Abstract WP400: Simulation Training is a Feasible Implementation Strategy for Evidence Based Stroke Swallowing Screening

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Karen Stonecypher ◽  
Racquell Garrett ◽  
Barbara Kimmel ◽  
Stephanie Daniels ◽  
Jane Anderson
Keyword(s):  
Nursing Staff ◽  
Best Practice ◽  
Simulation Training ◽  
Quality Care ◽  
Video Clip ◽  
Implementation Strategies ◽  
Oral Intake ◽  
Evidence Based ◽  
Train The Trainer ◽  
Swallowing Screening

Backgroud and Purpose: A well-established best practice in providing safe, high quality care for patients with stroke is screening swallowing prior to oral intake. Effective implementation strategies are needed to support evidence based swallowing screening. The use of simulation is now being widely used to train healthcare professionals in evidence based practices. The purpose of this project was to assess the feasibility of simulation training modules (STMs) to support delivery of evidence based swallowing screening with frontline emergency department (ED) nurses. Methods: A train-the-trainer approach was used with (n=8) nurse champions who received didactic instruction and training with video clips and medical mannequins programmed to simulate auditory elements of stroke swallowing screening. After demonstration of mastery, each nurse champion then trained their peers using the same format. Feasibility for implementation of the STMs was evaluated through process mapping. Acquisition of skills was evaluated with a competency checklist and medical mannequins simulated with various stroke patient profiles. Knowledge was assessed using a pre/posttest. Results: A portable simulation lab was set up in the ED and nurse champions trained 100% of nursing staff over a two-month period. A total of 16 simulation sessions were needed to train all nursing staff (N=42). Didactic and video clip review was completed in 45-minute group sessions followed by 30-minute simulation practice sessions. Competency and knowledge was assessed 2-weeks after completing STMs. Competency checkoff sessions were completed in approximately 15-minutes. There was a significant increase in nurses’ knowledge and skills from baseline to posttest. Conclusions: It is feasible to implement STMs with frontline ED nurses. The STMs were beneficial for training and acquisition of skills in a controlled environment with a variety of patient examples. Repeated practice is critical to develop the auditory perceptual skills necessary for swallowing screening interpretation. STMs can be used in the ED for nurses to independently practice and improve swallowing screening skills.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

AN INTERNATIONAL POSITION STATEMENT ON THE MANAGEMENT OF FRAILTY IN DIABETES MELLITUS: SUMMARY OF RECOMMENDATIONS 2017

2017 ◽  
pp. 1-11
Author(s):  
A.J. SINCLAIR ◽  
A. ABDELHAFIZ ◽  
T. DUNNING ◽  
M. IZQUIERDO ◽  
L. RODRIGUEZ MANAS ◽  
...  
Keyword(s):  
New England ◽  
American Medical ◽  
Best Practice ◽  
English Language ◽  
Quality Care ◽  
Position Statement ◽  
Evidence Based ◽  
Medicine Journal ◽  
Wide Range ◽  
International Experts

Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology – Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.

Improving Oral Care in Patients Receiving Mechanical Ventilation

2005 ◽  
Vol 14 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Constance J. Cutler ◽  
Nancy Davis
Keyword(s):  
Mechanical Ventilation ◽  
Best Practice ◽  
Current Practice ◽  
Oral Care ◽  
Implementation Strategies ◽  
Baseline Period ◽  
Evidence Based ◽  
Oral Secretions ◽  
Mucosal Tissues ◽  
Care Practices

• Background Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results. • Objectives To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care. • Methods This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward. • Results Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter. • Conclusions Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.

Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 43-43
Author(s):  
Nabeela Ratansi ◽  
Aimee Langan ◽  
Irene Blais ◽  
Erin Svara ◽  
Karla Houser ◽  
...  
Keyword(s):  
Best Practices ◽  
Performance Management ◽  
Capacity Planning ◽  
Best Practice ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Care ◽  
Practice Variation ◽  
Evidence Based ◽  
Gi Endoscopy

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.

scholarly journals Building National Capacity for Research Mentor Training: An Evidence-Based Approach to Training the Trainers

2015 ◽  
Vol 14 (2) ◽  
pp. ar24 ◽  
Author(s):  
Christine Pfund ◽  
Kimberly C. Spencer ◽  
Pamela Asquith ◽  
Stephanie C. House ◽  
Sarah Miller ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Mentoring Relationships ◽  
Evidence Based ◽  
Mentor Training ◽  
Train The Trainer ◽  
Research Mentoring ◽  
High Satisfaction ◽  
National Capacity ◽  
Research Mentor ◽  
Widespread Dissemination

Research mentor training (RMT), based on the published Entering Mentoring curricula series, has been shown to improve the knowledge and skills of research mentors across career stages, as self-reported by both the mentors engaged in training and their mentees. To promote widespread dissemination and empower others to implement this evidence-based training at their home institutions, we developed an extensive, interactive, multifaceted train-the-trainer workshop. The specific goals of these workshops are to 1) increase facilitator knowledge of an RMT curriculum, 2) increase facilitator confidence in implementing the curriculum, 3) provide a safe environment to practice facilitation of curricular activities, and 4) review implementation strategies and evaluation tools. Data indicate that our approach results in high satisfaction and significant confidence gains among attendees. Of the 195 diverse attendees trained in our workshops since Fall 2010, 44% report implementation at 39 different institutions, collectively training more than 500 mentors. Further, mentors who participated in the RMT sessions led by our trained facilitators report high facilitator effectiveness in guiding discussion. Implications and challenges to building the national capacity needed for improved research mentoring relationships are discussed.

