scholarly journals Utilising Practice Development and the PARIHS Framework to Implement the Liverpool Care Pathway

2021 ◽  
Author(s):  
◽  
Theresa Mary MacKenzie
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Care Pathway ◽  
Hospital Setting ◽  
Practice Change ◽  
Health Board ◽  
Successful Implementation ◽  
Parihs Framework ◽  
Practice Development

<p>The LCP is an evidence-based integrated care pathway that provides guidance to generic health care professionals to deliver best practice end-of-life care. My role as the LCP Project Coordinator in a District Health Board in New Zealand is central to the exploration of this process of implementing practice change. Working with clinicians to advance effective care and management of patients during the process of dying in an acute hospital setting requires not only knowledge and understanding of the clinical pathway and evidence supporting best practice, but also careful working with cultural and contextual change. This paper descriptively addresses the bases of both components, and provides a case example of the development. Working with health care professionals to bring about practice change is complex and challenging. Successful implementation of evidence in practice is dependant not only on the strength and nature of the evidence, but also the context and models of facilitation. Practice development (PD) methodology informs the realities and complexities of practice change and of achieving sustainable development. The 'Promoting Action in Research Implementation in Health Services' (PARIHS) framework identifies the interplay and interdependence of factors that resonate with the reality of the complexity of practice change in relation to the evidence and best practice for particular clinical contexts. Highlighting PD processes and the relevance of the PARIHS framework alongside real-time practice change will continue to stimulate recognition of change and development complexities and bring consideration of these as robust methods for working between the theory and implementation of evidence in practice.</p>

scholarly journals Utilising Practice Development and the PARIHS Framework to Implement the Liverpool Care Pathway

2021 ◽  
Author(s):  
◽  
Theresa Mary MacKenzie
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Care Pathway ◽  
Hospital Setting ◽  
Practice Change ◽  
Health Board ◽  
Successful Implementation ◽  
Parihs Framework ◽  
Practice Development

<p>The LCP is an evidence-based integrated care pathway that provides guidance to generic health care professionals to deliver best practice end-of-life care. My role as the LCP Project Coordinator in a District Health Board in New Zealand is central to the exploration of this process of implementing practice change. Working with clinicians to advance effective care and management of patients during the process of dying in an acute hospital setting requires not only knowledge and understanding of the clinical pathway and evidence supporting best practice, but also careful working with cultural and contextual change. This paper descriptively addresses the bases of both components, and provides a case example of the development. Working with health care professionals to bring about practice change is complex and challenging. Successful implementation of evidence in practice is dependant not only on the strength and nature of the evidence, but also the context and models of facilitation. Practice development (PD) methodology informs the realities and complexities of practice change and of achieving sustainable development. The 'Promoting Action in Research Implementation in Health Services' (PARIHS) framework identifies the interplay and interdependence of factors that resonate with the reality of the complexity of practice change in relation to the evidence and best practice for particular clinical contexts. Highlighting PD processes and the relevance of the PARIHS framework alongside real-time practice change will continue to stimulate recognition of change and development complexities and bring consideration of these as robust methods for working between the theory and implementation of evidence in practice.</p>

scholarly journals Pre-hospital advanced life support education – core components for pre-hospital professionals

2018 ◽  
Vol 15 (1) ◽  
Author(s):  
David Reid ◽  
Russell Jones ◽  
Moira Sim
Keyword(s):  
Health Care ◽  
Human Factors ◽  
Health Care Professionals ◽  
Best Practice ◽  
Life Support ◽  
Hospital Setting ◽  
Advanced Life Support ◽  
Institutional Setting ◽  
High Quality ◽  
Team Members

