Early detection of phlebitis among hematology-oncology patients: a best practice implementation project.

INTRODUCTION: Peripherally-inserted venous catheters (PIVC) are essential for cancer patients to receive treatment. Phlebitis is a major complication of PIVC. Currently, nurses' assessment of phlebitis mainly involves visual inspection. However, the latest literature suggests palpation for tenderness to promote the early detection of phlebitis. OBJECTIVES: This project evaluated the effectiveness of a bundle approach to increase nurses' compliance with PIVC site assessment to promote early detection of phlebitis (grade 2 and above). METHODS: The JBI Evidence Implementation Framework was used to conduct this project in a 28-bed hematology-oncology ward in a Singapore hospital. The bundle approach used in this project consisted of a training presentation, medical mannequin, and phlebitis scale card. The rate of nurses' compliance with best practice for PIVC site assessment was measured at 1 month and 6 months post-implementation. The incidence of phlebitis was monitored up until 12 months post-implementation. RESULTS: Baseline data indicated that only 18.75% (3 out of 16) nurses palpated for tenderness when assessing for phlebitis. Data at 1 month and 6 months post-implementation reported sustained high compliance rates of 85.71% (24 out of 28) and 89.29% (25 out of 28), respectively. Late detection of phlebitis was reduced by 66% (from three cases to one case) at 6 months post-implementation, and no patients required invasive interventions. CONCLUSIONS: The bundle approach used in this project facilitated early detection of phlebitis following the inclusion of palpation into nurses' assessment for phlebitis. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A204.

Structured, nurse-led ward rounds to improve interprofessional communication and optimize care of vascular surgery patients: a best practice implementation project.

INTRODUCTION: Ward rounds are crucial inpatient activities during which patients' conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results. METHODS: An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out. RESULTS: The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, "best medical therapy" rates, and inpatient complications. A statistically significant improvement in nurses' confidence to lead discussions during medical rounds was also observed ( p  = 0.026). CONCLUSIONS: This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses' confidence in team communication, bolstering their ability to provide high-quality patient care.

Diagnostic accuracy and validity of image-assisted versus face-to-face wound assessments for the management of chronic wounds: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the accuracy and validity of diagnostic decisions derived from image-assisted wound assessments compared with face-to-face consultations for chronic wound care. INTRODUCTION: Images are often used within the inpatient, outpatient, and community settings to facilitate interdisciplinary transfer of care, objective wound assessments, and accurate treatment decisions. An ever-changing and ever-improving selection of image-capturing devices has been created and studied in recent years. To improve future chronic wound care programs, there is a need to explore how accurately clinicians can diagnose specific wound characteristics using these images, especially when these devices are operated in the clinical setting. INCLUSION CRITERIA: Peer-reviewed studies and unpublished/gray literature comparing image-assisted with face-to-face modalities for chronic wound care will be included. Chronic wounds include, but are not limited to, diabetic foot ulcers, ischemic lower limb ulcers, and pressure ulcers. Studies will be excluded if they examine acute wounds or if the reference standard is not face-to-face assessment. METHODS: A comprehensive search of multiple databases and gray literature sources (MEDLINE, CINAHL, Embase, Web of Science, Scopus, Google Scholar, and ProQuest Central) will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature published from 2000 onward will be retrieved. Two reviewers will independently screen and appraise the articles. Data extraction and synthesis will be performed based on the JBI methodology for the conduct of diagnostic test accuracy systematic review. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021265679.

Implementing an evidence-based structured education and management program in an inpatient adult oncology setting to improve patients' pain control.

BACKGROUND AND AIMS: Cancer-related pain is prevalent across the cancer trajectory, and is probably one of the most feared of all cancer symptoms for patients and their families. Although there were guidelines and framework regarding the management of cancer pain, pain control among patients remain suboptimal. This best practice implementation project aimed to improve patients' perception on cancer pain management and pain control through implementing structured patient and family education and patient information leaflet (PIL) on managing cancer pain. METHODS: The current implementation project conducted in an adult oncology inpatient unit utilized the JBI Practical Application of Clinical Evidence System and Getting Research into Practice module for promoting evidence-based health care. RESULTS: A comparison between the preimplementation and postimplementation findings showed significant improvements for both audit criteria outcomes. The percentage of patients receiving verbal education rose from 0 to 69%, whereas the percentage of patients receiving PIL increased 0-100%. Patient compliance to analgesic regime increased from 0 to 100%. There was a significant improvement in patients' pain levels ( P  < 0.001), with majority rate having none-mild pain post intervention. CONCLUSION: A structured educational program on cancer-related pain improved patients' knowledge on cancer-related pain management and pain control. Despite the remarkable increase in the compliance rate, further interventions may still be required to achieve 100% compliance. Continuous audits will be held to guide follow-up interventions to ensure compliance and sustention of the project.

