Audit Criteria Research Articles

Introducing multidisciplinary ward rounds in Malawi: a best practice implementation project.

The Royal College of Physicians (RCP) and the Royal College of Nursing (RCN) in the United Kingdom advocate the use of structured multidisciplinary team (MDT) ward rounds since they can enable safe, effective, improved care and enhanced staff satisfaction. This project sought to implement best practices for MDT ward rounds in a male medical ward in a hospital in Malawi. The project was conducted in line with the JBI Evidence Implementation Framework. A baseline audit of MDT ward rounds was conducted with six staff members. Audit criteria consisted of ten best practices, as recommended by JBI, the RCP, and the RCN. Stakeholder meetings were held to review the baseline audit results and highlight areas of non-compliance. JBI's Getting Research into Practice (GRiP) tool was used to identify barriers to compliance with best practices, and a follow-up audit was conducted to determine changes in practice. The results only showed improvement for one criterion, which rose from 33% to 100% (n=6) where nurses attended the ward round. This study demonstrated some challenges in evidence implementation projects and how these can, in part, be overcome. While the results only demonstrated improvement for one criterion, this paper shows how audits can be used to promote best practice, which in this case resulted in nurses being more involved in ward rounds, improvements in MDT communication, enhanced nurse inclusion in decision-making and, consequently, patient care. http://links.lww.com/IJEBH/A233.

Frailty management in older patients: a best practice implementation project

ABSTRACT Introduction: Frailty in older adults can lead to a gradual decline in organ function. Without timely diagnosis and intervention, this condition can progress rapidly, increasing the risk of disability and mortality. Objectives: The aim of this project was to implement evidence-based practices for managing frailty in the medical ward to prevent disability in older patients. Methods: This project was conceptually informed by the JBI Evidence Implementation Framework. This framework uses an audit and feedback approach and a pre- and post-test design to measure baseline compliance, develop implementation strategies responsive to gaps in compliance, and conduct a final evaluation to measure changes in compliance. JBI PACES and JBI GRiP situational analysis software were used to support data collection and implementation planning. Ten audit criteria were used with a sample of 30 patients in a regional teaching hospital in southern Taiwan. Results: The baseline audit showed poor compliance, with rates below 30% for all ten audit criteria. Through strategies such as professional training and education, the implementation of evidence-based care guidelines, and interdisciplinary consensus-building, the follow-up audit revealed an increase in compliance to over 90% for each audit criterion. Conclusions: Frailty management strategies based on evidence-based audit criteria were implemented and routinely measured. The most effective strategies for improving compliance included the development of a training course, a digitized assessment tool, team meetings, interdisciplinary collaboration, communication, and consensus-building. Spanish abstract: http://links.lww.com/IJEBH/A225

Fall assessment and intervention among community-dwelling older people in a primary health care center in Spain: a best practice implementation project.

The implementation of fall prevention programs in the community is complex. Although there is solid scientific evidence that supports the effectiveness of such programs, there are multiple barriers that should be addressed using multifaceted strategies. The aim of this project was to increase compliance with evidence-based recommendations regarding fall risk screening and preventive interventions among older adults in a primary health care setting. This project used a pre-/post-implementation clinical audit based on the JBI Evidence Implementation Framework. Eight audit criteria were derived from JBI evidence summaries. The sample size was 62 patients aged 70 years or older. Data collection methods included a review of medical records and a questionnaire. A baseline audit was conducted and five barriers to best practice were identified. Strategies were then developed to increase compliance with the evidence-based recommendations, guided by JBI's Getting Research into Practice (GRiP) analysis. A follow-up audit was conducted in July 2022 to evaluate changes in compliance with best practices. The baseline audit showed 0% compliance with best practice recommendations for seven out of eight audit criteria. Five barriers were identified: (1) absence of fall risk screening tools, (2) lack of fall prevention intervention protocols, (3) insufficient reporting of fall episodes in the records, (4) need for staff training, and (5) high staff turnover. Following the implementation of a fall risk assessment and intervention protocol, along with staff training, seven out of eight audit criteria increased from 0% to between 22.6% and 100%. This evidence-based implementation project improved nursing practice in relation to compliance with best practice interventions to prevent falls. http://links.lww.com/IJEBH/A229.

