Evidence Implementation in Clinical Practice (EICP)

Abstract

Objectives: This study aims to assess ongoing practices concerning oral hygiene in acute care setting, training on best practice recommendations and assessment of effect of implementing the training among hospital nursing staff. Specifically, we aimed to identify possible barriers and facilitators for optimal implementation of oral care, provide targeted training according to the needs of nurses and assess if training led to positive changes in practice.

Introduction: Oral hygiene in hospitalized patients is not always optimal, with discrepancies between practice and knowledge of nursing staff about oral hygiene. Available evidence recommends the use of chlorhexidine in critically ill patients in the acute care setting.

Methods: We conducted semi-structured interviews of 25 to 40 minutes duration with nursing staff using the Zoom platform. Interviews started in February 2022. We sought nurses' opinions about the importance of oral hygiene and asked about the practice, education, and potential needs in their everyday work. This was followed by online training lead by trained nurse experienced in practice and teaching. Follow-up audit was done using a questionnaire to assess attitudes regarding usefulness of training, practice in terms of use of available guidelines and protocols and overall knowledge on oral hygiene.

Results: Nurses considered oral hygiene in hospitalized patients important, although the level of knowledge among them varied. Oral hygiene is mostly performed using agents based on paraffine or hexetidine and gauze and is most often done in intensive care units. Nurses lack of time as one of the
main challenges in the delivery of oral care, but they all emphasized the need for additional education. Majority considered training useful and used the agents and techniques provide during training in practice. Awareness about guidelines was raised.

Conclusions: Oral hygiene in hospitalized patients is recognized as an important factor contributing to overall health. Nurses need more time and additional equipment to perform oral health care according to the best available recommendations. Education of nursing staff with demonstration on how to perform oral hygiene proved to be useful.

Keywords: breast cancer lymphedema; rehabilitation; manual lymphatic drainage; compression sleeve; practice guideline

Abstract word count: 331

Abstract

Introduction: Orthodontic therapy is associated with a more significant accumulation of dentobacterial plaque and impaired oral hygiene, which increases the risk of developing dental caries and periodontal disease. Therefore, it is crucial to educate orthodontic patients about proper oral hygiene maintenance and oral health before and during treatment.

Objectives: The aim of this project was to implement evidence-based best practices related to oral hygiene in adult orthodontic patients and improve compliance. In addition to evaluating oral hygiene practices, another goal of the project was to assess the knowledge of orthodontic patients regarding
oral health.

Methods: Seven audit criteria were developed for pre- and post-audit based on the best available evidence. The project was carried out at the private dental clinic (Split, Croatia) involving 45 patients. Results: The baseline audit showed a gap between clinical practice and the best evidence. Three criteria achieved a high compliance baseline, while after implementation, there were substantial improvements in compliance for both. The everyday use of mouthwash improved from 17.8% at baseline to 66.7% at follow-up, as well as the use of interdental aids, which increased from 55.6% to 91.1%. Statistically significant differences were found in the total score for oral health knowledge between the baseline (6.67±1.74) and the follow-up audit (7.78±0.56, P≤0.001).

Conclusion: The strategies developed in this project were effective in providing essential information to adult orthodontic patients and improving compliance with evidence. Guidelines on this topic should be designed to assist orthodontists and patients in maintaining oral health and oral hygiene.

Keywords: clinical audit; evidence-based practice; implementation project; oral-hygiene practice; orthodontics

Abstract word count: 250

You can find a video presentation here.

Abstract

Objective: Heart failure (HF) remains a significant burden on healthcare systems, with high rates of mortality and hospital readmissions. This study aims to evaluate the impact of post-discharge disease management programs on mortality, readmissions, and quality of life in HF patients.

Introduction: HF affects millions of people worldwide and incurs substantial healthcare costs. Postdischarge disease management programs have been proposed to improve outcomes, but their effectiveness on hard and soft endpoints remains uncertain.

Methods: This evidence implementation project followed the JBI framework, including baseline audit, intervention implementation, and follow-up audit. Healthcare professionals and patients completed structured questionnaires to assess their knowledge and attitudes towards HF management.

Results: Healthcare professionals demonstrated good knowledge in some aspects of HF management, but gaps were identified, particularly regarding guideline-directed treatment and pharmacotherapy. Patients expressed willingness to adhere to HF medications, but some reported financial burdens and
lack of education on self-titration of diuretics.

Conclusion: The study highlights the importance of tailored education and structured support in postdischarge HF care. Implementing comprehensive disease management programs could potentially reduce mortality and readmissions, improve patient self-management, and enhance overall outcomes
in HF patients.

Keywords: congestive heart failure; disease management programs; discharge; outcomes; practice

Abstract word count: 187

PROJECT SUMMARY

The research was conducted at the Oncology and Radiotherapy Clinic of KBC Split and included residents and specialists in the field of oncology and radiotherapy who in their clinical practice deal with oncology patients undergoing anti-PD1/anti-PD-L1 therapy.

The research was divided into two phases. In the first phase, an assessment of the current situation was carried out using a questionnaire specially developed for this research. The questionnaire assessed the frequency of occurrence of secondary bullous dermatoses after the use of anti-PD-1/PD-L1 therapy in KBC Split, the current practice in treating them, and the knowledge of residents and specialists about therapeutic guidelines for secondary bullous dermatoses.

In the second phase of the research, the respondents were educated on modern therapeutic guidelines for the treatment of secondary bullous dermatoses after the application of anti-PD-1/PD-L1 therapy in the form of an educational lecture. At the lecture, the examinees were introduced to therapeutic guidelines based on the best available evidence. After the educational lecture, all respondents received a leaflet with summarized clinical guidelines for easier application in medical practice. In a period of one or three months after the training, a subsequent assessment of the condition was carried out among the respondents. The subsequent assessment of the condition was investigated using a new questionnaire. The follow-up assessment aimed to examine the changes in the respondents' knowledge about the treatment of bullous dermatoses in oncology patients undergoing anti-PD1/anti-PD-L1 therapy and whether the knowledge of the current guidelines introduced any changes in clinical practice. Also, the goal was to find out about possible obstacles that may be encountered during the implementation of modern guidelines, as well as comments on what would further help in their better implementation.

All responses were collected in an anonymized form and analyzed using appropriate statistical methods. Data collection and analysis, as well as providing feedback, was done by the research manager with the help of other members of this project.

Keywords: Oncology, Anti-PD1/PD-L1 Therapy, Bullous Dermatoses

Abstract word count: 321

Abstract

Objectives: This implementation project aims to assess current practices of conflict resolution among nurses in a hospital setting and implement evidence-based guidelines to improve conflict resolution strategies.

