Preventing aggression in a pediatric inpatient unit: a best practice implementation project.

HIV is a retrovirus affecting the body's immune system. People living with HIV (PWH) aged ≥45 have a higher risk of atherosclerotic cardiovascular disease (ASCVD). Statins are generally recommended for PWH with a 10-year ASCVD risk of ≥5%. This project aimed to promote evidence-based practices (EBPs) regarding statin-prescribing for eligible PWH in an outpatient specialty clinic. Guided by the JBI Evidence Implementation Framework, two EBPs for increasing statin-prescribing were used as audit criteria: (1) use of a validated tool to estimate ASCVD risk and (2) presence of an alert for clinicians in the electronic health record (EHR) for positive screenings. To determine compliance with EBPs, a baseline audit was completed via EHR reviews. Then, barriers to compliance were identified and strategies to improve compliance were implemented. A follow-up audit was conducted to measure changes in compliance with best practices. The baseline audit revealed 56% and 0% compliance with the two EBPs, respectively. Barriers to compliance included the absence of a standardized process for estimating patients' CVD risk and clinicians often being unaware of patients' statin eligibility. Strategies to improve EBP compliance included using a "Smart Phrase" to automatically insert a calculation of the 10-year ASCVD risk score into the EHR and placing a statin eligibility notification into eligible patients' EHRs. The follow-up audit indicated a decrease in compliance for Criterion 1 (56% to 52%) but an increase of 100% for Criterion 2. The project objective was partially met, but interventions were impractical for sustainability. Prescribing practices among nurse practitioners and medical doctors should be explored, as differences in prescribing habits were noticeable. http://links.lww.com/IJEBH/A516.

Prior studies have shown that about half of critically ill patients in intensive care units (ICUs) have abnormal blood glucose. Both hyperglycemia and hypoglycemia increase the risk of death in critically ill patients; therefore, controlling blood glucose in such patients is crucial. There is a significant gap between clinical practice and the current best evidence regarding glycemic control in ICU. This best practice implementation project aimed to improve glycemic control for critically ill patients in a tertiary hospital in China by promoting best practices. This project was conducted according to the JBI Evidence Implementation Framework, which is based on an audit and feedback strategy. Four audit criteria were developed for the baseline and follow-up audits. An implementation protocol was designed based on the barriers and facilitators identified in the baseline audit. Nursing documentation from patients' medical records and interviews with nurses were used to assess the baseline and follow-up audit compliance rates. The results showed improved compliance with the four criteria in the follow-up audit. Except for only slight improvement in Criterion 2 (increasing from 15.3% to 26.6%), the three other criteria all achieved significant improvements. The compliance rate for Criterion 1 increased from 43.8% to 70.0%, Criterion 3 increased from 0% to 100%, and Criterion 4 increased from 46.8% to 65.8%. This evidence-based implementation project successfully increased nurses' compliance with best practice recommendations for glycemic control in critically ill patients. http://links.lww.com/IJEBH/A338.

Medication incidents are the second most frequently occurring incident in Australian hospitals. The number of medication incidents in the targeted unit of this project has increased this year compared with previous year, and medication omissions accounted for a significant portion of these incidents. The aim of this project was to identify medication omissions and develop and implement strategies to reduce medication omissions in the targeted medical unit in compliance with best practice. This implementation project was conducted in an acute medical unit of an acute tertiary hospital. Evidence-based audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute. Using the Joanna Briggs Institute Practical Application of Clinical Evidence System software, a baseline audit was conducted including a sample size of 21 patients followed by an identification of barriers of medication omissions and development of strategies to reduce medication omissions. A follow-up audit including a sample size of 24 patients was conducted by using same audit criteria. Twenty-four nursing staff were surveyed in both baseline and follow-up audits. The baseline audit results showed that most audit criteria results were found to be less than 50%, which indicated poor compliance with the current evidence. Following implementation of the strategies, which included education, development of a "Medication Omission Reminder Card" and a regular weekly audit on medication omissions, there was an improvement in all the criteria audited, with criteria 3 and 4 achieving 100% compliance, and criteria 1 and 2 showing 45% and 13% compliance, respectively. Medication omissions were reduced on the completion of the project as there was an increased awareness of the medication omissions standards and medication safety among the nursing staff in the unit.

