Abstract
BackgroundDespite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada.In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation.MethodsData were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period.ResultsFollowing the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies.ConclusionsFurther research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0120-1) contains supplementary material, which is available to authorized users.
Highlights
Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children
Study design This study focused on the 16 hospital units allocated to the Evidence-based Practice for Improving Quality (EPIQ) intervention
Effectiveness of evidence-based Knowledge translation (KT) strategies At the completion of the four EPIQ intervention cycles: 18/23 (78%) pain practice aims were met, exceeded, or came within 80% of achievement, while 5/23 (22%) aims were less than 80%; 92% of the pain assessment aims were attained or came within 80% compared to 64% of the pain management aims
Summary
Institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. Pain assessment and management practices for hospitalized children remain sub-optimal, despite significant research, best practice guidelines, and institutional policies. Based on the results of 33 systematic reviews, Prior et al [4] reported that the most effective KT strategies included the use of multifaceted interventions, such as interactive education sessions and clinical reminder systems. Some studies highlight the importance of contextualizing strategies to meet this need [6]
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