Introduction: Conflict is inherent to human interactions, both personally and professionally. Different perspectives exist on conflict, ranging from negative interpretations to recognizing its potential for positive outcomes. In healthcare settings, conflicts arise due to issues related to leadership, change, and interpersonal relationships. Numerous conflict resolution strategies have been identified, highlighting the importance of education and clear definitions of acceptable behavior. This project seeks to implement effective conflict resolution strategies in a hospital in Croatia where such practices are not well-established.

Methods: The project will utilize the Joanna Briggs Institute Practical Application of Clinical Evidence Summary (JBI PACES) and Getting Research into Practice (GRiP) tools for the implementation process. The three phases include conducting a baseline audit, designing and implementing a practice
improvement intervention based on the audit results, and conducting a follow-up audit to evaluate changes in conflict resolution practices. The project will involve nurses from various departments in the hospital.

Results: The baseline audit will assess the current practices and knowledge of conflict resolution among nurses. Based on the findings, a tailored intervention will be implemented, providing educational materials and guidelines. Three months after the intervention, a follow-up audit will be conducted to evaluate the effectiveness of the implemented strategies. Conclusion: By implementing evidence-based conflict resolution strategies, this project aims to
improve the working environment, enhance patient care, and foster better relationships among colleagues in the hospital setting. Additionally, the project contributes to the clinical implementation of conflict-resolution strategies, addressing a gap in the existing literature.

Keywords: Conflict resolution strategies, Healthcare settings

Abstract word count: 275

Abstract

Objectives: This study aims to assess ongoing practices concerning oral hygiene in acute care setting, training on best practice recommendations and assessment of effect of implementing the training  among hospital nursing staff. Specifically, we aimed to identify possible barriers and facilitators for
optimal implementation of oral care, provide targeted training according to the needs of nurses and assess if training led to positive changes in practice.

Introduction: Oral hygiene in hospitalized patients is not always optimal, with discrepancies between practice and knowledge of nursing staff about oral hygiene. Available evidence recommends the use of chlorhexidine in critically ill patients in the acute care setting.

Methods: We conducted semi-structured interviews of 25 to 40 minutes duration with nursing staff using the Zoom platform. Interviews started in February 2022. We sought nurses' opinions about the importance of oral hygiene and asked about the practice, education, and potential needs in their everyday work. This was followed by online training lead by trained nurse experienced in practice and teaching. Follow-up audit was done using a questionnaire to assess attitudes regarding usefulness of training, practice in terms of use of available guidelines and protocols and overall knowledge on oral hygiene.

Results: Nurses considered oral hygiene in hospitalized patients important, although the level of knowledge among them varied. Oral hygiene is mostly performed using agents based on paraffine or hexetidine and gauze and is most often done in intensive care units. Nurses lack of time as one of the main challenges in the delivery of oral care, but they all emphasized the need for additional education. Majority considered training useful and used the agents and techniques provide during training in practice. Awareness about guidelines was raised.

Conclusions: Oral hygiene in hospitalized patients is recognized as an important factor contributing to overall health. Nurses need more time and additional equipment to perform oral health care according to the best available recommendations. Education of nursing staff with demonstration on how to perform oral hygiene proved to be useful.

Keywords: oral hygiene, critically ill patients, hospitals, nurses, acute care setting

Abstract word count: 331

Abstract

Objectives: The objective of this implementation project was to enhance the process of assessing pain during stroke in the emergency medical service (EMS) setting. The project aimed to determine the current situation, provide training and a validated tool for pain assessment, and assess the impact on
everyday practice.

Introduction: EMS plays a critical role in providing pre-hospital care, with the potential to prevent irreversible pathology and secondary damage during the crucial early phase of treatment. Ensuring up to-date supplies, standardized checklists, and appropriate equipment are available are essential for effective emergency care.

Methods: The project followed the three-phase approach within the JBI framework, including a baseline audit, design and implementation of strategies to improve practice (GriP), and a follow-up audit. The implementation was conducted at the Institute of Emergency Medicine in Split Dalmatia County, Department on the island Hvar. Medical doctors, nurses, and medical technicians working in EMS participated in the project. Surveys were used to assess the current practices, provide training on best practice recommendations, and introduce a validated tool for pain assessment during stroke. A follow-up survey evaluated the compliance with the tool's use after the intervention.

Results: Fifteen participants completed the surveys, including seven medical doctors, four nurses, and four medical technicians. While most participants were aware of the tool's usefulness and considered its items important, half of them did not use the tool consistently. Two-thirds of respondents were not
familiar with the evidence or clinical guidelines related to the tool's use, and most felt the need for further education on the topic. After the intervention, participants expressed their willingness to change their practice and advocated for the tool's adoption nationwide to ensure consistency in patient care.
Conclusion: The implementation project highlighted the importance of enhancing pain assessment during stroke in the EMS setting. Although some participants recognized the value of the tool, consistent usage and familiarity with evidence-based guidelines were lacking. The project's findings emphasize the need for continued education and implementation efforts to improve the care provided by EMS workers and ensure better outcomes for patients.

Keywords: emergency medicine; pain assessment tool; stroke; checklists; clinical practice

Abstract word count: 341

Abstract

Objectives: The aim of this implementation project was to adopt the evidence-based recommendations for tobacco dependence in hospitalized smokers. Brief interventions became a standard part of routine daily care.

Introduction: Hospitalization represents a great opportunity for a smoking cessation, but such interventions are yet not adequately utilized.

Methods: The baseline audit of smoking status records and provision of brief interventions took place at the 3rd Medical Department, General University Hospital during December 2021. Clinical practice guidelines implementation thru the brief intervention’s adoption, a leaflet distribution and a follow-up post-discharge phone call if agreed were realized between January and October 2022, post-implementation re-audit in November 2022.

Results: Completion of medical records about tobacco use improved from 93.6 % to 99.8 %. Out of 360 identified smokers (19% of all hospitalized patients), 181 (50.3 %) (112 women/69 men, mean age 64 years (min-max 19 – 92 years) were intervened using a brief intervention and a leaflet about tobacco.
Brief interventions became a standard part of routine care for all inpatiens. Almost 75 % of intervened smokers (135) gave consent with post-discharge phone call in a month, but only 106 were reached (78.5 %). Several barriers were identified, while lack of perceived importance of interventions and the smoking status of healthcare professionals being the most important ones. Collision with other medical procedures to be solved.

Conclusions: Only a half of smokers were reached by brief interventions, mainly due to collision with other medical procedures. Improved planning should take place to overcome this barrier.

Keywords: tobacco, smoking, hospitalization, tobacco dependence treatment, brief intervention

Abstract word count: 250

Abstract

Introduction and Objectives: Acute pancreatitis is an acute inflammatory disease of the pancreas, which can have a life-threatening course with various complications. The cornerstone of the initial management is aggressive fluid administration followed by nutrition strategies. Clinical practice of treatment of this serious condition does not always reflect the latest evidence. The main aim of this project was to improve compliance with recent nutrition management guidelines in hospital healthcare workers treating acute pancreatitis patients.

