Evidence-based Toolkit Research Articles

Reducing Alcohol Related Harm - Evidence-based Good Practices Tool Kit

Reducing Alcohol Related Harm - Evidence-based Good Practices Tool Kit

To Eat or Not to Eat: Managing Dysphagia at End of Life (FR435)

•Understand how the anatomy and physiology of the swallow mechanism is impacted by compensatory swallow techniques.•Identify evidence-based considerations for patients choosing PO intake despite risk for aspiration pneumonia.•Understand the role of the speech-language pathologist in management of patients with dysphagia receiving palliative services across the lifespan. Dysphagia is a common diagnosis for many of our patients nearing end of life. Our goal within the session is to empower physicians along with other helping professionals to improve management of patients with swallow disorders receiving palliative services. We will help to develop a better understanding of the anatomy and physiology of the swallow mechanism to improve use of bedside compensatory swallow techniques as well as outline the patient populations that are appropriate for PO intake at end of life. As speech-language pathologists, we will outline our role to assist and develop an evidence-based toolkit with strategies to improve comfort with eating/drinking, reduce aspiration risk, and further prevent pulmonary disease.

Improving the Patient Experience in the Urology Office: An Evidence-Based Tool Kit to Impact Staff Perception Of Patient Satisfaction

Researchers evaluated the effectiveness of an educational intervention, which included use of an evidence-based tool kit for healthcare providers to improve patient satisfaction. Findings demonstrated improved staff perceptions of their actions influencing patient experiences, use of standardized patient care processes, and increased patient experience scores.

Placing Evidence-Based Interventions at the Fingertips of School Social Workers.

Through a university-community collaborative partnership, the perceived needs of evidence-based practices (EBPs) among school social workers (SSWs) in a large school district in central Florida was assessed. A survey (response rate = 83.6%) found that although 70% of SSWs claim to use EBPs in their everyday practice, 40% do not know where to find them, which may partially explain why 78% of respondents claim to spend 1 to 4h every week looking for adequate EBPs. From this needs assessment, the translational model was used to address these perceived needs. A systematic review of the literature found 40 tier 2 EBPs, most of which (23%) target substance use, abuse, and dependence. After discussion with academic and community partners, the stakeholders designed, discussed, and implemented a searchable, online, password-protected, interface of these tier 2 EBPs, named Evidence-Based Intervention Toolkit (eBIT). Lessons learned, future directions, and implications of this "one-stop shop" for behavioral health are discussed.

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community.

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities.

Delivering Better Oral Health: what the third edition offers

Sue Gregory OBE examines the third edition of Delivering Better Oral Health: An Evidence-based Toolkit for Prevention and how this can aid dental nurses in delivering oral health education

Embracing an evidence-based toolkit for prevention – personal accounts

Recent changes in healthcare include a shift from mainly restorative or operative-focused healthcare towards more preventive models of patient care. Oral diseases are common and yet largely controllable, thus it is increasingly a priority for dental professionals to support patients in order to promote good health and control disease in an evidence-informed manner. The publication of the first edition of Delivering Better Oral Health – An Evidence-based Toolkit for Prevention, in England in 2007, 1 was an important milestone in this process. It provided dental practitioners in England with a clear synthesis of contemporary evidence. These practical guidelines, now updated, offer the potential for consistency in practice and emphasize the importance of delivering preventive dentistry for everyone in the population, together with special measures for high-risk patients. Clinical Relevance: This article provides an overview of the key messages in Delivering Better Oral Health and explores how these evidencebased guidelines may be implemented by dental professionals across education, policy and practice, based on personal examples from previous editions. 1 , 2 This article is of relevance for all dental professionals and can act as a guide to implementing the recently published updated Toolkit. 3

Improving Depression Care Through an Online Learning Collaborative.

