Implementation Of Practice Change Research Articles

Implementation processes and capacity-building needs in Ontario maternal-newborn care hospital settings: a cross-sectional survey.

Maternal-newborn care does not always align with the best available evidence. Applying implementation science to change initiatives can help move evidence-informed practices into clinical settings. However, it remains unknown to what extent current implementation practices in maternal-newborn care align with recommendations from implementation science, and how confident nurses, other health professionals, and leaders are completing steps in the implementation process. We aimed to understand Ontario maternal-newborn teams' (1) approaches to implementing practice changes and the extent to which their implementation processes aligned with an implementation science planned-action framework; and (2) perceptions of importance and confidence completing implementation activities. We conducted a cross-sectional survey between September-November 2023. Using purposive sampling, we invited Ontario maternal-newborn nurses, other healthcare professionals, and leaders who had experience participating in or leading implementation projects to complete an online questionnaire. The questionnaire was informed by an implementation science framework, which includes three core phases (identify issue; build solutions; implement, evaluate, sustain). The questions probed respondents' perceptions of frequency of completion, importance, and confidence for each of the 28 implementation activities. We used descriptive statistics for the closed-ended questions and grouped the written responses into categories. We received 73 responses from 57 Ontario maternal-newborn hospitals, the majority being nurses in point-of-care and leadership roles. Nearly all respondents agreed that each of the 28 implementation activities were important. Respondents reported always completing a median of 8 out of 28 activities, with the number of activities completed declining from phase 1 through to 3. Most respondents indicated they were somewhat confident completing the implementation activities and agreed their teams would benefit from increasing their knowledge and skills to use an evidence-informed approach to implementing practice changes. Despite viewing implementation activities as important, many teams are not consistently doing them and lack confidence, particularly in later phases of the implementation process. These findings inform where further capacity-building and supports may be needed to enable maternal-newborn nurses, other healthcare professionals, and leaders to apply implementation science to their change initiatives.

Theory-driven assessment of intentions and behaviours related to mobility of older inpatients: a survey of patients and healthcare professionals.

Low mobility of patients during hospitalisation is associated with adverse outcomes. To successfully change behaviours related to mobility of older hospitalised patients, we need to better understand the mechanisms underlying patient and healthcare professional behaviours. In this study, we thus assessed patient- and healthcare professional-reported intentions and behaviours related to mobility of older patients hospitalised on an acute medical ward, based on a theoretical framework - the Health Action Process Approach (HAPA) model - and on additional barriers and facilitators to mobility. We conducted a cross-sectional survey in April 2022 among patients aged ≥60 years recently hospitalised on an an acute medical ward of one of three hospitals of different language/cultural regions of Switzerland, and healthcare professionals (physicians, nurses/nursing assistants, physiotherapists) working on those wards. The survey assessed the HAPA model and additional barriers and facilitators to patient mobility at hospital, as previously identified in the literature. The target behaviour studied was "to move as much as possible during hospitalisation" for patients and "to ensure my patients move as much as possible during hospitalisation" for healthcare professionals. We conducted hierarchical linear regressions to determine factors associated with the self-reported intention to perform the behaviour and with the self-reported behaviour itself. A total of 142 healthcare professionals (61 physicians, 59 nurses, 22 physiotherapists) and 200 patients (mean age 74 years) completed the survey. Patients with higher intention to move as much as possible during hospitalisation scored significantly higher on factual knowledge, outcome expectancies and risk perception. Healthcare professionals with higher intention to ensure that their patients move as much as possible during hospitalisation scored higher on action knowledge, outcome expectancies and risk perception. The more the patients reported that they moved as much as possible during hospitalisation, the higher their action knowledge and action control. The more healthcare professionals reported that they ensure that patients move as much as possible during hospitalisation, the higher they scored on factual knowledge, role perception, planning and action control. factual and action knowledge, self-efficacy, outcome expectancies, risk perception, planning and action control were identified as important drivers of patient- and healthcare professional-reported intentions and behaviours related to inpatient mobility. These parameters can be addressed through behaviour-change interventions and should be considered in future interventions to successfully implement practice changes, with the goal of improving mobility of older patients during hospitalisation, and thus the outcomes of this particularly vulnerable population.

Implementation and Evaluation of a School Nurse Toolkit to Reinforce Best Practices for Asthma Care in Schools.

A toolkit, developed by a multidisciplinary team of national and statewide professionals, was promoted among school nurses in Michigan to support use of the standards of care for asthma in schools. We evaluated the effectiveness of the toolkit to assist school nurses in providing support for students with asthma. We used a multimethod approach to assess use of the toolkit, changes in nursing practices as a result of using the toolkit, and challenges encountered when implementing the standards for asthma care. During a 12-month period, from July 2022 through June 2023, increases in time on web page and monthly page views aligned with efforts to promote toolkit use. School nurses reported using the toolkit and implementing practice changes pertaining to training and education, ensuring proper use of and access to asthma medications, and advocating for self-carry of asthma medications. Challenges to implementing the standards of asthma care were time, parental engagement, institutional support, and identifying students with asthma. We found that our promotional efforts prompted school nurses to access the toolkit, which helped school nurses to effectuate practice changes to improve support for students with asthma in schools.