Methods: The project followed the JBI Implementation framework. Baseline and follow-up audits were conducted to assess compliance with four audit criteria based on available evidence before and after a bedside reminder and information sheet was used to foster evidence-based treatment.

Results: The compliance in three (out of four) criteria improved significantly, although 100% was not reached. The compliance in one criterion could not be assessed due to the low number of patients.

Conclusions: This project suggests that compliance with clinical practice guidelines for the treatment of acute pancreatitis can be significantly increased using a very simple implementation tool at a very low cost. As a consequence, increased adherence to evidence-based guidelines may bring substantial benefits in terms of better patient care as well as cost-effectivity.

Keywords: acute pancreatitis; enteral nutrition; enteral feeding; evidence-based practice; implementation; practice guidelines

Abstract word count: 200

You can find a video presentation here.

Abstract

Objectives: The objective of this best practice implementation project was to improve compliance withthe diagnosis part of Nutrition Care Process (NCP) in the daily practice of a university dietetics counselling office in Brno, Czech Republic.

Introduction: Current trends in healthcare lead to a higher pressure on proving effectiveness and efficacy of various interventions, including nutrition care. One of the necessary factors to gather meaningful data is to use a standardized approach. Nutrition Care Process developed by the Academy of Nutrition and Dietetics provides controlled vocabulary with a system of precisely defined nutrition diagnoses complemented by Problem-Etiology-Sign/Symptom (PES) statements. Using NCP provides evidenced benefits for patients and a baseline for evidence-based approach of a dietitian.

Methods: We used a three-phased JBI Evidence Implementation framework comprising of baseline audit, developing strategies to overcome the barriers and follow-up audit monitoring the change in beforehand defined evidence-based criteria.

Results: The follow-up audit demonstrated improved results in all the audit criteria except for criterion 1 (Nutrition diagnosis is stated appropriately according to the assessment data), where the fulfillment rate dropped due to previous diagnoses mismatch, and criterion 3 (Nutrition diagnosis is expressed using standardized terminology), because the standardized terminology had been used before the commencement of the project. The other criteria improved especially due to the introduction of PES statements, allowing for proper performance of the diagnostic part of NCP, as they are dependent on stating the PES as such.

Conclusions: The change in practice in the audited office indicates that the implementation was generally successful. We managed to introduce NCP into the nutrition care documentation, therefore ensuring a better quality of care provided to our patients. We plan to continue by further implementation of the whole NCP with the history, intervention and monitoring part of the process.

Keywords: audit; documentation; implementation; nutrition care process

Abstract word count: 295

Abstract

Introduction and Objectives: Assessment of the faecal continence, especially before closing the stoma is difficult and there is no ideal method for the exact appraisal of its function. One of the feasible examinations can be a retention test – the ability to hold an instilled water inside the rectum. The main objective was to implement the water-holding test into the practice at our hospital and collect data for further assessment of its diagnostic value in patients before closing the stoma.

Methods: The project has been conducted according to the JBI Implementation model. Methodology and technique was performed according to The Water holding method developed by Schwandner et al. (1)

Results: Six patients were examined with the method total of eleven stoma closures. Patients were compliant in undertaking the retention test. The difficulty of performing the water-holding test was low. There is potential for repeating the test in one patient, if necessary. In the decision-making scheme prior to restoring the gastrointestinal tract, the importance of this method is, however, unclear. The selection of patients, which would profit from this retention test, is questionable. Organization scheme and execution of the examination struggled due to the internal rigidity of the workplace and unclear guidelines for indication and selection of the patients.

Conclusions: The project implemented a new auxiliary method for the evaluation of sphincter function, which can be developed in the terms of the number of patients undergoing the procedure, a different substance used for the test, and/or determination of its importance for potential benefit from sphincter rehabilitation.

Keywords: faecal continence, retention test, anorectal manometry, stoma reversal, implementation

Abstract word count: 254

Abstract

Objectives: This evidence implementation project aimed to assess and improve compliance with evidence-based criteria regarding management for adult patients with acute ischemic stroke admitted through Clinical Video Assessment for Stroke (CVAS) system in the Peterborough City Hospital “PCH”.

Introduction: Stroke is the second leading cause of mortality and severe disability worldwide.Treatment of stroke is time-critical and based on an accurate diagnosis. According to clinical guidelines, all patients with suspected stroke should undergo brain imaging urgently, within 60 minutes of arrival in the hospital. The project took place in North West Anglia NHS Foundation Trust hospitals which represent a catchment area of acute stroke for 850,000 people with over 800 admissions per annum. The Hyperacute Stroke Centre of Peterborough City Hospital “PCH” (35 beds) and the Acute Stroke Unit of Hinchinbrook Hospital “HH” (30 beds) were selected for this project realization.

Methods: The present evidence implementation project was carried out in April-May 2022 (baseline audit), May – November 2022 (intervention) and November 2022 – February 2023 (post-implementation audit) utilizing the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools. Five audit criteria that represented best practice recommendations for diagnostic investigations in patients with suspected stroke were used. Both baseline and postimplementation audits were undertaken to determine changes in practice.

Results: The pre-implementation audit results showed low compliance to the audit criteria, however following the implementation of strategies (CVAS) to align current care with evidence-based recommendations, the post-implementation audit showed improvement in all audit criteria and other measured variables: DIT (door to imaging [CT] time (30 min vs 8 min), CT request mean time ( 18 min vs immediately), DNT (door to needle time) (81 min vs 27 min), decision mean time (47 min vs 15 min), arrival to HASU (Hyper Acute Stroke Unit)  (100 min vs 45 min).

Conclusions: Compliance with evidence-based criteria regarding timely management (DIT, DNT) of patients with suspected stroke was determined and improved after implementing CVAS and identifying and addressing barriers and facilitators. Multiple educational strategies and trainings (especially continuity of training and knowledge translation, regular teaching sessions as well as more formalized coaching and tutoring program) proved effective in enhancing the compliance with evidence-based criteria. The current DIT has reached the desirable neuroimaging time (DIT of ≤20 minutes). The CVAS has emerged as promising strategy that could be used outside of GB. Finally, this project is sustainable and will continue, since further education and training for all staff involved in the care of stroke patients are essential for achieving higher compliance with evidence and for saving more lives of stroke patients.

Keywords: Stroke, TIA, CT head, video assessment, Ambulance, HASU, Paramedic, Pre-Hospital, Triage, Video.

Abstract word count: 431

Abstract

Introduction and Objectives: Recurrent stroke affects 9-15 % of people after one year. Clinical practice guidelines have been developed to provide recommendations for effective stroke secondary prevention to reduce the risk of recurrent strokes. Prescribing errors are common and preventable events that might result in severe harm or death in patients with stroke or TIA. The aim of this project was to reduce prescribing errors in secondary prevention  amongst adult patients with ischaemic stroke or TIA in hyperacute stroke centre.