Depression is a leading cause of disability worldwide, and many internists diagnose and treat depression. This study aimed to examine the impact of a practice improvement intervention on screening and managing patients with depression in primary care. This pre-post study design included a physician practice survey designed to capture what the physicians believed they were doing in practice, a chart audit tool to capture what physicians were actually doing in practice, and an intervention that included an evidence-based educational program, online toolkit, and practice improvement coaching conference calls that promoted group learning. Following completion of the intervention, participants increasingly used the Patient Health Questionnaire-9 to detect, diagnose, and gauge treatment success for depression and reported increased use of guidelines and team-based care. Although barriers to improving depression care exist, this study suggests that evidence-based quality improvement programs can positively affect practice.

Empowering parents for evidence-based fever management: An integrative review.

Many parents of young, febrile children lack evidence-based tools to manage fever (knowledge, skills, confidence, support), fear negative outcomes, and prioritize the reduction of fever over management of its source. This review examines the literature for evidence of factors that must be considered when designing effective fever management educational interventions for parents, especially those whose health literacy is low. A systematic search identified studies from 1980 to 2011 using the databases PubMed, CINAHL, Embase, Cochrane Review, Web of Science, PsychInfo, Medline Plus, Joanna Briggs Institute, and Google Scholar. The most effective educational interventions are 1:1, multidimensional, structured, relevant, and reinforced over time. Parental culture, health literacy, knowledge deficits, and beliefs must be addressed by nurse practitioners (NPs) to maximize evidence-based behaviors. Parents often strive to do what is best for their child but may become overly protective and anxious when managing their child's fever. NPs have a prime opportunity to improve parents' fever management practices. An evidence-based toolkit, created with respect for those who may have low health literacy, will give parents tangible tools to help them provide safer and less costly care for their febrile child.

Improving surgical ward care: development and psychometric properties of a global assessment toolkit.

To develop a toolkit that covers the clinical, nontechnical, and empathic skills required for effective, safe surgical ward care. Despite the explosion of interest in patient safety, little attention has been placed on the skill set required for safe and effective surgical ward care. Currently, there is a lack of a systematic approach to improving ward care via assessing and improving residents' ward care skills. A comprehensive evidence-based and expert-derived toolkit was developed, including a novel clinical checklist for ward care (Clinical Skills Assessment for Ward Care: C-SAW-C); a novel team assessment scale for wards rounds (Teamwork Skills Assessment for Ward Care: T-SAW-C); and a revised version of a physician-patient interaction scale (Physician-Patient Interaction Global Rating Scale: PP-GIS). Interassessor reliability (κ, intraclass correlation), internal consistency (Cronbach α), and convergent validity (Pearson r correlations) were evaluated statistically in 38 simulated scenarios (during which a patient rapidly deteriorated) involving 185 residents. Excellent interassessor reliability was obtained for C-SAW-C [median κ = 0.89; median intraclass correlation coefficient (ICC) = 0.94], T-SAW-C (median ICC = 0.99), and the revised PP-GIs (κ = 1.00; ICC = 0.98 or higher). Internal consistency was also very high for all team skills assessed by T-SAW-C (Cronbach α range 0.87-0.94 across 6 skills) and the revised PP-GIS (Cronbach α = 0.96)-all P's < 0.001. Significant positive correlations were obtained between the 3 assessments (r = 0.73-0.92, P < 0.001) thus showing evidence for convergent validity. We developed a toolkit that captures comprehensively the skills that are required for safe and effective ward care, including the high-risk situation where a patient decompensates. The toolkit offers a systematic evaluation of the quality and safety of surgical ward care and can be used to train and debrief residents' skills and performance.

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

PurposeTo increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial. MethodsTwenty primary care practices treating children (range for n=536–8183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months–18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010–2011 and 2011–2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes. ResultsOverall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P<0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms – 8/10 Intervention (all P<0.001) and 7/10 Control sites (P-values=0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child's likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR]=1.29; 95% confidence interval [CI]=1.23–1.34), having commercial insurance (OR=1.30; 95%CI=1.25–1.35), higher pre-intervention practice vaccination rate (OR=1.25; 95%CI=1.16–1.34), and being in the Intervention arm (OR=1.23; 95%CI=1.01–1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates. ConclusionsImplementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates.Clinical trial registry name/number: From Innovation to Solutions: Childhood Influenza/NCT01664793.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol.