IntroductionThere is a broad evidence base supporting advanced life support (ALS) education to health care professionals to be structured, realistic and inclusive of a range of human factors. However, published literature largely focusses on ALS education within institutional settings such as hospitals and associated health care facilities, with typically predictable human and material resources. The aim of this paper is to explore the literature on ALS education and report the results of an international survey undertaken to identify those educational elements which differ in the pre-hospital setting compared to the institutional setting. High quality education in pre-hospital resuscitation is important because it is critical that pre-hospital professionals provide high quality ALS to maximise the likelihood of patient survival.MethodsMEDLINE was searched using MESH terms ‘resuscitation’, ‘advanced life support’ and ‘prehospital’ as core terms. Fifteen articles relating specifically to pre-hospital resuscitation and a further 91 articles on resuscitation education were reviewed. Articles ranged in publication year from 1987 to 2016.An online survey on ALS education was developed and administered and attracted 177 responses from a range of health care professionals nationally and internationally. A total of 83 respondents completed the full survey.ResultsThe literature identifies that best practice ALS education should (a) be taught in the environment in which ALS will be performed, (b) involve team members who are similar to those they will encounter while providing ALS, and (c) use equipment the provider uses in their workplace. Human factors, in particular leadership and communication, are important components of ALS education. However, results of the survey demonstrate that best practice is not well incorporated into pre-hospital ALS education.ConclusionTo improve pre-hospital patient outcomes and maximise the chances of patient survival, ALS education to pre-hospital providers should incorporate the context of their workplace (that is, the environment in which they function), the team members they regularly work with and the equipment they use in the pre-hospital setting. Human factors, in particular leadership, should be considered as part of pre-hospital resuscitation education.

scholarly journals Building capacity for implementation—the KT Challenge

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Agnes T. Black ◽  
Marla Steinberg ◽  
Amanda E. Chisholm ◽  
Kristi Coldwell ◽  
Alison M. Hoens ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Professionals ◽  
Qualitative Data ◽  
Practice Change ◽  
Evidence Based ◽  
Science Literature ◽  
Health Care Settings ◽  
Improvement Programs ◽  
The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. Methods The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. Results Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. Conclusions The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

scholarly journals The Patient Experience of Inpatient Care During the COVID-19 Pandemic: Exploring Patient Perceptions, Communication, and Quality of Care at a University Teaching Hospital in the United Kingdom

2021 ◽  
Vol 8 ◽  
pp. 237437352199774
Author(s):  
Thomas Key ◽  
Avadhut Kulkarni ◽  
Vikram Kandhari ◽  
Zayd Jawad ◽  
Angela Hughes ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Patient Experience ◽  
Health Care Professionals ◽  
Disease Transmission ◽  
Inpatient Care ◽  
University Teaching ◽  
Health Board ◽  
Experience Of Care

The coronavirus disease 2019 (COVID-19) pandemic has necessitated many rapid changes in the provision and delivery of health care in hospital. This study aimed to explore the patient experience of inpatient care during COVID-19 pandemic. An electronic questionnaire was designed and distributed to inpatients treated at a large University Health Board over a 6-week period. It focused on hospital inpatients’ experience of being cared for by health care professionals wearing personal protective equipment (PPE), explored communication, and patients’ perceptions of the quality of care. A total of 704 patients completed the survey. Results demonstrated that patients believe PPE is important to protect the health of both patients and staff and does not negatively impact on their care. In spite of routine use of PPE, patients were still able to identify and communicate with staff. Although visiting restrictions were enforced to limit disease transmission, patients maintained contact with their relatives by using various electronic forms of communication. Overall, patients rated the quality of care they received at 9/10. This single-center study demonstrates a positive patient experience of care at an unprecedented time.

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

scholarly journals The management of infant developmental needs by community nurses - Part 2: The development of guidelines for the support of community nurses in the management of infant developmental needs

Curationis ◽  
2007 ◽  
Vol 30 (2) ◽  
Author(s):  
R. Leech ◽  
N.C. Van Wyk ◽  
C.J.E. Uys
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Best Practice ◽  
Scientific Information ◽  
Scope Of Practice ◽  
Developmental Needs ◽  
Developmental Care ◽  
Health Care Clinics ◽  
Research Findings

In the previous article, the author described, according to the scope of practice of registered nurses, the responsibilities oi community nurses with regard to the management of infant developmental needs in primary health care clinics in South Africa. In this article, the focus is on the development of guidelines for the support of community nurses in fulfilling these responsibilities. Before the development of the guidelines is addressed, a brief overview of the background of the study, assumptions of the researcher and the methodology of the study is given. The development of the set of guidelines (DEFINE HOPE) is set against the background of the drive to improve the quality of developmental care for infants and their families. As guidelines help to translate scientific information into statements, it could be valuable to community nurses to improve their delivery of developmental care. To gather evidence for the formulation of the guidelines, the researcher utilised the themes identified during the analysis process in phase one of the research; investigated research articles; and compared findings and recommendations of the articles with the research findings obtained in phase one. In addition to the research findings and literature review, a focus group (health care professionals represented in the case study), was utilised to assist with the final development and validation of the guidelines. The researcher adapted a number of desirable attributes for guidelines, which are indicated in the literature, to compile the criteria for validation of the guidelines. In conclusion, guidelines are necessary to support community nurses in finding “best practice” within their scope of practice to ensure higher quality of developmental care to families with infants 0-2 years.