Methods: This evidence implementation project used the JBI Evidence Implementation framework.
1. A team for the project and undertaking a baseline audit based on criteria informed by the evidence was established.
2. Reflection was made on the results of the baseline audit, designed and implemented two strategies to address non-compliance found in the baseline audit informed by the JBI Getting Research into Practice (GRiP) framework.
3. A follow-up audit to assess the outcomes of the interventions implemented to improve practice and identify future practice issues was conducted.

Results: In phase 1, we undertook the baseline audit at Peterborough City Hospital Hyperacute Stroke Unit in September 2020 and found three prescribing errors. Findings were consistent with previous experience.

In phase 2, we designed four types of stroke diagnosis-specific stickers (ischaemic stroke, ischaemic stroke with atrial fibrillation, haemorrhagic stroke, and haemorrhagic stroke with atrial fibrillation) and a specific sticker to inform about the start/stop dates of indicated medication. Stickers were applied on the drug charts as soon as a stroke secondary prevention plan was made. They were introduced as a pilot in October 2020. Multiple strategies on multiple level were implemented.

The results of the first follow up audit with one prescribing error in November 2020 were presented at the Medicines Safety Committee in December 2020. There were two more prescribing errors (in January and April 2021). The strategy received the final approval by MSC in April 2020. The second strategy, standardised Post-take Ward Round and Ward Round Proforma with explicit plan on stroke secondary prevention were introduced in March 2020. Both strategies continued in parallel since March 2020.

In phase 3, the Follow-up audit showed one more prescribing error in July 2021 and no more up until May 2022.

Conclusions: The aim to reduce prescribing errors in secondary prevention amongst adult patients with ischaemic stroke or TIA in hyperacute stroke centre was realised with no prescribing error since July 2020. The implementation project has significant impact on the quality of care and was proven to be sustainable.

Keywords: Implementation; Ischemic Stroke; Prescribing errors, Secondary prevention

Abstract word count: 425

Abstract

Introduction and Objectives: This implementation project describes the last year and success of the five-year-long national project Clinical Practice Guidelines (CPGs) which has aimed to implement a generally accepted approach to CPGs development, based on Evidence-based healthcare (EBHC) and
GRADE (grading of recommendations, assessment, development, and evaluation) approaches. Specific objectives were to draft a guideline development process and national methodology and to design a system of education and training in CPGs development among staff, policymakers, academics, and
others working in the healthcare field.

Methods: A baseline audit was conducted in November 2017. Strategies to overcome the identified barriers to better compliance with audit criteria (set-up ad-hoc) were suggested and implemented. Two follow-up audits were described in our previous paper. Results of two further F/U audits are presented here.

Results: Compared to the audit results of the baseline audit, all the follow-up audits showed an increase in compliance in all audit criteria (e. g. number of methodologists, completed CPGs, methodological guidelines). The project has not only provided guidelines of CPGs development, but also yielded 41 CPGs based on EBHC and GRADE and increased relevant knowledge in involved healthcare professionals.

Conclusions: National methodology guidelines, and national CPGs have been developed. The project incited educational activities and knowledge translation targeted at healthcare professionals. A national center focusing on guidelines, recommendations and quality indicators has been created within the Czech Ministry of Health to sustain and increase the project achievements.

Keywords: clinical practice guidelines; Czech Republic; GRADE; implementation; methodology

Abstract word count: 237

Abstract

Objectives: The aim of this project was to improve compliance with best evidence in assessment and examination of the children´s feet during regular check – ups at the age of 3, 5 and 7 years.

Introduction: Flat foot (FF) is a quite common postural deformity and one of the most common diagnoses given by a paediatrician during regular check-ups at children of pre-school age. Although, the children’s feet can be “flat” up to 8 years in typical development, it is necessary to identify if the development is running in the right way or some problems occur. The biggest challenge for health care professionals is to identify when and if the children’s feet fall outside the considered normal development.

Methods: The implementation project utilized the JBI Practical Application of Clinical Evidence System audit tool for promoting change in healthcare practice. A baseline audit was conducted with the audit criteria derived from the best available evidence. After completing the baseline audit each paediatrician was individually instructed in using the podoscope and after a month of using podoscope during regular check-ups a follow-up audit was performed.

Results: Following implementation podoscope during regular check-ups using of an objectification tool has improved. An increase from 0 to 3 paediatricians using an objectification tool emerged. There was also an increase in criterion related to situation in which paediatricians are evaluating the childs´ feet. At baseline audit most of the paediatricians observed mostly in static situations and from dynamic they chose mostly only gait, at follow-up audit more of them evaluate gait with combination of squatting of one leg standing. Another increase was observed in criterion regarding the next step in case of non-ideal state of child´s feet. Increase of referring children to physiotherapy was observed from 5 at baseline audit to 7 in follow-up audit.

Conclusions: Implementation of a podoscope as an examination and objectification tool during regular check-ups led to improvement in regular examination of the child’s feet at paediatricians. Podoscope is considered to be a good evaluation tool, helps the paediatricians to be more sure with diagnosis, deciding on further action and communicating the state of child´s feet and further approach with parents. There have emerged some problems and questions regarding further education, more precise interpretation of results and documentation management which should be solved. In next 6 - 12 months further audits will be undertaken to determine sustainability of practice changes.

Keywords: assessment; children; development; flat foot; podoscope

Abstract word count: 398

You can find a video presentation here.

Abstract

Introduction and Objectives: Organizational Health Literacy (OHL) refers to an organization’s policy and ability to support stakeholders to obtain, process, and apply health information and services needed. Effective communication and Shared Decision Making (SDM) are herein vital. We aim to emphasize dentists' OHL skills and attitudes, introducing supporting evidence-based strategies in German and Austrian dental care.

Methods: The project (November 2022 to February 2023) used JBI's methodological guidelines. The baseline audit included a standardized online questionnaire with 41 items. Compliance with twelve audit criteria was assessed, including leadership, integration, patient inclusion, health literacy skills,
communication standard, access and navigation, media, communication in high-risk situations, costs, workforce training, SDM, and patient-physician communication. The implementation strategy involved a one-day interactive online educational training with barrier, strategy, and resource identification. The post-implementation audit replicated the baseline audit.

Results: In the baseline audit, 68% (N = 9) of dentists responded. Compliance to audit criteria ranged from 50% to 100%. The main barriers to implementation were lack of time, skills, and compensation. Initially, only 15% (N = 2) responded to the follow-up audit, but after reminders and identification of a multiplier, the participation rate increased to 46% (N = 6). Five audit criteria improved, five worsened, and two showed no change.

Conclusions: A single interactive online educational training was insufficient to bring about a profound change in participants' OHL skills. Future projects should focus on a more comprehensive educational program and identify multipliers earlier for sustainable and wide-ranging results.