Positive Impact of Audit Quality on Sharia Banks

Sharia banking can thrive by using the company's financial success, which is closely aligned with the audit process. The purpose of the audit task is to acquire evidence and assess it impartially to determine if the audit criteria are satisfied, so ensuring a high-quality audit and preventing fraud. Subsequently, a study was conducted to ascertain the influence of ethical factors and auditor expertise on the level of audit excellence in the financial statements of Islamic banks in Banda Aceh. The research employed a quantitative approach, utilizing the multiple linear regression model for data analysis. The primary data was collected through a questionnaire and processed using IBM Statistics to test statistical hypotheses. The study findings indicate that both ethical factors and audit experience have a favorable influence on the quality of audits conducted by Islamic institutions.

Education of adult type 1 diabetes patients in a diabetes ward setting: a best practice implementation project.

Type 1 diabetes is an autoimmune disease that destroys insulin-producing cells in the pancreas. Education is the cornerstone of effective diabetes care. In this implementation project, we aimed to improve compliance with best practices regarding type 1 diabetes educational interventions for adult hospitalized patients. This project was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted involving 20 nurses and 20 type 1 diabetes patients who received regular educational measures. Areas of non-compliance were identified and an improvement strategy was implemented. A follow-up audit was then conducted to evaluate the effectiveness of the improvement strategy. The project was conducted in Poland in 2021 in a tertiary referral unit that specializes in the diagnosis and treatment of diabetes. Substantial improvements were noted for all audit criteria after the implementation of strategies to address areas of non-compliance. Use of the education program improved from 0% to 100%. Compliance regarding patients receiving handouts and personalization of the program increased to 100%. We observed a significant improvement from 0% to 80% in the structuring of the program content. This project successfully improved the quality of education provided for type 1 diabetes patients in all relevant areas. We devised an education program, covering important aspects of diabetes education, with the patients reporting increased satisfaction with the personalized educational measures during their hospital stay. http://links.lww.com/IJEBH/A215.

Compression therapy in patients with venous leg ulcers: a best practice implementation project.

Venous leg ulcers are the most common ulcerations of the lower extremities. Compression is the most important consideration and the gold standard treatment for venous leg ulcers. This implementation project aimed to promote best practices in the management of venous leg ulcers in a rural community-care setting. This project was guided by the JBI Evidence Implementation Framework, which is grounded in audit and feedback processes, along with a structured approach to identifying and managing barriers to compliance with recommended best practices. Compliance with best practices increased for most audit criteria. The use of compression therapy increased from 16.7% to 60%, documentation increased from 6.7% to 50%, replacement of compression bandages from 6.7% to 60%, patient education from 0% to 46.7%, and holistic assessment from 0% to 13%. However, compliance for individualized interventions to promote adherence remained at 0%. This project succeeded in introducing compression therapy as a basic treatment for venous ulcers. However, continued improvement in the care for venous ulcers and guarantee of long-term implementation of evidence are necessary. http://links.lww.com/IJEBH/A212.

Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.

This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India. Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs. This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months. The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance. This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence. http://links.lww.com/IJEBH/A211.

Sociodemographic reporting in videomics research: a review of practices in otolaryngology- head and neck surgery.

To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS). Narrative review. Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations. Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%. There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project.

Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. http://links.lww.com/IJEBH/A186.

Using the i-PARIHS theoretical framework to develop evidence implementation strategies for central venous catheter maintenance: a multi-site quality improvement project.

Evidence-based nursing practice can reduce complications associated with central venous catheters (CVCs). In this project, the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was considered an ideal theoretical instrument to identify facilitators and barriers to implementing evidence-based practice. The project was conducted in pediatric intensive care units in six Chinese tertiary children's hospitals. Twenty-two audit criteria were obtained from best practice recommendations, and a baseline audit was conducted to assess current practice against best practice. Next, the i-PARIHS framework was used to identify facilitators and barriers to best practice and develop improvement strategies. A follow-up audit was then conducted to measure changes in compliance with best practices. Facilitators and barriers were identified at the innovation, recipient, and context levels. A comprehensive CVC maintenance strategy was then developed to apply the best evidence to nurses' clinical work. Of the 22 audit criteria, 17 showed significant improvement compared with the baseline audit. The i-PARIHS framework is an effective tool for developing targeted, evidence-based improvement strategies and applying these to the clinical setting. The quality of the nurses' clinical practice improved during CVC maintenance. However, there is no certainty that these positive results can be maintained, and long-term data are needed to verify this. http://links.lww.com/IJEBH/A185.

