scholarly journals Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial

2019 ◽  
pp. bmjqs-2019-009588 ◽  
Author(s):  
Marie-José Roos-Blom ◽  
Wouter T Gude ◽  
Evert de Jonge ◽  
Jan Jaap Spijkstra ◽  
Sabine N van der Veer ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Audit And Feedback ◽  
Outcome Indicators ◽  
Pain Scores ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
Adequate Pain Management

BackgroundAudit and feedback (A&F) enjoys widespread use, but often achieves only marginal improvements in care. Providing recipients of A&F with suggested actions to overcome barriers (action implementation toolbox) may increase effectiveness.ObjectiveTo assess the impact of adding an action implementation toolbox to an electronic A&F intervention targeting quality of pain management in intensive care units (ICUs).Trial designTwo-armed cluster-randomised controlled trial. Randomisation was computer generated, with allocation concealment by a researcher, unaffiliated with the study. Investigators were not blinded to the group assignment of an ICU.ParticipantsTwenty-one Dutch ICUs and patients eligible for pain measurement.InterventionsFeedback-only versus feedback with action implementation toolbox.OutcomeProportion of patient-shift observations where pain management was adequate; composed by two process (measuring pain at least once per patient in each shift; re-measuring unacceptable pain scores within 1 hour) and two outcome indicators (acceptable pain scores; unacceptable pain scores normalised within 1 hour).Results21 ICUs (feedback-only n=11; feedback-with-toolbox n=10) with a total of 253 530 patient-shift observations were analysed. We found absolute improvement on adequate pain management in the feedback-with-toolbox group (14.8%; 95% CI 14.0% to 15.5%) and the feedback-only group (4.8%; 95% CI 4.2% to 5.5%). Improvement was limited to the two process indicators. The feedback-with-toolbox group achieved larger effects than the feedback-only group both on the composite adequate pain management (p<0.05) and on measuring pain each shift (p<0.001). No important adverse effects have occurred.ConclusionFeedback with toolbox improved the number of shifts where patients received adequate pain management compared with feedback alone, but only in process and not outcome indicators.Trial registration numberNCT02922101.

scholarly journals Improving pain management in childhood acute otitis media in general practice: a cluster randomised controlled trial of a GP-targeted educational intervention

2020 ◽  
Vol 70 (699) ◽  
pp. e684-e695
Author(s):  
Rick T van Uum ◽  
Roderick P Venekamp ◽  
Nicolaas PA Zuithoff ◽  
Alies Sjoukes ◽  
Alma C van de Pol ◽  
...  
Keyword(s):  
Pain Management ◽  
Randomised Controlled Trial ◽  
Educational Intervention ◽  
Controlled Trial ◽  
Acute Otitis Media ◽  
Intervention Group ◽  
Cluster Randomised Controlled Trial ◽  
Cluster Randomised ◽  
Randomised Controlled ◽  
Analgesic Use

BackgroundPain management in acute otitis media (AOM) is often suboptimal, potentially leading to unnecessary discomfort, GP reconsultation, and antibiotic prescribing.AimTo assess the effectiveness of a GP-targeted educational intervention to improve pain management in children with AOM.Design and settingPragmatic, cluster randomised controlled trial (RCT). GPs in 37 practices (intervention n = 19; control n = 18) across the Netherlands recruited 224 children with GP-confirmed AOM and ear pain (intervention n = 94; control n = 130) between February 2015 and May 2018.MethodGPs in practices allocated to the intervention group were trained (online and face-to-face) to discuss pain management with parents using an information leaflet, and prompted to prescribe weight-appropriate dosed paracetamol. Ibuprofen was additionally prescribed if pain control was still insufficient. GPs in the control group provided usual care.ResultsMean ear pain scores over the first 3 days were similar between groups (4.66 versus 4.36; adjusted mean difference = −0.05; 95% confidence intervals [CI] = −0.93 to 0.83), whereas analgesic use, in particular ibuprofen, was higher in the intervention group. The total number of antibiotic prescriptions during the 28-day follow-up was similar (mean rate 0.43 versus 0.47; adjusted rate ratio [aRR] 0.97; 95% CI = 0.68 to 1.38). Parents of children in the intervention group were more likely to reconsult for AOM-related complaints (mean rate 0.70 versus 0.41; aRR 1.73; 95% CI = 1.14 to 2.62).ConclusionAn intervention aimed at improving pain management for AOM increases analgesic use, particularly ibuprofen, but does not provide symptomatic benefit. GPs are advised to carefully weigh the potential benefits of ibuprofen against its possible harms.

scholarly journals Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management – a PREDICT mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Libby Haskell ◽  
Emma J. Tavender ◽  
Sharon O’Brien ◽  
Catherine L. Wilson ◽  
Franz E. Babl ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Audit And Feedback ◽  
Time Constraints ◽  
Evidence Based ◽  
Educational Materials ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract Background Bronchiolitis is the most common reason for hospitalisation in infants. All international bronchiolitis guidelines recommend supportive care, yet considerable variation in practice continues with infants receiving non-evidence based therapies. We developed six targeted, theory-informed interventions; clinical leads, stakeholder meeting, train-the-trainer, education delivery, other educational materials, and audit and feedback. A cluster randomised controlled trial (cRCT) found the interventions to be effective in reducing use of five non-evidence based therapies in infants with bronchiolitis. This process evaluation paper aims to determine whether the interventions were implemented as planned (fidelity), explore end-users’ perceptions of the interventions and evaluate cRCT outcome data with intervention fidelity data. Methods A pre-specified mixed-methods process evaluation was conducted alongside the cRCT, guided by frameworks for process evaluation of cRCTs and complex interventions. Quantitative data on the fidelity, dose and reach of interventions were collected from the 13 intervention hospitals during the study and analysed using descriptive statistics. Qualitative data identifying perception and acceptability of interventions were collected from 42 intervention hospital clinical leads on study completion and analysed using thematic analysis. Results The cRCT found targeted, theory-informed interventions improved bronchiolitis management by 14.1%. The process evaluation data found variability in how the intervention was delivered at the cluster and individual level. Total fidelity scores ranged from 55 to 98% across intervention hospitals (mean = 78%; SD = 13%). Fidelity scores were highest for use of clinical leads (mean = 98%; SD = 7%), and lowest for use of other educational materials (mean = 65%; SD = 19%) and audit and feedback (mean = 65%; SD = 20%). Clinical leads reflected positively about the interventions, with time constraints being the greatest barrier to their use. Conclusion Our targeted, theory-informed interventions were delivered with moderate fidelity, and were well received by clinical leads. Despite clinical leads experiencing challenges of time constraints, the level of fidelity had a positive effect on successfully de-implementing non-evidence-based care in infants with bronchiolitis. These findings will inform widespread rollout of our bronchiolitis interventions, and guide future practice change in acute care settings. Trial registration Australian and New Zealand Clinical Trials Registry: ACTRN12616001567415.

Sign in / Sign up

Export Citation Format

Share Document