Keywords: Health Literacy, Patient-Centered Care, Health Communication, Shared Decision Making, Organizational Culture/Leadership

Abstract word count: 245

Abstract

Objectives: The project aimed to promote running as the best treatment for low back pain (LBP) in an outpatient setting.

Introduction: Low back pain is one of the most common diseases worldwide. Half of all Germans suffer from episodes of non-specific back pain at least once a year, while one-fifth of them will become chronic. Intervertebral disc (IVD) degeneration is a physiological process that brings acute back pain over a short period. It is a physiological process and should not cause fear and avoidance strategies, which are strongly associated with pain chronification. This implementation project aimed to educate patients about this process. Running and, if not possible, walking was chosen as preventive method.

Methods: The implementation project was carried out in an outpatient physiotherapy center in Brandenburg, Germany. The basis for this project was JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool. The timeframe goes from April 2021 to December 2021. Five german physiotherapists with academic education underwent the baseline audit. The sample consisted of twenty patients with low back pain aged from 25 to 60 years. The baseline and follow-up audits were conducted in a group meeting.

Results: The baseline audit disregarded yellow flags screening, and not every physiotherapist indicated walking, as there is a knowledge gap. Some patients do exercises on their own. However, many are confused about which exercises are good and which are more likely not. Few patients continue to go running. Those who have taken a break due to pain report uncertainty about returning to it.

Conclusions: Patient education is a crucial component in supporting the understanding of the processes in the body. This understanding of the cause-and-effect principle generates a greater willingness to implement the treatment offered. Fear, uncertainty, and lack of knowledge are avoided. The project gave the already "running" patients the security to try again or get back into it after an even more extended break.

Keywords: Implementation Project; Intervertebral Disc; Low Back Pain; Physical Therapy Modalities

Abstract word count: 321

Abstract

Introduction: After THR surgery, one of the most frequently performed surgeries in Germany, there is no evidence in favor of movement precautions or restrictions. Against best practice recommendations, it is common that health care professionals still provide patients with movement restrictions which slows down their recovery.

Objectives: The aim of this project was to assess and improve clinical care delivery amongst health care professionals such as physicians, physical therapists and ergo therapists by instructing about unnecessary movement restrictions in patients after THR surgery at the University Hospital Brandenburg/Havel in Germany.

Methods: This implementation project was based on the JBI evidence-based healthcare model. Thereby the project was based on the audit and feedback strategy to promote healthcare change. A baseline audit followed by an implementation workshop and a reaudit afterwards was performed.

Results: The first audit showed a compliance to best practice of 0% whereas the reaudit could measure an improvement to 100%.

Conclusions: With this implementation project best practice adherence could largely be improved. Further measures would be necessary to ensure sustainability.

Keywords: implementation project; movement restrictions; total hip replacement (THR)

Abstract word count: 173

Click here for a presentation.

Abstract

Objectives: The aim of this study was to develop a strategy to increase the rate of preoperative stoma site marking in three hospitals within Brandenburg Medical School, Germany.

Methods: This project was developed based on the JBI Evidence Implementation Strategy. All phases of the project were conducted in close collaboration with stakeholders in clinical setting. Phase 1 included baseline audit of stoma-marking for the last 1-5 years. Phase 2 consisted of meetings with stakeholders where discussions were held about barriers to 100% stoma-marking compliance and strategies that might help the increase. The development of the suggested strategies followed. The third phase includes a reaudit of the stoma-marking one year after the strategies-implementation.

Results: Baseline audit results were as follows: In year 2021, stoma-marking rates were 33% in clinic A (11% emergencies, 74% elective), 88% in clinic B (50% emergencies, 100% elective) and 63% in clinic C (0% emergencies, 70% elective). In year 2020, rates were 97% in clinic B (80% emergencies, 100% elective) and 30% in clinic C (0% emergencies, 38% elective). In year 2019, 83% of stomas were marked in clinic B (56% emergent, 100% elective) and 30% in clinic C (0% emergent, 45% elective). Clinic C also provided data for two additional years: 42% in 2018 (0% emergencies and 62% elective) and 43% in 2017 (0% emergencies and 61% elective). For emergencies, stakeholders reported the following barriers: patient’s physical condition, lack of time, knowledge of other professionals, memory. For elective cases the reported barriers were: uncertainty in documentation and information and communication (with nurses and residents). The following strategies were decided and implemented: workshops in each clinic with surgeon colleagues, nurses, and/or other professionals; development of a standard operating procedure; inclusion of a check box for reporting stoma-marking in the preoperative protocol. Re-audit phase will follow in December 2023.

Discussions: Stoma-marking varies considerably between clinics. However, there is potential for improvement in marking rates, especially in emergencies. The logistics and resources at each clinic vary, so tailored interventions are required for each clinic.

Keywords: Implementation science; Intestinal ostomy; Living with stoma; preoperative stoma site marking, siting.

Abstract word count: 335

Click here for a presentation.

Abstract

Objectives: To introduce and promote evidence-based Advanced Care Planning (ACP) into cross-setting oncology and palliative care at a midsize regional hospital amidst COVID-19 pandemic.

Introduction: ACP is a process that supports individuals and their relatives in understanding and sharing their personal values, life goals and preferences regarding future medical care. It has been reported to be beneficial for patients receiving end-of-life care in accordance with their wishes. The goal of ACP is to help ensure that patients receive medical care that is consistent with their values, goals and preferences during serious and chronic illness. Especially in oncology and palliative care, patients can benefit greatly from ACP. We therefore intended to promote ACP in the care processes of a midsize hospital on the outskirts of Berlin (Germany).

Methods: The Best Practice Implementation Project (BPIP) was based on JBI Implementation model. The BPIP was carried out from April 2021 to April 2022. A baseline audit involving qualitative interviews (n=10) and workshops (n=2) with representatives of all professions involved in oncology and palliative care was undertaken and compared to eight best practice recommendations. This step was followed by the implementation of targeted strategies, involving key stakeholders in German ACP-practice. Finally, due to high infection rates and clinical burden, a semi-quantitative, questionnaire based, post-implementation follow-up audit was conducted.

Results: The baseline audit results revealed high acceptance of ACP among HCP. ACP has already been implemented in line with all eight best practice recommendations according to HCP. Yet, base line audit revealed that understanding of ACP among HCP was heterogeneous and responsibilities and distribution of tasks lacked coordination. An education strategy and joint analysis of ACP process was implemented. Minor improvements in accordance with the best practice criteria have been measured.

Conclusions: Education and team-based process analysis can facilitate ACP implementation to crosssetting oncology and palliative care. Lasting change in clinical processes as well as ACP implementation require resources and time to reflect, which is scarce amidst Covid-19 pandemic. In times of crisis HCP seek to maintain existing healthcare rather than to implement best practice changes.

Keywords: Advanced Care Planning; Oncology; Palliative Care; Qualitative Research; Patient Autonomy, Covid-19

Abstract word count: 342

Click here for a presentation.