Adolescent school-based mental health screening: a best practice implementation project.

More than one in ten people globally live with a mental health illness. Adolescent mental health is a major contributor to that statistic, as 27% of adolescents have one or more mental, emotional, developmental, or behavioral problems. School-based health care clinics can provide mental health services for this age group. This project aimed to promote evidence-based practices regarding adolescent mental health screening in schools. This project used the JBI Evidence Implementation Framework to promote evidence-based practices for adolescent mental health screening in schools. The JBI framework is grounded in an audit and feedback process, along with a structured approach to identifying and managing barriers to compliance with best practices. Five audit criteria representing best practice recommendations were developed. A baseline audit was conducted, followed by the implementation of an improvement strategy. The project was finalized with a follow-up audit to determine any changes in compliance with best practice recommendations. The baseline survey of students revealed a 25% average compliance for audit criteria 1 and 2. The primary barrier to compliance was students' unawareness of the availability of mental health services. The improvement strategy included an educational presentation for students regarding mental health. The follow-up audit revealed an increase in compliance with best practices. The project achieved a 29% increase in compliance with best practices, although only 23% of the students were reached via the improvement strategy. http://links.lww.com/IJEBH/A189.

Early enteral nutrition support for patients with acute pancreatitis in the inpatient setting: a best practice implementation project.

Acute pancreatitis is a major disease that endangers the health and lives of people. Historically, clinical therapy has recommended. that patients with acute pancreatitis remain nil by mouth. As one of the therapies recommended in recent guidelines, early enteral nutrition support reduces the incidence of infectious complications and reduces the risk of severe conditions. However, early enteral nutrition support has not been optimally implemented within clinical practice for acute pancreatitis inpatients. This evidence implementation project aimed to increase compliance with best practice recommendations for early enteral nutrition support, while standardizing the enteral nutrition support process and reducing the incidence of delayed enteral nutrition. The project was guided by the JBI Evidence Implementation Framework, which is grounded in the audit and feedback process, as well as a seven-stage structured approach to identifying and managing barriers to compliance with recommended practices. In the baseline audit, compliance rates were low for all evidence-based audit criteria. Four of the eight criteria showed 0% compliance. However, after implementation, all eight criteria achieved a minimum compliance rate of 60%, with Site 2 achieving 90% to 100% compliance. In addition, nurses improved their knowledge and skills in early enteral nutrition support. The incidence of delayed enteral nutrition also fell from 86.2% to 20.7% at both study sites. The implementation strategy included a training program, psychological interventions, and financial and human resource support. This project not only significantly improved early enteral nutrition support for acute pancreatitis patients, but also increased nurses' knowledge and practice skills, standardized the process of enteral nutrition support, and reduced the incidence of delayed enteral nutrition. http://links.lww.com/IJEBH/A177.

The current standard of the shoulder trauma series in Ireland – A national audit

Objectives/aimsThe primary aim of this study was to assess the current standard of shoulder radiographs in Ireland. The secondary aim of this study was to determine whether orthopaedic surgeons in Ireland are of the opinion that a national protocol is required, and what this protocol should consist of. MethodsA national audit of shoulder trauma series x-rays performed in emergency departments was conducted. The number and type of views performed was recorded. The anteroposterior (AP) and axillary or Velpeau views were assessed to determine if they met pre-defined audit criteria. Consultant orthopaedic surgeons working in public trauma hospitals were invited to participate in an online survey by email. ResultsThe number of shoulder trauma series included in this audit was 789. The majority of patients had two views performed (75.92%, n ​= ​599) and 21.17% (n ​= ​167) had an axillary or Velpeau view. The AP view met the audit criteria in 23.09% (n ​= ​181) of cases. The survey response rate was 70.8% (n ​= ​17). 88.2% (n ​= ​15) of surgeons agreed that three views should be performed for a shoulder trauma series and 94.12% (n ​= ​16) agreed that an axillary or Velpeau view should be included. The majority of surgeons surveyed (94%, n ​= ​16) are in favour of establishing a national protocol. ConclusionThe current standard shoulder trauma series in Irish hospitals consists of two views, most frequently a thoracic AP and a scapular Y view. We propose the introduction of a national protocol consisting of three views: Grashey AP, Scapular Y, and an axillary or Velpeau view.