Strengthening the Chain: A Continuing Medical Education Program for Test Results Follow-up.

The Canadian Medical Protective Association (CMPA)'s Commitment to Change in Test-Results Follow-Up (CTC-TRFU) program aims to provide physicians with resources to enhance their test results follow-up systems for improved patient safety. Framed around the Transtheoretical Model, the program involves a 6-month multimodal educational intervention involving individual and group coaching sessions, action planning, and reflection surveys. This study evaluates the CTC-TRFU program's impact by analyzing survey responses and course documents, focusing on three main outcomes: physicians' perceived barriers and challenges, changes in their confidence and commitment, and implemented practice changes with perceived impact on patient safety. Participants were Canadian physicians who enrolled through the CMPA's open-access registration, with a particular emphasis on those facing challenges in test result follow-up. One hundred two physicians have enrolled in the program. Of these physicians, 34 (33.3%) have successfully completed the program and 28 (27.5%) are actively enrolled. Among the 34 physicians who successfully completed the program, an overwhelming majority of 97.1% (n = 33) expressed their belief that the improvements made to their test follow-up system significantly enhance patient safety within their practice. We observed a significant increase in confidence in the robustness of the physician's follow-up system from program registration to completion (P < .001). Physicians reported catching specific missed test results (55.9%, n = 19), including various laboratory reports and diagnostic imaging like abnormal mammograms or missing MRI/CT results. Physicians who participated in the CTC-TRFU program reported meaningful practice changes, which we believe underscores the value of comprehensive, longitudinal continuing patient safety CPD initiatives. These findings indicate the potential for future studies to explore the long-term impact of similar programs and their scalability.

Antimicrobial Stewardship Practice Changes Following a Statewide Educational Conference in Nebraska

Background: In 2023, Nebraska held its 4th state antimicrobial stewardship (AS) educational conference, an annual one-day in-person event with continuing education offered for nurses, pharmacists, microbiology lab technicians, and physicians. One challenge of educational events is determining if content has been translated into practice. We sought to assess AS-related practice changes implemented by conference attendees. Methods: Conference attendees were sent 2 surveys by email following the conference. Survey 1 questions were integrated into the continuing education credit evaluation immediately following the conference. Survey 2 was sent three months later to all registered attendees. Qualitative responses were grouped by theme and descriptive statistics were used to evaluate Results: There were 203 attendees from across the state including a diverse group of learners (Table 1) representing metropolitan and rural areas of Nebraska (Figure 1) from acute care hospitals, critical access hospitals, long-term care settings, and public health. A total of 148 attendees (73%) answered questions in Survey 1 (Table 2), and 79 (39%) attendees responded to Survey 2. On Survey 1, 94% of respondents indicated that they intended to make practice changes, though 60% anticipated barriers including further staff training needs and lack of resources and health system support. On Survey 2, 83% of respondents indicated successful implementation of practice changes at three months after the conference. The most common practice changes included enhanced communication strategies, improved antibiotic tracking, monitoring, and review, policy and procedure updates, and AS tool implementation. On Survey 1, 26% (35/131) strongly agreed that their ability to treat patients was adequate prior to the conference; this increased to 55% (72/131) post-conference. On Survey 2, 56% (22/39) of respondents reported improvement in patient outcomes because of implemented practice changes following conference attendance. However, some also mentioned a short follow-up survey timeline as a limitation in assessing patient outcome improvements. Reported outcomes included improved receptiveness from providers, patients, and families to antibiotic use recommendations, shorter prescribed durations, and more appropriate initial antibiotic selection. Improved team performance was noted by 73% (27/37) of respondents. Themes included improved communication with internal and external stakeholders, more collaborative team discussions, increased confidence in recommendations, expanded provider and staff engagement, and increased leadership involvement. Conclusions: In addition to improved knowledge and understanding for a variety of AS-related areas, attendees of the conference also reported a high rate of practice changes that led to perceived improvements in patient outcomes and team function.

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.

Moving towards a continuous health care system—payment reform for post-acute care in Changsha City Of China