Abstract

Objective: To introduce and promote evidence-based and exercise-centred self-management strategies in chronic musculoskeletal pain conditions at a physiotherapy department of a midsize regional hospital in Germany.

Introduction: Evidence-based self-management strategies in chronic disease management are associated with increased self-efficacy and health-related quality of life. Physiotherapists however, feel unprepared to promote these strategies in chronic musculoskeletal pain conditions. We thus, aimed to promote exercise-centred self-management strategies in a physiotherapy department of a midsize regional hospital at the tails of Berlin, Germany.

Methods: The project relied on JBI’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool. The project was conducted at a physiotherapy department of a University Hospital (Immanuel Clinic Rüdersdorf) being part of the Brandenburg Medical School Theodor Fontane network. The study was carried out from June 2022 to February 2023. A baseline audit comprised semi-structured, qualitative interviews of musculoskeletal pain experts of the team to identify barriers and facilitators to best practice implementation. A 31-item, standardized questionnaire survey of all team members (N = 16) was applied to determine compliance to seven audit criteria (criterion 1: assessment of self-management capabilities; criterion 2: training in selfmanagement facilitation; criterion 3: patient education & self-monitoring techniques; criterion 4: participatory agreement on health care goals; criterion 5: participatory action plan development; criterion 6: action plan documentation; criterion 7: monitoring of progress). The implementation phase
was guided by two participatory, face-to-face workshops containing audit result presentations, barrier, strategy and resource identification, interactive educational training and the development of two standardized physiotherapeutic assessment and documentation forms. The post-implementation audit replicated the quantitative baseline audit methodology.

Results: In the baseline audit, 56% (N = 9) of team members responded to the questionnaire. Compliance to audit criteria ranged from 0% to 89% (criterion 1: 44%; criterion 2: 33%; criterion 3: 11%; criterion 4: 0%; criterion 5: 33%; criterion 6: 67%; criterion 7: 89%). Following qualitative data (N = 5 interviews), most relevant barriers to implementation represented the lack of knowledge on the facilitation of self-management strategies (including assessment of patient capabilities, pain education, goal-setting, self-monitoring and action plan development), as well as unstandardized documentation procedures at the department. The applied implementation strategy combined interactive educational training with the development of two standardized clinical assessment and documentation forms in which basic action and coping planning criteria were integrated. Moreover, a short-form exercise diary was developed to facilitate patient self-monitoring. In the follow-up audit, 75% (N = 12) of team members responded. Five out of seven audit criteria improved compared to baseline audit (criterion 1: 50%; criterion 2: 91%; criterion 3: 8%; criterion 4: 58%; criterion 5: 82%; criterion 6: 78%; criterion 7: 82%).

Conclusions: A combination of interactive educational training, standardized physiotherapeutic assessment and documentation, as well as a short-form exercise diary implementation seems to be an appropriate strategy to increase compliance to exercise-related self-management facilitation. To evaluate the sustainability of the implementation strategy, further investigations will be required.

Keywords: exercise therapy; implementation; audit; self-management, physical therapy

Abstract word count: 486

Abstract

Objectives: To increase physician adherence to best clinical practice with regard to intra-articular injection decision and the materials used for this intervention, as well as to increase patient awareness on evidence based practice. Introduction: Intra-articular knee injections constitute a common treatment modality in osteoarthritis. Patients unresponsive or unfit to initial steps of management may be offered this treatment. However, lack of adherence to the best clinical practice endangers potential benefits and increases associated risks. Step-wise treatment modalities are commonly disregarded and patients are offered several intra-articular injection materials. These are commonly not more helpful than a placebo or even harmful to their joints. Another contributor to this practice is patients’ attitude. Patients seeking a quick resolution of their symptoms are biased to select injections. Mutual decision making on these grounds commonly endangers adherence to best clinical practice, as both sides might shortsidedly benefit from this choice.

Methods: The implementation project was based on JBI’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool. The project was carried out from May 2021 to May 2022. The current status of clinical practice, in terms of patient selection and used materials for injection was determined using a two-fold approach. First, a survey among physicians was completed, and second, patient and hospital records were scanned. Physician survey also included questions to document physicians’ knowledge on the latest evidence based recommendations. Then, audit criteria were set-up to follow-up intervening actions. Using GRIP guidelines, barriers and corresponding actions were determined. Informative briefings were organized for physicians and an informative flyer was prepared for patients to receive an IA injection. A follow-up audit was completed using the same audit criteria.
Results: Baseline audit results showed a very low rate of adherence to latest evidence based treatment algorithms with less than 50% compliance rate for any criteria. Most of the physicians didn’t apply current recommendations into their clinical practice considering the compliance rates on the first two criteria was 20 and 50%. Patient survey revealed that they weren’t fully informed about the used materials (50% compliance), or their possible complications (20% compliance). Most of the patients rejected or were not offered a step-wise treatment incorporating a physiotherapeutical approach (50%) or nutritionist referral (10%). Following the GRiP procedure, only a minor improvement was observed in four audit criteria (up to 30% increase). There was a moderate increase in compliance in two audit criteria (40 and 50%), and major increase in one audit criteria with 80%.

Conclusions: A higher compliance to best clinical practice was observed but increase was not satisfactory. Although evidence based up-to-date knowledge was shared with the treating physicians, a change in clinical practice was less reflected than their individual survey results. Patient involvement had satisfactory results in terms of having more informed patients. However, intra-articular injections might be better monitored by the healthcare providers, or institutions incorporating regulations to increase adherence to best clinical practice, as it was observed that improvement on individual basis was not satisfactory alone.

Keywords: intra-articular injection, osteoarthritis, knee pain, primary gonarthrosis.

Abstract word count: 497

You can find a video presentation here.

Abstract

Objectives: The aim of this project was to improve and harmonize the practice of preoperative education (PE) in patients undergoing total knee arthroplasty (TKA).

Introduction: PE affects clinical outcomes in TKA. The clinical setting was the department of orthopaedics and traumatology, a certified centre of joint replacement in a German hospital. The topic of interest was improving the preoperative education of patients before undergoing total knee arthroplasty. The healthcare aims are to make patient expectations more realistic and to standardize the knowledge of education of interest within the stakeholder groups involved in preoperative education, including nurses, surgeons, and physiotherapists.

Methods: We used the JBI Evidence Implementation framework. After collecting information regarding the state of knowledge in preoperative education through interviewing three surgeons, two nurses, two physiotherapists, and ten patients in the clinical setting, we facilitated the change with a multifaceted intervention, including individual talks, workshops, booklet revision, and discussion on our institutional guidelines.

Results: The baseline audit revealed PE is well established in the setting. Physiotherapists (PTs) are not involved in PE, and patients' expectations are barely included. After the intervention, PTs at least refer to PE content in the postoperative phase, and surgeons and nurses put more regard on patient expectations. Patients do not sufficiently remember PE content.