A Quality Improvement Project to Measure and Improve the Quality of Below-Knee Ankle Cast Application in Emergency Departments.

Background Ankle fractures are very common injuries seen in an emergency setting. Initial management involves the application of below-knee plaster casts. At our local trauma meetings, we have observed that below-knee casts are often applied incorrectly which can result in suboptimal outcomes for patients and increase the burden on plaster room services if re-application is required. This quality improvement project aimed to assess the quality of below-knee cast applications for ankle fractures in two local district general hospitals (DGHs). Methodology We performed a closed-loop audit utilising a retrospective analysis of patients who underwent casting for unstable ankle fractures. Two audit cycles were completed over a 90-day period across two DGHs. Working within our local orthopaedic unit, we created a targeted, multi-disciplinary educational programme led by experienced plaster technicians. Between audit cycles, we organised a single interactive session with specialist nurses in the urgent treatment centre (UTC) of our DGH while a second DGH did the same with junior doctors working in the emergency department. Both sessions demonstrated correct casting techniques and discussed the importance of a neutral ankle position for optimal patient recovery. Our audit criteria were based on AO Foundation guidance, which states that the ankle should be immobilised in a neutral plantigrade position. All patients with an unstable ankle fracture requiring immobilisation in a below-knee cast were included in the audit. We measured the angle of plantarflexion from neutral, with 90° representing a neutral angle. The angle between the axis of the tibia and the sole of the foot was measured and judged to be within an acceptable range if it was between 80° and 100°, representing a stable ankle position. The audit findings were presented in our local audit meeting. Results In our first audit cycle, we collected data from 65 patients across both sites (N = 32 for DGH 1 and N = 33 for DGH 2). The mean angle was 108.5° and 18 of the 65 (27.7%)patients had angles of ankle plantarflexion that were in the acceptable range (80°-100°). Following the intervention, we again collected data from 61 patients across both sites (N = 28 for DGH 1 and N = 33 for DGH 2). The mean angle was 106.2° and 23 of the 61 (37.7%)patients had an acceptable angle of ankle plantarflexion (80°-100°). Both of our outcome measures showed an improvement but were not statistically significant. The hospital that provided an educational session for the doctors showed an improvement in acceptable ankle casts of 3% while the hospital which provided an educational session for the UTC team improved by 22%. Conclusions We demonstrated a quantifiable approach to assess and improve the quality of below-knee cast application for ankle fractures via a single intervention that would be easily reproducible in other hospitals. We suggest further studies to investigate below-knee cast application quality and its association with patient outcomes as our data and other preliminary sources suggest that current standards are unsatisfactory.

Rehabilitation exercises for kidney transplant recipients in an organ transplant ward: a best practice implementation project.

Kidney transplantation is an effective treatment for end-stage kidney disease. Kidney transplant recipients (KTRs) are prone to experiencing reduced physical function, depression, fatigue, and lack of exercise motivation due to their sedentary lifestyle before surgery. Exercise is an effective intervention for KTRs, but it has not been properly implemented in many practice settings. This project aimed to promote evidence-based exercises as part of KTRs' rehabilitation to improve their health outcomes. This project was informed by the JBI Evidence Implementation Framework. The project was conducted in the organ transplant ward of a tertiary comprehensive hospital in Changsha, China. Based on a summary of best evidence, 12 audit criteria were developed for the baseline and follow-up audits involving 30 patients and 20 nursing staff. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool were used to identify barriers and facilitators and develop targeted strategies to improve issues. Compared with the baseline audit, significant improvements were achieved in most of the criteria in the follow-up audit, with 9 of the 12 criteria reaching 100% compliance. Notably, the 6-minute walk distance test results were significantly higher, while the Self-Rating Depression Scale and Self-Rating Anxiety Scale scores were significantly lower ( p < 0.05). This project demonstrates that evidence-based practice can improve the clinical practice of rehabilitation exercises for KTRs. The GRiP strategies proved to be extremely useful, notably, the formulation of a standardized rehabilitation exercise protocol, training, and enhancement of the exercising environment. Head nurses' leadership and decision-making also played an important role in the success of this project. http://links.lww.com/IJEBH/A180.

Oral hygiene in critically ill patients at a tertiary hospital in São Paulo, Brazil: a best practice implementation project.

This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil. The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs. This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit and (7) consideration of the sustainability of changes in practice. Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement. This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients. http://links.lww.com/IJEBH/A175.