Pregnancy and vaginal delivery may cause urinary incontinence (UI) in some women, which can impact on their quality of life. Pelvic floor muscles training (PFMT) is a safe and effective intervention for preventing UI associated with pregnancy. The aim of this evidence-implementation project was to promote PFMT to prevent UI among antenatal and postnatal women in an obstetric and gynecological hospital in China. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Six audit criteria that represent best practice recommendations for PFMT were used. A baseline audit was conducted followed by the implementation of multiple strategies and finalized with a follow-up audit to determine change in practice. Results from pre- and post-implementation audits indicated that compliance rates for Criterion 1 (nurse education), Criterion 2 (information providing), Criterion 3 (needs and precautions identifying), Criterion 4 (assessment of pelvic floor function and referral suggestion) reached 100% in the follow-up audit. The compliance rate for Criteria 5 (women education) and Criteria 6 (follow-up providing) attained 90 and 63%, respectively, in the follow-up audit. The project was successful in improving women's knowledge and skills around UI and PFMT. A variety of strategies, such as an effective education program, simple and clear instruments, multiple educational materials can facilitate implementation of evidence in clinical practice. Future plans for continuous improvements in practice and outcomes should be discussed. Further audits will need to be carried out to monitor practice and effect change as required.

The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients. The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care. This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients. The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit. The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

The emergency department is a fast-paced and complex health care setting, where critical care is provided to patients of all ages. However, various environmental factors, such as high patient volumes, overburdened staff, and frequent nurse turnover, can hinder the use of evidence-based practices during procedural sedation. Proper patient monitoring is essential to prevent adverse events during procedural sedation. The goal of this implementation project was to enhance compliance with best practices for patient monitoring during procedural sedation in the emergency department. The project used the JBI Model of Evidence-Based Healthcare and JBI's Getting Research into Practice (GRiP) tool for implementing evidence-based monitoring practices for adult patients during procedural sedation in the emergency department. A baseline audit was conducted to assess current practice against evidence-based recommendations, followed by the implementation of strategies to improve compliance with best practices. The project concluded with a follow-up audit to determine any improvement in practice. The baseline audit revealed 81% overall compliance with evidence-based practice. Three barriers were identified, namely, lack of staff education, increased turnover rate of nurses, and the need for nurses to be mobile during procedural sedation. Strategies were implemented to improve compliance with evidence-based practice. The follow-up audit showed an overall improvement of 95% after project implementation. The project improved best practices for patient monitoring during procedural sedation in the emergency department. However, more work remains to be done to ensure the sustainability of the best practices, including monitoring of end-tidal capnography and vital sign assessment.

The current implementation project aimed to promote evidence-based practice with prechemotherapy nursing assessment among adult cancer patients in a large university cancer center in Shanghai, China, over a 6-month timeframe. Prechemotherapy nursing assessment is an essential element of cancer patient care, aiming to prevent or minimize potential problems from chemotherapy treatment. Regular comprehensive prechemotherapy assessment is not part of routine care currently in many clinical settings within China. The project utilized the JBI approach to implementation, incorporating audit and feedback tools. Twelve evidence-based audit criteria were developed for use in the program. A baseline audit was conducted of prechemotherapy nursing assessment among adult cancer patients, with a sample size of 68 patients and 36 nursing staff. Following implementation of systematic strategies based on the analysis of three main barriers, a follow-up audit involving a similar sample as the first audit was conducted using the same audit criteria. The baseline audit indicated that for nursing assessment among adult cancer patients undergoing chemotherapy, the criteria (1, 10, 11 and 12) which related to nurse education, weight measurement, premedication and access device assessment had very high compliance (from 93 to 100%). Compliance for criteria (2, 6, 7, 9) related to medical history, previous exposure to chemotherapy, patients' or caregivers' comprehension of treatment and psychosocial assessment was 0%, while compliance with the other five criteria (3, 4, 5, 8) was low, ranging from 16 to 61%. There was improvement in all 12 criteria in the follow-up audit. Criteria 1, 11 and 12 maintained high compliance (100%). Criterion 2 (patients' medical history), criterion 3 (presence or absence of allergies), criterion 7 (previous exposure to chemotherapy) and criterion 9 (psychosocial elements) demonstrated a significant improvement in compliance. Although progress has been made, there were still some criteria that require further improvement. These included assessment of patients' current diagnosis and cancer status (criterion 4, from 61 to 66%), recent laboratory results (criterion 5, from 31 to 62%), patients' and/or caregivers' comprehension of information regarding the disease and treatment (criterion 6, from 0 to 34%), any previous exposure to chemotherapy agents (criterion 7, from 0 to 57%), and physical assessment of the patient (criterion 8, from 46 to 72%). The project achieved increased compliance with evidence-based best practice in all assessed audit criteria improving the practice of prechemotherapy assessment. Involvement of informatics technology is a great strategy to help overcome barriers, simplify the change process and assist in sustaining evidence-based practice change. Future plans and ideas are in place and have been discussed. Further audits will need to be carried out to improve the validity and quality of nursing assessment.