Conclusions: The overall knowledge about preoperative education among the stakeholders is very good. The main barriers to harmonizing the process lie within accessibility and stakeholder involvement before surgery, but not in disagreements between stakeholders. Advanced strategies for delivering PE content are needed to ensure sustainable knowledge in patients.

Keywords: preoperative education, joint replacement, knee replacement, orthopaedics, physiotherapy, outcome, patient's perspective

Abstract word count: 258

Abstract

During the baseline study audit we have learned that humification of low flow oxygen was commonly used in COVID-19 ward in a county hospital. The reason for non-compliance was the lack of staff knowledge. Simple educational intervention was developed, comprising of two educational sessions with the wards’ stuff. After the intervention measured compliance with the best clinical practice improved significantly. Due to low numbers of participants, additional educational interventions provided during the project and potential significant difference in staff characteristics across different wards these results cannot be generalised, yet support the idea that simple educational interventions improve medical staff knowledge.

Keywords: Humification, COVID-19, Medical staff

Abstract word count: 101

Abstract

Objectives: The aim of this implementation project was to enhance compliance with the best available evidence regarding pre-operative education in patients after knee replacement in one of the hospitals in Poland.

Introduction: Total knee replacement (TKR) is one of the most commonly performed musculoskeletal surgical procedures. Patient education is an essential part of patient care in all settings. The aim of preoperative education is to improve people's knowledge, health behaviours and health outcomes. The content of pre-operative education should include, at a minimum: preparation for surgery (e.g. medical clearance, assessments, nutrition etc.), patient expectation, intra-operative care (e.g. anaesthesia), discharge planning, post-operative care and recovery (e.g. rehabilitation, mobility at home, infection prevention etc.).

Methods: This study was conducted at the orthopaedic hospital in Cracow. Seven healthcare professionals participated in the baseline and follow-up audits, 16 patients participated in the baseline audit, while 23 patients participated in the follow-up audit. The evidence implementation involved three phases of activity. The first phase of the project involved stakeholders and identifying relevant  team participants for the project. The project team consisted of the hospital medical director, head of physiotherapy department, head of Rehabilitation Clinic UJ, physicians, physiotherapists and the hospital quality specialist. All team participants were responsible for delivering education, collecting data, providing feedback and helping to implement strategies to improve target outcomes. A baseline audit was performed with the use of criteria based on best available evidence. In the second phase, reflecting on the results of baseline audit, the project team designed and decided on which strategies to implement to address non-compliance found in the baseline audit, informed by the GRiP framework.The last phase involved conducting a follow-up audit to assess the outcomes of the intervention implemented to improve practice and identify future issues to be addressed in subsequent audits.

Results: This implementation project has achieved improvements in compliance with best practice for the pre-operative education of patients after knee replacement. According to the results obtained during the baseline and follow-up audits, improvement was achieved in all evaluated criteria. The project team identified three barriers and defined strategies for addressing them: the lack of a structured, evidence-based educational program, the lack of information on post-arthroplasty knee joint rehabilitation and mobility, the lack of educational materials. An improvement in the conduct of pre-operative education was achieved, according to the responses of medical staff from 57% to 100%, according to patients’ responses from 44% to 100%.

Keywords: knee replacement, pre-operative education, compliance

Abstract word count: 402

Click here for a presentation.

Abstract

Objective: The aim of the project is to improve practice in nursing regarding the assessment of patients with the risk of falls at admission to the hospital in Poland

Introduction: Patient falls are the most common adverse events reported in hospitals. Inpatient falls result in significant physical and economic burden to patients (increased injury and mortality rates and decreased quality of life, depression, social isolation, loss of self-confidence) as well as to medical organizations (increased lengths of stay, medical care costs, and litigation). Falls prevention programs recommend early identification of patients at high risk of falls so that early interventions can be provided to patients at-risk. Elimination of threats and factors predisposing to an increased number of falls should be a priority in maintaining the basic health needs of people receiving institutional care.

Methods: The implementation of changes in practice consisted of introducing an administrative and training change following IBI implementation model.

Results: The baseline audit did not show compliance with the criterion "The falls risk assessment tool was used to assess patients 65 years of age or older on admission to the hospital." The follow-up audit noted a noticeable improvement in this criterion. Falls risk assessment has begun to be used in healthcare facilities where the JBI project has been implemented.

Conclusions: We performed an audit of the frequency of risk falls assessment at admission to the hospital. Enhancing the use of risk falls assessment at admission to the hospital among department nurses by means of specific training emphasizing the importance of documentation showed a positive impact on practice. Follow-up audit results justify the sustainability of the implemented strategies.

Keywords: implementation; audit; scale; falls risk; patient

Abstract word count: 271

Click here for a presentation.
You can find a video presentation here.

Abstract

Objectives: In this implementation project we aimed to enhance compliance with the best available evidence regarding type 1 diabetes educational interventions in adult hospitalized patients.

Introduction: Type 1 diabetes is an autoimmune disease that leads to the destruction of insulin-producing cells in the pancreas. Successful self-management of type 1 diabetes involves frequent self-monitoring of glucose and appropriate insulin administration. Education, focused on the diabetic individual and his or her individual needs, is the cornerstone of effective diabetes care.

Methods: This evidence implementation project used the JBI Evidence Implementation framework using audit and feedback approach. A baseline audit involved 20 type 1 diabetes inpatient education and 20 members of the ward personnel. An implementation strategies including staff meeting, devising a structured, patient-centered, individualized education program and a review of educational materials for patients was conducted, followed by a post-implementation re-audit with 20 staff members and 15 patients. The project was conducted over 8 months (March to October 2021) in the Department of Metabolic Diseases and Diabetology of University Hospital (Cracow, Poland), a tertiary referral unit that specializes in diagnosing and treatment of diabetes patients.

Results: According to the survey results, there was a substantial improvement in all audit criteria after implementation of intervention strategies. Criterion 1 (utilizing education program) improved from 0% do 100%. Criteria 2 (patients receiving handouts), 4 and 5 (individualization of the program), with high levels of positive answers at baseline (80%, 90% and 90% respectively), increased up to 100%. In Criterion 3 (structurization and program contents) we observed a significant improvement from 0% to 80%).

Conclusions: We succeeded in improving the quality of education provided for type 1 diabetes patients in all planned fields. Most importantly, we devised and utilized the education program, covering all important aspects of diabetic education, with the patients reporting increased satisfaction with individualized educational measures during the hospital stay. In the future we will strive to sustain the implemented strategies, with a perspective of further advances in the field of diabetes education.

Keywords: education program, individualized education, structurization, multidisciplinary, communication

Abstract word count: 330

Abstract

Objective: The aim of the project was to improve practice in nursing among patients with pressure ulcers in a polish hospital.