Palliative care communication with stroke patients: a best practice implementation project.

Stroke patients frequently experience debilitating deficits, and some receive a terminal diagnosis. Palliative care services are introduced to prioritize care, with the goal of improving quality of life. However, palliative care communication (PCC) is often delayed or used inefficiently with stroke patients. This project aimed to promote PCC evidence-based practices (EBPs) with stroke patients. This project used the JBI Evidence Implementation Framework to improve compliance with PCC EBPs with stroke patients in a medical center in Mississippi, USA. Four EBPs were identified from a JBI evidence summary and used as audit criteria. A baseline audit was conducted to measure compliance of current practice with best practice. Barriers to EBPs were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine compliance changes. The baseline audit revealed 53% to 80% compliance with the four EBPs. Barriers to EBPs included lack of health care professionals' knowledge regarding EBPs; lack of PCC, miscommunication, or delayed PCC with patients regarding hospitalization timeline and quality of life; and no standardized documentation or location for PCC within the electronic health record. Improvement strategies included a PCC education program for health care professionals and a concise statement and validation checkbox to the "progress note" in the electronic health record to promote daily PCC with patients. The follow-up audit revealed 20% to 34% compliance rate improvement with EBPs. Annual PCC training should be conducted for health care professionals. Implementing PCC through a multidisciplinary approach can promote more meaningful discussion and efficient decision-making, prioritizing patients' quality of life. http://links.lww.com/IJEBH/A174.

Prevention and management of enteral nutrition-related diarrhea among adult inpatients: a best practice implementation project.

Diarrhea, the most common complication for patients during enteral nutrition, poses a range of risks and care burdens. Medical staff are aware of the importance of proactively preventing and managing enteral nutrition-related diarrhea. However, clinical prevention and management methods are not standardized, and the scientific basis and effectiveness of these methods need to be further verified. This project aimed to promote evidence-based practices for the prevention and management of enteral nutrition-related diarrhea among adult inpatients in a public tertiary hospital in China. This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tools. Twelve audit criteria were developed to conduct a baseline audit to measure compliance with best practices. A barrier analysis was conducted, and strategies were implemented to overcome the barriers. The project was finalized with a follow-up audit to determine any changes in compliance with best practices. The overall compliance rate for the audit criteria increased from 27.37% at baseline to 89.62% in the follow-up audit, with six criteria achieving a compliance rate of 100%. The implementation of evidence-based practices can effectively narrow the gap between current practice and best practice. This project improved the ability of medical staff to prevent and manage enteral nutrition-related diarrhea, as well as promoting evidence-based practice in the hospital. http://links.lww.com/IJEBH/A168.

Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project.

Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan. This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance. After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%. The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline. http://links.lww.com/IJEBH/A171.

Development of a Framework for Risk-Based Integrated Safety Audit to Enhance Construction Safety Performance

Presently, there is a notable surge in infrastructure development, leading to a heightened occurrence of accidents within the construction sector. This trend has positioned the construction industry as one of the most accident-prone areas compared to other sectors. This suggests that the current construction safety audit procedures have not proven effective in preventing accidents. Typically, audits are conducted primarily during the construction phase, with infrequent assessments during the design phase. According to the Szymberski theory, actions taken during the design phase significantly influence the occurrence of accidents more than those taken during construction. Previous research has discussed a lot about safety management systems. However, it has not discussed how to assure the quality of its implementation. Considering this, the research aims to (a) identify the processes, elements, activities, sub-elements, objectives, criteria, and risks associated with construction safety audits and (b) formulate an integrated, risk-based audit process covering both the design and construction phases. This qualitative research employed the Delphi method to gather insights from construction safety experts, and the developed audit process utilized a risk management approach. The resulting audit process integrates principles from ISO 19011:2018 and Regulation of the Minister of Public Works and Housing Number 10 of 2021. The findings revealed 34 activities in audit program management, 34 activities in audit implementation, and 32 sub-elements in audit criteria. These components are incorporated into a comprehensive construction safety audit framework, organizing audit processes, activities, and criteria. This framework underscores that improving construction safety performance is not solely confined to the construction phase but extends to the design phase as well. The audit results serve as a foundation for continuous improvement, aiding in enhancing safety performance and preventing accidents within the construction industry. Doi: 10.28991/CEJ-2024-010-03-08 Full Text: PDF