Pelvic floor dysfunctions are common complications during the childbirth process. Pelvic floor muscle training (PFMT) has been used as a conservative treatment in both prenatal and postnatal women. The aim of this project was to assess the compliance with evidence-based criteria regarding PFMT among prenatal and postnatal women in mother fit healthcare centres. The current study was performed in three phases. Phase 1: stakeholder engagement and team establishment and baseline audit. Phase 2: Design and implementation of strategies to improve PFMT among prenatal and postnatal women in mother fit healthcare centres. Phase 3: Follow-up audit. Baseline and follow-up audit with six yes/no audit questions was performed using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Fifteen midwives involved in prenatal and postnatal healthcare centres and 60 pregnant women participated in this study. The compliance for each audit criterion found in the baseline audit was low (0-7%). However, after implementation of the project and training the trainers (midwives), the compliance increased significantly (77-100%). The current study demonstrated that we have some problems in the healthcare system to teach PFMT to pregnant women. We should also implement similar projects in all healthcare centres country wide. Healthcare system managers should be aware of the value of holding PFMT courses for pregnant women and it is recommended to use pelvic floor physiotherapists to train midwives.

Major burn injury patients commonly fast preoperatively before multiple surgical procedures. The Societies of Anesthesiology in Europe and the United States recommend fasting from clear fluids for two hours and solids for six to eight hours preoperatively. However, at the Royal Adelaide Hospital, patients often fast from midnight proceeding the day of surgery. This project aims to promote evidence-based practice to minimize extended preoperative fasting in major burn patients. A baseline audit was conducted measuring the percentage compliance with audit criteria, specifically on preoperative fasting documentation and appropriate instructions in line with evidence-based guidelines. Strategies were then implemented to address areas of non-compliance, which included staff education, development of documentation tools and completion of a perioperative feeding protocol for major burn patients. Following this, a post implementation audit assessed the extent of change compared with the baseline audit results. Education on evidence-based fasting guidelines was delivered to 54% of staff. This resulted in a 19% improvement in compliance with fasting documentation and a 52% increase in adherence to appropriate evidence-based instructions. There was a notable shift from the most common fasting instruction being "fast from midnight" to "fast from 03:00 hours", with an overall four-hour reduction in fasting per theater admission. These results demonstrate that education improves compliance with documentation and preoperative fasting that is more reflective of evidence-based practice. Collaboration with key stakeholders and a hospital wide fasting protocol is warranted to sustain change and further advance compliance with evidence-based practice at an organizational level.

Background Current discharge practices have shown to be inefficient which results in delayed transfers from the emergency department, resulting in patients waiting for extended periods of time before admissions to their home wards, and bed blocking within the emergency department. This implementation project focuses on implementing criteria led discharge (CLD) within a short stay surgical unit. Objectives The primary objective of this evidence implementation project was to promote best practice for criteria led discharge, and thereby improve patient outcomes, reduce patient length of stay and improve resource allocation. Methods This project utilized the audit and feedback model using the Joanna Briggs Institute's Practical Application of Clinical Evidence System. Audit criteria were created based on the best available evidence on the topic through a search performed by the JBI team. All audit criteria were obtained through case note review following discharge. All audits were undertaken within the same 28-bed surgical unit. Results The post-implementation (follow-up) audit showed significant improvement in compliance to best practice guidelines in many of the audit criteria selected. Despite this, the ongoing follow up audits have shown a decrease in compliance. Further education and monitoring is required. Conclusions This project has shown that using the audit and feedback as an implementation tool has proved effective in changing practice and improving compliance to the best available evidence on discharging patients, once they have met the criteria developed.