BackgroundCare of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice.ObjectivesTo systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework.Methods1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign.DiscussionInterprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.

The role of evidence in humanitarian assessment: the Seed System Security Assessment and the Emergency Market Mapping and Analysis

This paper reviews advances in the development and use of two evidence-based assessment toolkits: the Seed System Security Assessment (SSSA) and the Emergency Market Mapping and Analysis (EMMA). Both were created in the past five years and have been employed in a range of acute and chronic stress contexts across Africa, Asia, and parts of the Americas, in periods of civil strife, displacement, and drought, as well as following earthquakes, flooding, and political instability. The aims of this paper are threefold: to review advances with regard to each tool; to compare how each toolkit gathers and uses evidence, while considering possibilities for greater complementarity; and to reflect on the nature of 'evidence' used to guide humanitarian response in sudden-onset and chronic crisis situations. A comparison highlights the importance of triangulation and informed analysis for drawing conclusions from imperfect evidence, understanding the limitations of each assessment methodology, and confronting tacit assumptions.

An Implementation Evaluation of the Community Engagement and Planning Intervention in the CPIC Depression Care Improvement Trial

The goal of this paper is to document and evaluate the process of implementing an evidence-based depression intervention in community settings through the use of community-academic partnered approaches. We discuss how and to what extent the goals of community engagement and collaborative planning were achieved in the intervention arm of the Community Partners in Care study that aimed to adapt evidence-based depression care toolkits for diverse agencies in Hollywood and South Los Angeles. We find that partnered research strategies have a potential to effectively engage community members around depression and involve them in intervention planning activities. Our results suggest that successful collaboration among diverse agencies requires that they understand what is expected of them, are comfortable with the role they choose to perform, and have organizational support to contribute to the project. To facilitate the development of collaborative relationships, time and effort should be devoted to explaining how collaboration among diverse agencies may take place.

Diagnostic uncertainty: dichotomies are not the answer

Over two decades ago, Alvan Feinstein, a leading figure in the development and evaluation of diagnostic research methods, argued that the binary ‘positive–negative’ framework used in test accuracy research is not representative of diagnostic decision making in clinical practice.1 In particular, he called for a move away from the dichotomisation of quantitative test scales (tests that are on a continuous or ordinal scale) and advocated an approach that allows for the explicit recognition of an ‘uncertain’ diagnostic outcome. Twenty years on and little progress has been made on this issue; reporting the accuracy of quantitative tests based on a single ‘optimal’ threshold continues to be common practice. Here we present how improving the methods for evaluating quantitative tests would be of greatest benefit to GPs, providing them with a better evidence-based toolkit of strategies for recognising and handling diagnostic uncertainty head-on. Summerton reported that failures relating to diagnosis account for nearly one-third of GP complaints.2 Diagnostic uncertainty is particularly rife in general practice due to a number of obstacles intrinsic to the clinical setting.3 First, the prevalence of serious disease is typically low in a community population, weakening the overall predictive value of diagnostic tests. Secondly, the majority of disease presenting in general practice is commonly in its early stages, when many ‘red flag’ symptoms are yet to evolve and departures from physiological normality are slight. Furthermore, many of the tests used are not disease-specific; they are typically predictive of a symptom that …

Using the delphi approach to identify priority areas for health visiting practice in an area of deprivation.

Families with children living in areas of high deprivation face multiple health and social challenges, and this high level of need has impacts on the work of health practitioners working in such areas. All families in the UK with children under five years have access to health visiting services, and health visitors have a key role in mitigating the effects of deprivation by addressing health needs through evidence based practice. This paper reports the first stage of a project in Tower Hamlets, London, an area of significant deprivation, which aims to develop an evidence-based toolkit to support health visitors in their practice with families. The first stage used a modified Delphi process to identify the priority health needs of families in the area between June and July 2012. The three-stage Delphi process involved 25 people: four health visitors, four other members of the health visiting service, and 17 representatives of other services working with families. A focus group event was followed by a second event where individuals completed a questionnaire ranking the 27 priorities identified in the first event. The consultation process concluded with participants completing a second questionnaire, by email, confirming or changing their prioritisation of the topics.

