Resultados de la implementación de una guía de recomendaciones en el cuidado de las personas con ostomías digestivas / Results in the Application of a Recommendation Guide for the Care of People with Digestive Ostomy / Resultados da implementação de diretrizes de recomendações no cuidado de pessoas com ostomias digestivas

Introducción. La instauración de una ostomía digestiva tiene una importante repercusión física y emocional en las personas. El objetivo de este estudio es analizar la adherencia de las enfermeras a las buenas prácticas en el manejo de las ostomías, la disminución de complicaciones y la adquisición de destrezas de los pacientes en su propio autocuidado tras la implementación de la Guía de Buenas Prácticas de la asociación de enfermeras de Ontario. Metodología. Estudio cuasiexperimental prospectivo en una unidad de cirugía digestiva desde 2017 hasta 2022. La intervención ha consistido en la implementación de las recomendaciones de cuidados de una Guía de Buenas Prácticas, analizando variables de proceso y de resultados en la salud a lo largo del proceso. Resultados. Se han encontrado diferencias significativas (p<0.05) en las variables de adherencia: educación sanitaria preoperatoria, marcaje del estoma, evaluación integral posoperatoria y educación sanitaria posoperatoria. No se han encontrado diferencias significativas en las variables de complicaciones del estoma (del 37.5% al 27.8%), ni en las complicaciones de la piel periestomal (del 12.5% al 10.2%). Sí se han encontrado diferencias en la variable de adquisición de destrezas del paciente en su autocuidado (del 44.44% al 98%). Discusión. Implantar recomendaciones de buenas prácticas mejora la calidad de los cuidados y disminuye las complicaciones. Conclusiones. La implementación de la guía ha aumentado la adherencia de las enfermeras a las buenas prácticas basadas en la evidencia y ha mejorado la adquisición de destrezas de los pacientes en su autocuidado, disminuyendo las complicaciones (aunque sin significación). Palabras clave: Estomía; Autocuidado; Guía de Práctica Clínica; Enfermería Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud

Introduction. The establishment of a digestive ostomy has an essential physical and emotional repercussion. This study aims to analyze nurses' adherence to the good practice of management in ostomy, the decrease of complications, and the acquisition of patients' ability in self-care after implementing the Ontario Nurses' Good Practices guide. Methodology. A quasi-experimental prospective study in a digestive surgery unit from 2017 to 2022. The intervention consists of implementing the recommendations made in the Good Practices Guide and analyzing variables of process and health throughout the process. Results. Significative differences have been found (p<0.05) in the adherence variables: preoperatory sanitary education, marking of stoma, post-operatory integral evaluation, and sanitary post-operatory education. The investigators did not find significant differences in the variable of stoma complications (from 37.5% to 27.8%) or the peristoma skin complications (from 12.5% to 10.2%). A difference in the acquisition of abilities of the patient self-care was found (from 44.4% to 98%). Discussion. To make good practice recommendations improves the quality of the care and reduces complications. Conclusions. Implementing the guide has increased the nurses' adherence to the good practices based on the evidence and the acquisition of abilities in the patient's self-care, decreasing the complications (even though it didn't show significance). Keywords: Ostomy; Self Care; Practice Guideline; Evidence-Based Nursing; Outcome Assessment, Health Care

Introdução. A realização de uma ostomia digestiva tem um importante impacto físico e emocional nas pessoas. O objetivo deste estudo é analisar a adesão das enfermeiras às boas práticas no manejo de ostomias, a redução de complicações e a aquisição de habilidades dos pacientes no seu próprio autocuidado após a implementação das diretrizes de boas práticas dos Associação de Enfermeiras de Ontário. Metodologia. Estudo prospectivo quase-experimental numa unidade de cirurgia digestiva de 2017 a 2022. A intervenção consistiu na implementação das recomendações de cuidados das Diretrizes de Boas Práticas, analisando variáveis de processo e resultados de saúde ao longo do processo. Resultados. Foram encontradas diferenças significativas (p<0.05) nas variáveis de adesão: educação em saúde préoperatória, marcação do estoma, avaliação pós-operatória abrangente e educação em saúde pós-operatória. Não foram encontradas diferenças significativas nas variáveis de complicações do estoma (de 37.5% para 27.8%), nem nas complicações da pele periestomal (de 12.5% para 10.2%). Foram encontradas diferenças na variável aquisição de habilidades de autocuidado pelo paciente (de 44.44% para 98%). Discussão. A implementação de recomendações de boas práticas melhora a qualidade dos cuidados e reduz complicações. Conclusões. A implementação das diretrizes aumentou a adesão das enfermeiras às boas práticas baseadas em evidências e melhorou a aquisição de habilidades de autocuidado pelos pacientes, diminuindo complicações (embora não significativamente). Palavras-chave: Estomia; Autocuidado; Guia de Prática Clínica; Enfermagem Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde

Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial.

