvement of 44.5% in nurses' compliance to the documentation of patient education being carried out. The percentage of patients who received a patient information leaflet on hand hygiene saw an increase of 36.1%. CONCLUSION This project demonstrated that a preimplementation and postimplementation audit is a viable method to implement change and translate evidence into practice. Through this project, patients gained an understanding on the importance of hand hygiene and could take better ownership of their well being. This may potentially improve hospitalization experience and benefit health outcomes. The positive results of this project are contributed by the enthusiastic involvement of all the stakeholders, from patients and their caregivers to the bedside nurses and nursing leaders. The sustenance will be an ongoing challenge to the project.
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Tricco AC, Ashoor HM, Cardoso R, MacDonald H, Cogo E, Kastner M, Perrier L, McKibbon A, Grimshaw JM, Straus SE. Sustainability of knowledge translation interventions in healthcare decision-making: a scoping review. Implement Sci 2016; 11:55. [PMID: 27097827 PMCID: PMC4839064 DOI: 10.1186/s13012-016-0421-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/09/2016] [Indexed: 11/17/2022] Open
Abstract
Background Knowledge translation (KT, also known as research utilization, and sometimes referring to implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health. A KT intervention is one which facilitates the uptake of research. The long-term sustainability of KT interventions is unclear. We aimed to characterize KT interventions to manage chronic diseases that have been used for healthcare outcomes beyond 1 year or beyond the termination of initial grant funding. Methods We conducted a scoping review by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Campbell from inception until February 2013. We included experimental, quasi-experimental, and observational studies providing information on the sustainability of KT interventions for managing chronic diseases in adults and focusing on end-users including patients, clinicians, public health officials, health service managers, and policy-makers. Articles were screened and abstracted by two reviewers, independently. The data were charted and results described narratively. Results We included 62 studies reported in 103 publications (total 260,688 patients) plus 41 companion reports after screening 12,328 titles and abstracts and 464 full-text articles. More than half of the studies were randomized controlled trials (RCTs). The duration of the KT intervention ranged from 61 to 522 weeks. Nine chronic conditions were examined across the studies, such as diabetes (34 %), cardiovascular disease (28 %), and hypertension (16 %). Thirteen KT interventions were reported across the studies. Patient education was the most commonly examined (20 %), followed by self-management (17 %). Most studies (61 %) focused on patient-level outcomes (e.g. disease severity), while 31 % included system-level outcomes (e.g. number of eye examinations), and 8 % used both. The interventions were aimed at the patient (58 %), health system (28 %), and healthcare personnel (14 %) levels. Conclusions We found few studies focusing on the sustainability of KT interventions. Most of the included studies focused on patient-level outcomes and patient-level KT interventions. A future systematic review can be conducted of the RCTs to examine the impact of sustainable KT interventions on health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0421-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Huda M Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Roberta Cardoso
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Elise Cogo
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Monika Kastner
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Laure Perrier
- Institute of Health Management, Policy and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Ann McKibbon
- Department of Clinical Epidemiology and Biostatistics, Health Information Research Unit, McMaster University Faculty of Health Sciences, 1200 Main Street West, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada. .,Department of Geriatric Medicine, University of Toronto, 27 Kings College Circle, Toronto, ON, M5S 1A1, Canada.
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McGahee A. Sustainability of Innovations. Part II: Exemplar of Addressing Sustainability Factors in the Development and Implementation of an Evidenced-Based Practice Improvement Project. Res Theory Nurs Pract 2016; 30:4-9. [PMID: 27024996 DOI: 10.1891/1541-6577.30.1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levin RF, Wright F, Pecoraro K, Kopec W. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project. AORN J 2016; 103:213.e1-213.e13. [DOI: 10.1016/j.aorn.2015.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 08/30/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022]
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