Improving critical care patients' sleep quality in a surgical high-dependency unit: An evidence-based practice project.

BACKGROUND: Sleep is an essential basic need. However, patients in critical care often experience poor and fragmented sleep. As such, there is a need to examine strategies to promote sleep in critical care patients. AIM: This project aimed to promote sleep in surgical high-dependency patients through the implementation of evidence-based best practice. METHODS: An evidence-based practice (EBP) project was implemented in May 2015 in a 24-bed surgical high-dependency (progressive care) unit in a public tertiary hospital in Singapore in three phases using the JBI framework. Outcomes measured were sleep quality, using the Richards-Campbell Sleep Questionnaire, and nurses' adherence to sleep promotion activities, using an audit tool adapted from the JBI-Practical Application of Clinical Education System. Data were collected at baseline, 1, 3, 6, and 12 months. Getting Research into Practice analysis was done at each time point. RESULTS: A total of 120 patients were surveyed, and 150 observation audits were conducted over 1 year. Sleep quality was similar between pre-audit (mean 53, SD 19.89) and month 1 (mean 54, SD 24.40), improved at month 3 (mean 64, SD 19.34), and sustained at month 6 (mean 64, SD 24.13) and 12 (mean 64, SD 19.4). The effect size between pre-audit and month 3 was a medium effect size of 0.49, which continued to improve at month 12, with a medium effect size of 0.56. Nurses' adherence to the EBP generally improved, and the thresholds of 80% were exceeded by month 12. LINKING EVIDENCE TO ACTION: Sleep is an essential basic need and can be improved through simple evidence-based interventions. Best practice for promoting sleep includes grouping nursing activities and reducing light and noise at night.

Reducing bruising and pain through enhancement of subcutaneous anticoagulant injection techniques: a best practice implementation project.

INTRODUCTION: Subcutaneous delivery of anticoagulant therapy is a common treatment modality across multiple medical disciplines. However, postinjection complications of bruising and pain continues to be a problem that has the propensity to affect patients physically and psychologically. A review of literature revealed a set of recommended injection techniques that have shown to improve these clinical outcomes. OBJECTIVES: The project aims to utilize an evidence implementation framework to introduce evidence-based injection technique, for the reduction of postinjection complications. METHODS: A best practice implementation project was administered across three adult- cardiology and cardio-thoracic general wards in Singapore from March 2018 to February 2019. The Joanna Briggs Institute (JBI)'s framework of evidence implementation was utilized to enable change. A baseline audit was carried out to ascertain existing injection practices. Guided by the latest evidence, a new subcutaneous injection workflow was created and disseminated. Follow-up audits were held at 1 and 8-month postimplementation to assess compliance to the new subcutaneous injection workflow and the sustainment of change. Data were consolidated and analysed with the aid of JBI Practical Application of Clinical Evidence System. Barriers to change were also identified and addressed with the aid of JBI's Getting Research into Practice tool. RESULTS: A large variation of subcutaneous injection techniques was observed at the baseline audit. At 1-month postimplementation, overall compliance with the new subcutaneous injection workflow was assessed to be 73.3%. Criteria 2 and 3 of the JBI Practical Application of Clinical Evidence System audit criteria improved from the baseline values (9.1-80%; 0-93.3%). At 8-month postimplementation, compliance rate remained high (83%) following strategies to reinforce and sustain change. Participants complied to Criteria 1 at all stages of the project. Correspondingly, the incidence of bruising reduced from baseline, with a relative risk reduction of 52% (1 month) and 29% (8 months). Median pain also decreased from the baseline, with an improvement from 2.0 (1.0-3.0) to 0.0 (0.0-1.0). CONCLUSION: Introduction and sustainment of change requires careful planning and execution. JBI's framework of evidence implementation is an effective model to guide this process. This project also highlighted the value of continuous learning, clinical update and practice standardization. This is especially important in the current climate of nursing mobility worldwide and the associated practice variations based on nursing education and experience.