An evidence‐based toolkit for the development of effective and sustainable root cause analysis system safety solutions

Root cause analysis (RCA) after adverse events in healthcare is a standard practice at many institutions. However, healthcare has failed to see a dramatic improvement in patient safety over the last decade. In order to improve the RCA process, this study used systems safety science, which is based partly on human factors engineering principles and has been applied with success in other high-risk industries like aviation. A multi-institutional dataset of 334 RCA cases and 782 solutions was analyzed using qualitative methods. A team of safety science experts developed a model of 13 RCA solutions categories through an iterative process, using semi-structured interview data from 44 frontline staff members from 7 different hospital-based unit types. These categories were placed in a model and toolkit to help guide RCA teams in developing sustainable and effective solutions to prevent future adverse events. This study was limited by its retrospective review of cases and use of interviews rather than clinical observations. In conclusion, systems safety principles were used to develop guidelines for RCA teams to promote systems-level sustainable and effective solutions for adverse events.

The conflict pathway: a model to address conflict in paediatric practice

Aims Disagreements over treatment decisions in paediatrics and in particular withholding or withdrawal of life sustaining care, are costly, time consuming and traumatic for all involved. This project seeks to identify if such conflicts follow an identifiable path in order to provide clinicians with a practical model for recognising and managing them. Method Participants were recruited through hospitals and hospices. Extreme-case sampling was used to identify 46 individuals who had direct experience of conflict at the interface of acute and palliative care including physical assault and court proceedings. 9 parents, 18 consultants, 9 nursing staff, 2 medical trainees, 2 lawyers, 3 religious leaders, and 1 ethicist were interviewed individually or in pairs. A further 100 professionals and families contributed to identifying trigger points for conflicts in general paediatrics, through a wide range of teaching sessions in hospitals and hospices. Interviews and triggers were transcribed and analysed for common themes and trends. Ethics approval was obtained and the study funded by a grant from the Department of Health. Results Data analysis identified key warning signs for the escalation of conflicts. Clearly identifiable events and behaviours by both clinicians and families were grouped into Green, Amber and Red stages of escalation. Further study of the data together with an analysis of Glasl9s 9 Stage Model of Conflict Escalation suggested that differing methods of conflict management would be appropriate at each stage. Thus events in the Green Zone could be managed by those within the team, conflicts within the Amber Zone might be resolved by an independent third party, for example a mediator, and conflict in the Red Zone would be more likely to require Police or Judicial Intervention. Conclusion The Conflict Pathway provides clinicians working on the front line with a practical, evidence-based toolkit to identify the warning signs in such conflicts. By proactive management of conflicts within the Green Zone early resolution may be achieved. By managing conflicts in the Amber and Red Zones in a timely manner, external help can be sought before the mental and physical safety of clinicians and families is put at risk.

Nurse-Led Change

For more than a decade, research has demonstrated both the widespread prevalence and negative outcomes associated with intensive care unit delirium. Hospitals are, therefore, being called to institute evidence-based protocols to prevent and manage its occurrence. Integrating evidence-based practice into bedside care can be a challenge. Having information ready and accessible is essential to implementing successful change. The state of Michigan, through the Michigan Health and Hospital Association Keystone Center, has historically gathered evidence and formulated processes to facilitate evidence implementation in statewide intensive care units. Toolkits have been developed to facilitate the spread of information and are used as a starting point for sites. This approach has been proven successful in reduction of ventilator-associated pneumonias and catheter-related blood stream infections, while in partnership with Johns Hopkins University. The purpose of this article is to describe the creation of evidence-based toolkits used to facilitate successful statewide changes in practice using an interprofessional team including nurses, physicians, and pharmacists. The content reflects a step-wise approach to not only engage and educate staff, but also strategies to execute and evaluate the effectiveness.

What's inside the DH's oral health toolkit?

In 2009, the Department of Health published the second edition of Delivering Better Oral Health: An evidence-based toolkit for prevention. Sam Ball revisits the guidance, exploring the key themes for dental nurses