Implementation of Wireless “Intelligent” Pump IV Infusion Technology in a Not-for-Profit Academic Hospital Setting

2007 ◽  
Vol 42 (9) ◽  
pp. 832-840 ◽  
Author(s):  
Lor Siv-Lee ◽  
Linda Morgan
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Hospital Setting ◽  
The United States ◽  
Main Campus ◽  
For Profit ◽  
Not For Profit ◽  
Drug Concentrations ◽  
Wireless Infrastructure ◽  
Infusion System

Purpose This paper describes the implementation of wireless “intelligent” pump intravenous (IV) infusion technology in a not-for-profit academic, multicampus hospital system in the United States. Methods The process of implementing a novel infusion system in a multicampus health care institution (main campus plus three satellite campuses) is described. Details are provided regarding the timelines involved, the process for the development of the drug libraries, and the initial implementation within and across campuses. Results In early 2004, with the end of the device purchase contract period nearing, a multidisciplinary committee evaluated potential IV infusion pumps for hospital use. In April 2004, the committee selected the Plum A+ infusion system with Hospira MedNet software and wireless capabilities (Hospira Inc., Lake Forest, IL). Implementation of the single-channel IV infusion system took place July through October 2005 following installation of the wireless infrastructure throughout the multicampus facility. Implementation occurred in July, one campus at a time; the three smaller satellite campuses went “live” before the main campus. Implementation of the triple-channel IV infusion system took place in March 2006 when the wireless infrastructure was completed and fully functional throughout the campuses, software was upgraded, and drug library revisions were completed and uploaded. Conclusion “Intelligent” pump technology provided a framework to standardize drug concentrations used in the intensive care units. Implementation occurred transparently without any compromise of patient care. Many lessons were learned during implementation that explained the initial suboptimal compliance with safety software use. In response, the committee developed strategies to increase software utilization rates, which resulted in improved acceptance by nursing staff and steadily improving compliance rates. Wireless technology has supported remote device management, prospective monitoring, the avoidance of medication error, and the timely education of health care professionals regarding potential medication errors.

scholarly journals Interpreting in Sexual and Reproductive Health Consults With Burma Born Refugees Post Settlement: Insights From an Australian Qualitative Study

2021 ◽  
Vol 6 ◽  
Author(s):  
Amita Tuteja ◽  
Elisha Riggs ◽  
Lena Sanci ◽  
Lester Mascarenhas ◽  
Di VanVliet ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Best Practice ◽  
Qualitative Methodology ◽  
Future Research ◽  
Care Providers ◽  
Face To Face ◽  
Consultation Room ◽  
Privacy And Confidentiality

Interpreters work with health care professionals to overcome language challenges during sexual and reproductive (SRH) health discussions with people from refugee backgrounds. Disclosures of traumatic refugee journeys and sexual assault combined with refugees’ unfamiliarity with Western health concepts and service provision can increase the interpreting challenges. Published literature provides general guidance on working with interpreters in primary care but few studies focus on interpretation in refugee SRH consults. To address this, we explored the challenges faced by providers of refugee services (PRS) during interpreter mediated SRH consultations with Burma born refugees post settlement in Australia. We used qualitative methodology and interviewed 29 PRS involved with migrants from Burma including general practitioners, nurses, interpreters, bilingual social workers, and administrative staff. The interviews were audio-recorded, transcribed, and subjected to thematic analysis following independent coding by the members of the research team. Key themes were formulated after a consensus discussion. The theme of “interpretation related issues” was identified with six sub-themes including 1) privacy and confidentiality 2) influence of interpreter’s identity 3) gender matching of the interpreter 4) family member vs. professional interpreters 5) telephone vs. face-to-face interpreting 6) setting up the consultation room. When faced with these interpretation related challenges in providing SRH services to people from refugee backgrounds, health care providers combine best practice advice, experience-based knowledge and “mundane creativity” to adapt to the needs of the specific patients. The complexity of interpreted SRH consultations in refugee settings needs to be appreciated in making good judgments when choosing the best way to optimize communication. This paper identifies the critical elements which could be incorporated when making such a judgement. Future research should include the experiences of refugee patients to provide a more comprehensive perspective.