Introduction: Clinical practice guidelines encourage the healthcare organizations to adopt classification system EPUAP (European Pressure Ulcer Advisory Panel), NPIAP (National Pressure Injury Advisory Panel), and ICD-11 PI (World Health Organization (WHO) International classification of diseases 11th revision. 2018) where categories are comparable. In Poland, the most commonly used scale is the Torrance scale. The change of classification of pressure ulcers from Torrance scale to pressure ulcers scale based on the definitions provided by EPUAP will enable uniform estimation of the occurrence of pressure ulcers in various healthcare institutions in Poland, consistent recommendations for treatment and care, and thus eventually the reduction of their incidence.
Moreover, it will result in a possibility to compare the data with international data.

Methods: This evidence implementation project used the JBI Evidence Implementation framework. The implementation of changes in practice consisted of introducing an administrative and training change to an appropriate classification system EPUAP (European Pressure Ulcer Advisory Panel) in place. The project team conducted the baseline audit in April 2021, which comprised of checking compliance of 111 individual nursing care cards and the collective nursing documentation with the best practice recommendation EPUAP (European Pressure Ulcer Advisory Panel). Online training for nurses was carried out from November 2021 to January 2022. The project team conducted the follow-up audit in March 2022 and included 111 samples.

Results: The baseline audit revealed significant deficits between current practice and best practice recommendation EPUAP. The healthcare organization/hospital did not use the classification of PU which is based on definitions provided by the EPUAP (European Pressure Ulcer Advisory Panel). The project team identified barriers for implementation of unification of the classification of pressure ulcers among the healthcare organization with best practice criteria, and it was followed by implementation of a bundled education strategy. The compliance with all best practice criteria clearly improved in the follow-up audit.

Conclusions: A group of nurses received education on the benefits for patients and nurses of using classification system EPUAP. The project team achieved the sustainability of practice changes after conducting training through the administrative procedure.

Keywords: classification scale; pressure ulcer; wound management.

Abstract word count: 363

Abstract

Objectives: In this implementation project we aimed to examine the compliance with best evidence-based practice in regards to providing pre-operative education among patients treated with intravitreal anti-VEGF injections.

Introduction: Age-related macular degeneration (AMD) is an ophthalmic disease affecting the part of the retina responsible for central vision. It is currently treated with anti VEGF intraocular injections. Each patient should be provided with pre-operative education and information before surgery procedures which can significantly improve the compliance and the results of the therapy.

Methods: This evidence implementation project used the JBI Evidence Implementation framework and utilized The Getting Research into Practice (GRiP) audit and feedback tool. The project was conducted over 8 months (July 2022 to February 2023) in the Department of Ophthalmology and Ocular Oncology of University Hospital (Cracow, Poland) which is a tertiary referral unit that provides diagnostic services for all types of ophthalmic diseases and one of the largest regional centers holding ophthalmology surgeries of all kinds.

Results: A baseline audit was undertaken and involved 7 medical doctors and 22 patients’ medical records. An intervention including staff meeting, developing a structured, patient-centered, educational material for patients and a review of patient’s pre-operative education was conducted, followed by a post-implementation re-audit with 6 medical doctors and 22 patients’ medical records. According to the survey results, there was a significant improvement in all audit criteria after implementation of intervention strategies. Criterion 1 (Patients receiving pre-operative education) remained the same (100%). However, criterion 2 (specific content of the pre-operative education) increased up to 71%.

Conclusions: We succeeded in improving the quality of pre-operative education provided for patients undergoing surgical procedures in ophthalmology setting. Most importantly, we devised and utilized the educational information in printed form, covering all important aspects of surgical procedure. In future we will strive to sustain the implemented strategies, with a perspective of further advances in the field of all ophthalmic surgeries.

Keywords: AMD, anti-VEGF injections, education, clinical audit, implementation

Abstract word count: 314

Click here for a presentation.

Abstract

Objectives: The main aim of this research was to improve practice and long-term dietary care using various counselling strategies among obese patients and/or patients with chronic diseases.

Introduction: Contemporary patient care requires a holistic approach. Dietary consultation is not limited solely to diagnosing and solving a clinical problem, it also requires using behavioural strategies and activation of patient to be a co-creator of the change process. Behavioural strategies have been proven to contribute to improved patient-nutritionist relationship and treatment outcomes.

Methods: This evidence-based quality improvement project used the JBI Getting Research into Practice program to identify gaps in clinical practice and the barriers to change practice. Recruitment was carried out among practicing dietitians with a maximum length of service of 10 years. Baseline audit was conducted online among participants in September 2021 and assessed the level of knowledge of behavioural techniques, the level of their application in practice and barriers to using such methods. To overcome one of the identified barriers in the next stage, a five-hour training was conducted online by a psychodietitian. A follow-up survey regarding the introduction of a practical change in the work of a dietitian with a patient was conducted online in February 2022.

Results: There was a slight improvement in audit criterion. After the training, 93% of participants declared that they use any counselling strategies which indicated a 13% improvement in comparison to baseline audit. The most common barriers to higher compliance were lack of guidance on the use or insufficient knowledge on cognitive-behavioural strategies. These data indicate that education among dietitians about behavioral strategies is needed.

Conclusions: Applying cognitive-behavioral strategies is a challenge in dietary practice. Analysis of the results indicated that education among dietitians about these techniques is needed. We suggest adapting already available recommendations on this topic (such as the USPTF) to the Polish population as the next stage.

Keywords: behavioural strategies, care, dietitian counselling

Abstract word count: 309

Abstract

Introduction: As patient effective communication is integral to digital orthodontic treatment and is associated with adherence to visits and recommendations, it is useful to understand the evidence regarding patient compliance and satisfaction associated with the different counseling strategies.

Aims: The main aim of this research was to improve dentist patient communication in orthodontics.

Methods: The dental office performed the audit in 3 phases: phase 1, basic audit documentations, phase 2 Introducing new procedures and education, phase 3. Follow up audit of documentations. The inclusion criterion for the study was only part 1 of treatment with the Invisalign and Spark method - only the first visit related to giving the aligners, procedures attachments and giving instructions an oral hygiene and aligner hygiene, as well as the rules of cooperation and wearing aligners during orthodontic treatment and their changes to the next numbers of aligners.

Results: Workflow of communication of the dental team, adherence to procedures in education and recommendations to the patient in oral and written form allows to increase treatment success in aligner orthodontics, when part of the responsibility is transferred to the patient's homework. Documentation of 23 was examined in the baseline audit. Educated 6 staff to give instructions by verbal, via email and printed. Follow up was performed for 34 patients who reported to the dental practice.

Conclusion: Best practice implementation projects regarding dentist communication in an orthodontics setting, can be an effective tool in daily digital orthodontic practice.

Keywords: digital orthodontic treatment, dentist-patient communication, patient compliance

Abstract word count: 241