BACKGROUND: 2 billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide each year. Almost one in two PIVCs fail before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure among hospitalised patients. METHODS: PREBACP was a cluster-randomised, controlled trial done at seven public hospitals in Spain. Clusters (hospital wards) had at least 70% permanent staff and data were collected from patients aged 18 years and older with one or more PIVCs at the start of intravenous therapy. Clusters were randomly assigned (1:1) to the multimodal intervention or control group using a centralised, web-based randomisation software, and stratified by type of setting. We concealed randomisation to allocation, without masking patients or professionals to the intervention. An intervention using a multimodal model and dissemination of protocols, education for health-care professionals and patients, and feedback on performance was implemented for 12 months in the intervention group. The control group received usual care. The primary outcome was all-cause PIVC failure at 12 months (phlebitis, extravasation, obstruction, or infections). Subsequently, through an amendment to the protocol approved on July 25, 2021, we included dislodgement as part of PIVC failure. Analysis was by modified intention to treat, which included all randomly assigned hospital wards for whom data on the primary endpoint were available. This trial is registered with the ISRCTN Registry, ISRCTN10438530. FINDINGS: Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients, 2235 PIVCs, and 131 nurses) or usual practice in the control group (n=11 clusters; 2282 patients, 2330 PIVCs, and 138 nurses). At 12 months, the proportion of PIVC failures was lower in the intervention group than in the control group (37·10% [SD 1·32], HR 0·81 [95% CI 0·72 to 0·92] vs 46·49% [2·59], HR 1·23 [1·04 to 1·39]; mean difference -9·39% [95% CI -11·22 to -7·57]; p<0·0001). Per-protocol-prespecified analysis of the primary outcome excluding dislodgement also showed the intervention significantly reduced PIVC failure compared with the control group at 12 months (33·47% [SD 2·98], HR 0·85 [95% CI 0·75 to 0·96] vs 41·06% [4·62], HR 1·18 [1·04 to 1·33]; mean difference -7·59% [95% CI -11·05 to -4·13]; p<0·0001). INTERPRETATION: A multimodal intervention reduced PIVC failure, thereby reducing potentially serious complications for hospitalised patients. The findings of PREBACP enabled a deeper understanding of decision making, knowledge mobilisation, and sense making in routine clinical practice. FUNDING: The College of Nurses of the Balearic Islands. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España / Social networks in the clinical practice evidence implementation strategy: experience from Hospital Regional Universitario de Málaga, Spain / Redes sociais na estratégia de implementação de evidências na prática clínica: experiência do Hospital Regional Universitario de Málaga, Espanha

Introducción. Twitter se ha convertido en el foro favorito para la comunicación de la atención médica, en cuanto permite a los usuarios publicar y compartir mensajes fácilmente a sus seguidores. En el Hospital Regional Universitario de Málaga (HRUM) se ha recurrido al uso de las redes sociales, particularmente Twitter, para facilitar la implementación y difusión de las recomendaciones de las Guías de Buenas Prácticas (GBP) de la Registered Nurses Association of Ontario (RNAO) en la práctica clínica. El objetivo del presente artículo es describir la estrategia y reflexionar acerca del rol de las redes sociales en las estrategias y los resultados de implantación de recomendaciones de GBP de la RNAO. Temas de reflexión. Siguiendo la metodología del modelo Best Practice Spotlight Organization (BPSO), se ha otorgado un papel protagonista a las enfermeras asistenciales de cada unidad a través de la formación, creación de equipos de implantación y difusión del programa. El uso de nuevos registros y, sobre todo, el uso de las redes sociales, ha obtenido unos resultados excelentes de adherencia de los profesionales al programa tanto a nivel cuantitativo como cualitativo. Conclusiones. El uso de las redes sociales como estrategia de difusión en la implantación de las recomendaciones de las GBP de la RNAO ha conseguido muy buena acogida por parte de los profesionales, pues muestra un alto nivel de participación, y es una herramienta útil como estrategia de difusión. Se necesita más tiempo para monitorizar el uso de las redes sociales y su posible impacto en la implantación de evidencias y la mejora de los resultados de salud de los pacientes y organizaciones de salud. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introduction. Twitter has become the favored forum for communicating health care, since it allows users to publish and share messages with their followers. At Hospital Regional Universitario de Málaga (HRUM), they have used social networks, particularly Twitter, to facilitate implementing and broadcasting the recommendations from the Registered Nurses Association of Ontario's (RNAO) Best Practice Guideline (BPG) for clinical practice. The objective of this paper is to describe the strategy and reflect on the role of social networks on the strategies and results of implementing the RNAO's BPG recommendations. Topics of reflection. In accordance to the methodology of the Best Practice Spotlight Organization (BPSO) model, a leading role has been given to the nurses at each unit through training, creation of implementation teams and broadcasting the program. Using new records and, most of all, social networks, the strategy has obtained excellent results from professionals when it comes to adherence to the program, both quantitatively and qualitatively. Conclusions. The use of social networks as a broadcasting strategy in implementing the RNAO's BPG recommendations has been well received by professionals. The strategy shows high participation levels and is a useful tool as a broadcasting strategy. More time is needed to monitor social network use and its possible impact on generating evidence, as well as the improvement of healthcare organizations and patient's health results. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introdução. O Twitter se tornou o fórum favorito para a comunicação no atendimento médico, pois permite que os usuários publiquem e compartilhem facilmente mensagens para seus seguidores. No Hospital Regional Universitário de Málaga (HRUM), foram utilizadas as redes sociais, particularmente o Twitter, para facilitar a implementação e disseminação das recomendações das Guias de Boas Práticas (GBP) da Registered Nurses Association of Ontario (RNAO) na prática clínica. O objetivo deste artigo é descrever a estratégia e refletir sobre o papel das redes sociais nas estratégias e nos resultados da implementação das recomendações do GBPs da RNAO. Tópicos de reflexão. Seguindo a metodología do modelo Best Practice Spotlight Organization, foi atribuído um papel essencial às enfermeiras de cada unidade por meio de treinamento, criação de equipes de implementação e divulgação do programa. O uso de novos registros e, sobretudo, o uso de redes sociais, obteve excelentes resultados de adesão dos profissionais ao programa, tanto quantitativa quanto qualitativamente. Conclusões. O uso das redes sociais como estratégia de disseminação na implementação das recomendações do GBPs da RNAO alcançou uma boa recepção pelos profissionais, pois mostra um alto nível de participação e é uma ferramenta útil como estratégia de disseminação. É necessário mais tempo para monitorar o uso das redes sociais e seu possível impacto na implementação de evidências e na melhoria dos resultados de saúde de pacientes e organizações de saúde. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571