scholarly journals Keeping people with epilepsy safe during the COVID-19 pandemic

Neurology ◽  
2020 ◽  
Vol 94 (23) ◽  
pp. 1032-1037 ◽  
Author(s):  
Jacqueline A. French ◽  
Martin J. Brodie ◽  
Roberto Caraballo ◽  
Orrin Devinsky ◽  
Ding Ding ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Care Pathway ◽  
Clinical Care ◽  
Health Care Facilities ◽  
Urgent Care ◽  
Consensus Recommendations ◽  
Consensus Statements ◽  
Care Facilities ◽  
Strongly Agree

ObjectivesTo provide information on the effect of the coronavirus disease of 2019 (COVID-19) pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the novel coronavirus pandemic.MethodsThe authors developed consensus statements in 2 sections. The first was “How should we/clinicians modify our clinical care pathway for people with epilepsy during the COVID-19 pandemic?” The second was “What general advice should we give to people with epilepsy during this crisis? The authors individually scored statements on a scale of −10 (strongly disagree) to +10 (strongly agree). Five of 11 recommendations for physicians and 3/5 recommendations for individuals/families were rated by all the authors as 7 or above (strongly agree) on the first round of rating. Subsequently, a teleconference was held where statements for which there was a lack of strong consensus were revised.ResultsAfter revision, all consensus recommendations received a score of 7 or above. The recommendations focus on administration of as much care as possible at home to keep people with epilepsy out of health care facilities, where they are likely to encounter COVID-19 (including strategies for rescue therapy), as well as minimization of risk of seizure exacerbation through adherence, and through ensuring a regular supply of medication. We also provide helpful links to additional helpful information for people with epilepsy and health providers.ConclusionThese recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic.

The Orkdal model: Development, implementation, and evaluation of collaboration between specialist and community care within cancer palliative care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 73-73 ◽  
Author(s):  
Anne-Tove Brenne ◽  
Anne Kari Knudsen ◽  
Cinzia Brunelli ◽  
Vidar Halsteinli ◽  
Stein Kaasa
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Cancer Patients ◽  
Health Care Professionals ◽  
Care Pathway ◽  
Care Services ◽  
Related Quality ◽  
Palliative Care Services ◽  
Specialist Health Care ◽  
Standardized Care

73 Background: Palliative care early in the cancer disease trajectory may improve health related quality of life for patients and their families. Collaboration between community and specialist health care professionals is paramount to achieve optimal cancer care. The objective of this study is to develop and to implement this model into our health care system.The target population is cancer patients with metastatic and/ or loco-regional disease. Methods: The study takes place in a rural district of 13 municipalities with a local hospital (Orkdal) in Mid Norway. It is designed as a prospective controlled observational pre- post cohort study with four main interventions: 1. Development and implementation of a standardized care pathway across health care levels, 2. Educational programme for health care professionals, 3. Information about cancer and palliative care to the public, 4.Information,education and support to family members.Outcomes are patient’s time spent at home, family member’s health related quality of life, improvement of health care providers’ knowledge and skills and distribution of health care service use. Results: A standardized care pathway for all palliative cancer patients including home care, care in nursing homes, and specialist care in hospitals (in- and outpatients) is developed. It focuses on access to palliative care services, transfer of medical data, and symptom assessment. The educational program consists of two parts; one to inform about the project and the standardized care pathway, and one to improve competence and skills in cancer palliative care. To the general public, information regarding chemo- and radiotherapy, symptom diagnosis and treatment and palliative care services in general is given. Conclusions: A total integrated model to improve care for cancer patients was developed focusing on collaboration between community and specialist health care, and on early integration of palliative care in the traditional cancer care trajectory. Improved care for cancer patients and their families in the Orkdal region to equal costs is expected. The Orkdal Model may be applied in other regions and for other chronic diseases. Clinical trial information: NCT02170168.

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