To describe the process of implementing evidence-based best practices to improve the prevention and management of Postoperative Delirium in the Post-Anesthesia Care Unit. Report on an evidence implementation project applying the JBI based on the audit and feedback process, with a structured approach to identifying and managing barriers in accordance with recommended clinical practices. Medical records, electronic nursing record systems, and staff interviews were used to assess compliance rates. In the baseline audit, a zero compliance rate was found in most criteria in relation to the best evidence. Following this phase, interprofessional training was carried out, a validated tool was provided to identify patients at risk of delirium, and changes were made to the electronic nursing records system. In the first follow-up audit, there was an increase in the compliance rate in four of the nine criteria audited. Four criteria achieved 100% compliance in the second follow-up audit. Best practices were implemented that contributed to improving the prevention and management of Postoperative Delirium. Subsequent to new training and re-auditing after one year, an increase in adherence to best practices was observed.

Prolonged sleep deprivation and poor sleep quality are common complaints among pregnant and postpartum women, and they have adverse effects on the physiological and psychological well-being of mothers antenatally and postnatally. The aim of this project was to improve antenatal and postnatal mothers' night-time sleep quality during hospitalization in an obstetric ward through multifaceted interventions. This project followed the JBI Model of Evidence-based Healthcare and applied the seven phases of the JBI Evidence Implementation Framework to conduct context analysis, strategy implementation, and review of practice using evidence-based audit criteria. JBI's Practical Application of Clinical Evidence System and the Getting Research into Practice situational analysis tool were used to support data collection and identify barriers and strategies. Mothers' sleep quality was measured using an adapted St. Mary's Hospital Sleep Questionnaire. Baseline audit results (0%) revealed that midwives and nurses were not implementing the multifaceted interventions to promote sleep in mothers. The results in follow-up audit 1 and follow-up audit 2 achieved compliance of 63.3% ( p < 0.000), respectively. Overall, the mothers were fairly satisfied with their sleep quality, were able to sleep longer, and felt more alert when waking up in the morning. There was an increase in compliance with best practices to improve mothers' sleep quality in the obstetric wards, although these results could be further improved. Mothers' perspectives of sleep promotion strategies should be explored in future projects to tailor the strategies to their needs. Sustainability plans include conducting follow-up audits and engaging ward nurses to continue implementing the multifaceted interventions. http://links.lww.com/IJEBH/A307.

More than one in ten people globally live with a mental health illness. Adolescent mental health is a major contributor to that statistic, as 27% of adolescents have one or more mental, emotional, developmental, or behavioral problems. School-based health care clinics can provide mental health services for this age group. This project aimed to promote evidence-based practices regarding adolescent mental health screening in schools. This project used the JBI Evidence Implementation Framework to promote evidence-based practices for adolescent mental health screening in schools. The JBI framework is grounded in an audit and feedback process, along with a structured approach to identifying and managing barriers to compliance with best practices. Five audit criteria representing best practice recommendations were developed. A baseline audit was conducted, followed by the implementation of an improvement strategy. The project was finalized with a follow-up audit to determine any changes in compliance with best practice recommendations. The baseline survey of students revealed a 25% average compliance for audit criteria 1 and 2. The primary barrier to compliance was students' unawareness of the availability of mental health services. The improvement strategy included an educational presentation for students regarding mental health. The follow-up audit revealed an increase in compliance with best practices. The project achieved a 29% increase in compliance with best practices, although only 23% of the students were reached via the improvement strategy. http://links.lww.com/IJEBH/A189.

ABSTRACTIntroduction:Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting.Objective:The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention.Methods:The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies.Results:The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention.Conclusions:This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future.Spanish abstract:http://links.lww.com/IJEBH/A261

Aggressive Behavior in Patients With Stroke: Association With Psychopathology and Results of Antidepressant Treatment on Aggression