The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: a systematic review.

BACKGROUND: Advancements in technology and medical treatment have made cancer care treatment more complex. With the current trend of sub-specialization in health care, cancer patients commonly receive care from multiple specialists and have wider treatment options. In view of this, there is a need to coordinate care and integrate information to enhance care and quality of outcomes for patients. Since the successful implementation of programs for increasing the survival rate of breast cancer patients at Harlem Hospital Center, New York, USA, patient navigation programs have been widely introduced in healthcare settings. Some literature has identified nurses as a primary candidate in assuming the role of a navigator. However, there is a need to further explore the effectiveness of patient navigation programs for their effectiveness in improving quality of life, and patient satisfaction and outcomes during the commencement of cancer treatment. OBJECTIVES: The objective of this review was to synthesize the best available evidence on the effectiveness of patient navigation programs in adult cancer patients undergoing treatments such as radiotherapy and/or chemotherapy. INCLUSION CRITERIA: This review considered studies that included adults aged 18 years and over, diagnosed with any type of cancer and undergoing treatment in an acute care hospital setting, including inpatient and outpatient/ambulatory care.This review considered studies that evaluated nurse-led patient navigation programs versus no patient navigation program or non-structured care coordination.A patient navigation program includes patient education, psychosocial support, and care coordination.This review considered randomized controlled trials and quasi-experimental studies.The review focused on the effects of patient navigator program clinical/patient outcomes. The review included studies on patient wellbeing and clinical outcomes, but excluded studies that had examined the impact of these programs on efficiency-related outcomes, such as length of hospital stay and resource use. SEARCH STRATEGY: A three-step search strategy was utilized to find both published and unpublished studies in the databases: CINAHL, MEDLINE, Academic Search Complete, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar (SCIRUS), MEDNAR (first 200 hits) and ProQuest Dissertations and Theses published between 1990 to 2013. Only studies published in English were included in this review. METHODOLOGICAL QUALITY: Two reviewers independently evaluated the methodological quality of studies that met the inclusion criteria for the review, using a standardized critical appraisal instrument from the Joanna Briggs Institute. DATA EXTRACTION: Data was extracted from the included papers using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: Quantitative data was pooled in a statistical meta-analysis using Review Manager 5.3. Effect sizes expressed as weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Heterogeneity was assessed statistically using the standard Chi-square test. Where statistical pooling was not possible, the findings are presented in narrative form. RESULTS: After the process of study selection, four studies (two randomized controlled trials and two quasi-experimental studies) with a total of 667 participants were included in the review. The results demonstrated no statistically significant difference in the quality of life of patients with cancer who had undergone patient navigation programs (pooled weighted difference = 0.41 [95% CI = -2.89 to 3.71], P=0.81). However, the two included studies that assessed patient satisfaction as an outcome measure both showed statistically significant improvements (p-values = 0.03 and 0.001, respectively). In the study that assessed patient distress level, there was no statistically significant difference found between the: nurse-led navigation and non-navigation groups (P = 0.675). CONCLUSIONS: Nurse-led patient navigation programs were not effective in addressing outcomes such as quality of life and distress levels, the systematic review did not find any significant difference between the two groups. However, there was a statistically significance difference in increasing patient satisfaction.There is limited evidence that patient navigation programs improve the outcomes of quality of life and reduce distress (for adult patients with cancer undergoing treatment). However, there is good evidence that patient navigation programs improve patients' satisfaction. Therefore it is recommended that patient navigation programs are used for adult cancer patients in the acute care setting to improve patients' satisfaction.There may be a need to explore a more rigorous evaluation of nurse-led navigation programs to determine their effectiveness. Researchers should consider multi-site studies and larger sample sizes for better generalization.

Effectiveness of the Sitz bath in managing adult patients with anorectal disorders.