Response to Drs Bergman and Zurhellen

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 842-844
Author(s):  
John B. Coombs
Keyword(s):  
Best Practice ◽  
Medical Condition ◽  
Quality Care ◽  
Biomedical Literature ◽  
Evidence Based ◽  
New Information ◽  
Accuracy And Precision ◽  
Practice Parameters ◽  
Practice Style ◽  
Solo Practitioner

In composing a response to these two articles, I must congratulate both presenters. Each created a stimulating summary of key components of what I consider to be the greatest challenge for practicing physicians in the future: information management. Dr Zurhellen has described an office information system that, in all probability, is enjoyed by fewer than 1 in 50 practitioners currently. Taking advantage of his position as a solo practitioner with a strong interest in computers, he has developed a system that brings greater simplicity, efficiency, and—I dare say—accuracy and precision to his office practice. The greatest challenge for the rest of us will be how to create the transition and the tremendous investment of time, financial resources, and risk that it will surely take to get where he is today. Given the need for improvement in the daily handling of office information, and given the estimated 7500 new articles entered daily in the peer-reviewed biomedical literature, futurists predict that practitioners during the next 15 years will need to adjust both their practice style and their continuing education. They will need to assimilate new information in accordance with this estimate: 75% of what one needs to know to provide top-quality care in any given patient encounter will change during a 12-month period. Dr Bergman has provided an up-to-date glimpse of how we are preparing to meet this challenge. Practice parameters condense new acientific information that is evidence based into defined best practice for a given medical condition. Gaps in evidence-based information are filled by selected expert opinion.

scholarly journals Nursing Surge Capacity Strategies for Management of Critically Ill Adults with COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 23-32
Author(s):  
Abbas Al Mutair ◽  
Anas Amr ◽  
Zainab Ambani ◽  
Khulud Al Salman ◽  
Deborah Schwebius
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Nursing Staff ◽  
Best Practice ◽  
Expert Panel ◽  
Evidence Based ◽  
Surge Capacity ◽  
Starting Point

Background: There is a vital need to develop strategies to improve nursing surge capacity for caring of patients with coronavirus (COVID-19) in critical care settings. COVID-19 has spread rapidly, affecting thousands of patients and hundreds of territories. Hospitals, through anticipation and planning, can serve patients and staff by developing strategies to cope with the complications that a surge of COVID-19 places on the provision of adequate intensive care unit (ICU) nursing staff—both in numbers and in training. Aims: The aim is to provide an evidence-based starting point from which to build expanding staffing models dealing with these additional demands. Design/Method: In order to address and develop nursing surge capacity strategies, a five-member expert panel was formed. Multiple questions directed towards nursing surge capacity strategies were posed by the assembled expert panel. Literature review was conducted through accessing various databases including MEDLINE, CINAHL, Cochrane Central, and EMBASE. All studies were appraised by at least two reviewers independently using the Joanna Briggs Institute JBI Critical Appraisal Tools. Results: The expert panel has issued strategies and recommendation statements. These proposals, supported by evidence-based resources in regard to nursing staff augmentation strategies, have had prior success when implemented during the COVID-19 pandemic. Conclusion: The proposed guidelines are intended to provide a basis for the provision of best practice nursing care during times of diminished intensive care unit (ICU) nursing staff capacity and resources due to a surge in critically ill patients. The recommendations and strategies issued are intended to specifically support critical care nurses incorporating COVID-19 patients. As new knowledge evidence becomes available, updates can be issued and strategies, guidelines and/or policies revised. Relevance to Clinical Practice: Through discussion and condensing research, healthcare professionals can create a starting point from which to synergistically develop strategies to combat crises that a pandemic like COVID-19 produces.

scholarly journals Review of implementation strategies to change healthcare provider behaviour in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Kerstin de Wit ◽  
Janet Curran ◽  
Brent Thoma ◽  
Shawn Dowling ◽  
Eddy Lang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Implementation Research ◽  
Best Practice ◽  
Clinical Care ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Medicine Research ◽  
Canadian Association ◽  
New Evidence

AbstractObjectivesAdvances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments.MethodsA systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies.ResultsWe produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research.ConclusionsWe present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

Achieving high-quality care: a view from NICE

Heart ◽  
2017 ◽  
Vol 104 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Gillian Leng ◽  
Gemma Partridge
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
Evidence Based ◽  
Implantable Cardioverter Defibrillators ◽  
Barriers To Change ◽  
Change In Practice ◽  
Nice Guidance ◽  
Pharmaceutical Agents ◽  
Cardioverter Defibrillators ◽  
Organisational Level

The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation.

scholarly journals Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention

2017 ◽  
Vol 19 (1) ◽  
pp. 38-50 ◽  
Author(s):  
Cara Finley ◽  
Katherine Suellentrop ◽  
Rebecca Griesse ◽  
Lawrence Duane House ◽  
Anna Brittain
Keyword(s):  
Public Health ◽  
Teen Pregnancy ◽  
Best Practice ◽  
Implementation Strategies ◽  
Future Research ◽  
Evidence Based ◽  
Teen Pregnancy Prevention ◽  
Local Stakeholder ◽  
Health Initiatives ◽  
Stakeholder Needs

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

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