Article type
Abstract
Introduction and Objective
A one-year study (March 2021 to March 2022) was conducted to implement evidence-based best practices for pressure injury (PI) prevention in the intensive care unit (ICU) of a 357-bed hospital in Japan. In this study, the status of baseline practices was audited to identify potential barriers to best practices, and the strategies to overcome these barriers were applied and evaluated for their effectiveness in improving best practice compliance.
Methods
This study used the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRIP) clinical audit and feedback tools. Based on the recommendations made within the JBI Evidence Summary, eight evidence-informed audit criteria were determined and used to identify possible barriers to best practices. These barriers were used to inform the strategies for improvement, which were implemented over 12 weeks. The same criteria as those used for baseline audit were applied post-implementation to evaluate changes in compliance with best practices.
Results
At baseline, the percent compliance rates for Audit Criteria 1 (valid patient assessment), 2 (skin assessment within 2 hours of ICU admission), and 4 (nutritional screening and assessment) were 90%, 100%, and 87%, respectively, whereas those for Audit Criteria 3 (skin assessment at repositioning and shift change), 5 (nutritional interventions for patients with PI risks), 6 (repositioning at least every 2 hours), 7 (additional interventions for patients at risk of pressure injury), and 8 (patient and caregiver education ) were 36%, 3%, 3%, 50%, and 0%, respectively. Post-implementation compliance rates increased for Audit Criteria 1, 4, 5, and 8, but decreased for Criteria 2, 3, 6, and 7 .
Conclusions
The strategies developed per the GRIP method improved compliance with several Audit Criteria. Importantly, this study improved the quality of practice and knowledge of the ICU nurses who participated. This study also suggests the need to take cultural background and mindset into consideration when using self-report surveys to assess nurses’ occupational performance and self-efficacy. The understanding and support of management and team leads are necessary to instill and maintain evidence-based nursing practices.
A one-year study (March 2021 to March 2022) was conducted to implement evidence-based best practices for pressure injury (PI) prevention in the intensive care unit (ICU) of a 357-bed hospital in Japan. In this study, the status of baseline practices was audited to identify potential barriers to best practices, and the strategies to overcome these barriers were applied and evaluated for their effectiveness in improving best practice compliance.
Methods
This study used the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRIP) clinical audit and feedback tools. Based on the recommendations made within the JBI Evidence Summary, eight evidence-informed audit criteria were determined and used to identify possible barriers to best practices. These barriers were used to inform the strategies for improvement, which were implemented over 12 weeks. The same criteria as those used for baseline audit were applied post-implementation to evaluate changes in compliance with best practices.
Results
At baseline, the percent compliance rates for Audit Criteria 1 (valid patient assessment), 2 (skin assessment within 2 hours of ICU admission), and 4 (nutritional screening and assessment) were 90%, 100%, and 87%, respectively, whereas those for Audit Criteria 3 (skin assessment at repositioning and shift change), 5 (nutritional interventions for patients with PI risks), 6 (repositioning at least every 2 hours), 7 (additional interventions for patients at risk of pressure injury), and 8 (patient and caregiver education ) were 36%, 3%, 3%, 50%, and 0%, respectively. Post-implementation compliance rates increased for Audit Criteria 1, 4, 5, and 8, but decreased for Criteria 2, 3, 6, and 7 .
Conclusions
The strategies developed per the GRIP method improved compliance with several Audit Criteria. Importantly, this study improved the quality of practice and knowledge of the ICU nurses who participated. This study also suggests the need to take cultural background and mindset into consideration when using self-report surveys to assess nurses’ occupational performance and self-efficacy. The understanding and support of management and team leads are necessary to instill and maintain evidence-based nursing practices.