OBJECTIVE: The objective of this review was to critically analyze and systematically review the best evidence related to the effectiveness of the Sitz bath in managing adult patients with anorectal disorders. METHODS: The text terms were established and searched systematically from the relevant databases from 1990 to November 2009 in the English language. The eligible studies that were congruent with the review's inclusion criteria were selected. The selected studies were critically appraised for their methodological validity by two independent reviews and the data were extracted from the studies by using the Joanna Briggs Institute Systems Meta Analysis of Statistical Assessment and Review Instrument. The results were presented in narrative form because statistical pooling was not possible due to clinical heterogeneity. RESULTS: A total of four randomized controlled trials was included in the review. The use of the Sitz bath had no significant impact on reducing the overall intensity of pain and postoperative pain. Conflicting findings for postdefecation pain were reported. The Sitz bath had no impact on accelerating fissure or wound healing. However, the patients were satisfied with using the Sitz bath and no severe complication was reported. CONCLUSION: There was no strong evidence to support the use of the Sitz bath for pain relief and to accelerate fissure or wound healing among adult patients with anorectal disorders. However, the Sitz bath may be prescribed for patients' satisfaction.

Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital.

BACKGROUND: Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube. AIM: The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting. METHOD: The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals. RESULTS: Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the practice change was implemented reported 26 (50%) observations of NG tube feeding in 26 audit wards. The key areas of practice change in feeding when tube placement was confirmed (84.6%) and proper testing of aspirate (76.9%) showed good compliance. CONCLUSION: The implementation of the change in the practice of confirming the correct placement of the NG tube in patients requires good coordination and a multidisciplinary team approach.

The experience of being a neutropenic cancer patient in an acute care isolation room: a systematic review of qualitative evidence.

BACKGROUND: Protective isolation is one of the precautionary measures put in place for neutropenic cancer patients, where patients will be placed in an isolation room during their medical treatment in the hospital. The purpose of this practice is to minimise neutropenic patients from contracting nosocomial infection and the length of stay in the isolation room varies depending on their medical condition. It has been reported in some literature that this group of patients experience social isolation, a wide range of emotions and psychological burdens such as depression and anxiety as a result of staying in the isolation room. Therefore, a systematic review on neutropenic cancer patients' experience in isolation room will add knowledge to the nursing science of providing high quality care for this particular group of patients. OBJECTIVES: The objectives of this review are to understand neutropenic cancer patients' experiences in the isolation room and their coping mechanisms. INCLUSION CRITERIA: The participants of interest were adults neutropenic cancer patients aged 18 years old and above.The phenomenon of interest i was the experience of neutropenic cancer patients who were nursed in an isolation room due to chemotherapy induced neutropenia or during the period of haematopoietic stem cell transplant.The studies of interests were are qualitative studies which focus on adult neutropenic cancer patients' experiences in an isolation room.The outcome of interest wai s patients' self reported experiences. SEARCH STRATEGY: An initial search to identify keywords was undertaken in MEDLINE and CINAHL. A second search using all identified keywords and index terms across the databases was performed subsequently. The final search included reference lists from included papers for additional studies. METHODOLOGICAL QUALITY: Six qualitative papers were included in this review. The papers were qualitative descriptive, phenomenological, qualitative exploratory and grounded theory. All the papers used interview as primary method to collect data except one study which had an additional art making directive method. DATA COLLECTION: Data were extracted using standardised data extraction tools from JBI-QARI. DATA SYNTHESIS: Categories were formed based on aggregation from the similar findings with like meaning. The categories were then read and reread to develop two synthesised findings that were presented as declamatory and generalisable statements to guide and inform clinical practice. RESULTS: Two syntheses were generated based on the meta-aggregation. The first synthesis was that health care workers need to be aware physical isolation could result in social isolation in patients that made them feel powerless. The second synthesis was that health care workers should encourage patients to use cognitive mechanisms to cope with isolation experiences. Family, friends and nurses should step in to provide help in any form whenever patients need it. CONCLUSIONS: Isolation room has a negative impact on the neutropenic cancer patients while they are hospitalised. However, they are coping effectively using cognitive mechanisms and receive adequate support externally.Offering patients more options especially having flexibility in their daily routine such as meal times could be a useful intervention to allow them to take some control. Notifying the patient in advance of their time of treatment and involving patients in their treatment care will promote their autonomy. Tracking the patients' coping mechanisms and offering support when necessary will ease the patients' isolation experience.The psychological effects of being cared for in isolation room may undermine the clinical benefits of infection control. Therefore, future research is needed to evaluate the effectiveness of isolation room in preventing neutropenic cancer patients from infection.