Introduction: As an integral component of a healthcare system，PAC is not fully developed in China largely attributing to the lack of sound medical insurance coverage and payment for PAC . Changsha City in the middle-south of China draws on international experience to carry out the value-based payment reform for post-acute rehablitation, in order to facilitate the development of rehablitative system and promote the continuity and integration of current health care system. &#x0D; Practice change implementation: According to the characteristics and rehabilitation intensity of inpatients, rehabilitation treatment is divided into two stages: recovery stage and chronic stage. For each stage, different patient classification systems are applied. For recovery phase Functional-Related Groups（FRGs）,a case based payment system is established locally. For chronic phase, payment is made on per-diem basis, and Patient-Driven Chronic Rehabilitation Groups (PDCRG) are applied as casemix groups. The adapted version of International Classification of Functioning, Disability and Health(ICF) scale is used to collect patient data as well as measure their functional gain, which enables the implementation of value-based payment. &#x0D; Aim and theory of change: The pilot reform is to support the effective and quality delivery of rehabilitation services, promote the development of PAC system, and push forward the value-based payment of the medical insurance.&#x0D; Targeted population and stakeholders: ·Inpatients with intensive or chronic rehabilitation needs in Changsha City&#x0D; ·Rehabilitation service providers (including general hospitals, public and private rehabilitation specialist hospitals and other facilities providing medical rehabilitation services）in Changsha City&#x0D; ·Social Medical Insurance Department of Changsha City&#x0D; Timeline: The payment policy was introduced in Jun. 2022 and the development is ongoing. &#x0D; Highlights: The key outcomes, impact and innovation include:&#x0D; ·Continuous rehabilitation: recovery stage and chronic stage, with acute care before and long-term care after&#x0D; ·The refinement of ICF assessment scale to local practice and the development of PAC insurance information system based on the assessment&#x0D; ·Value-based payment: provide a method to measure the functional gain of rehabilitation inpatients and link hospital payment to patient outcomes&#x0D; ·Offer practical experience for reform of medical insurance payment mode of rehabilitation&#x0D; Sustainability: ·The proposed mode stimulates the development of rehabilitation care services, meanwhile, decreases the burden on the medical and long-term care systems&#x0D; ·As a supplement of other payment modes, value-based payment mode fills the gap of rehabilitation medical insurance and supports integration of medical services.&#x0D; Transfer-ability: Nowadays, China has been pushing ahead with the payment reform of acute hospitalization and developing long-term care insurance for disabled elderly. The Value-based payment model for PAC could reliably classify the needs of rehabilitation inpatients, promoting the development of PAC system. There is significant potential for the model to be replicated.&#x0D; Conclusions (comprising key findings, discussion and lessons learned): Aimed at building a sound payment system for post-acute rehabilitaion, the payment reform for PAC in Changsha put forward a value-oriented payment model based mainly on patients’ functional conditions and classified rehabilitative patients into two stages. In the future, the criteria of the two stages and the referral mechanisms in the system need to be further explored and established.

Forward Thinking and Adaptability to Sustain and Advance IPECP in Healthcare Transformation Following the COVID-19 Pandemic

The proliferation of the novel SARS-CoV-2 (COVID-19) virus across the globe in 2020 produced a shared trauma internationally of unprecedented devastation, disruption, and death. At the same time, the pandemic has been a transformation catalyst accelerating the implementation and adoption of long overdue changes in healthcare education and practice, including telehealth and virtual learning. The COVID-19 pandemic has placed healthcare at a crossroads, either viewing it as a temporary situation that requires short-term solutions, or as a major disruption that presents opportunities for innovation for sustainable development and transformation. As COVID-19 transitions from pandemic to endemic, we have a unique opportunity to leverage lessons learned that can foster healthcare transformation through innovation, forward thinking, and interprofessional education and collaborative practice (IPECP). With the changing landscape of higher education and healthcare, IPECP leaders need to reflect on and implement ‘Forward Thinking and Adaptability’ and ‘Sustainability and Growth’ in their IPECP approaches and strategies to achieve the Quintuple Aim. To capitalize on this opportunity and based on a recent publication by InterprofessionalResearch Global, this paper explores and debates (from a global perspective) the impact and application of healthcare education and practice transformation on IPECP with the goal to identify best practices in integrating and sustaining IPECP and building a resilient workforce.

Development of Behavioural and Psychological Symptoms of Dementia(BPSD) App for use in a hospital setting

AbstractIntroductionPrevious quantitative audits at Wyong Hospital, a 300 bed regional and teaching hospital in the Central Coast Local Health District (CCLHD) showed that the majority of Clinical Aggression Response Team (CART) calls occurred in the geriatric population.Results suggested that often BPSD guidelines which were on the CCLHD intranet were not adhered to. It was suggested that medical officers need ready access to local guidelines and more education. Interviews with staff who were participating in CART calls found that medical staff were not confident in when to and what to prescribe and what was the most appropriate management.These audits, which involved interviewing participants of CART calls, plus evidence about implementing practice change, suggests that mobile phone apps are used more frequently and are more effective than intranet documents.ObjectiveDevelop a BPSD app with the potential to make evidence based recommendations and local guidelines accessible to the user at the bedside using a mobile device particularly during CART calls and enables the user to manage BPSD with ease.Methods1. Content of the app is based on BPSD guidelines published on the CCLHD intranet geriatric medicine webpages.2. A prototype of the app was developed on Marvel designs and provided to the IT and e‐health New South Wales department who provided suggestions, guidance on the app development and integration of the app onto the hospital IT system. Training sessions were provided via drop in sessions and online videos using Microsoft teams. Targeted education sessions on app usage was provided to medical personnel. Costs for the development of the app was funded by the Department of Geriatric medicine, Wyong and Gosford Hospital.3. Ethics approval was obtained from the Central Coast Local Health District Human Research Ethics Committee.ResultsThere has been more than 100 downloads of the app with levels of usage ranging from 1 to 38 on a daily basis.ConclusionThe development of the app allows ease of access to concise evidenced based information and supports clinicians in their role in managing BPSD.

Factors to Improve Reverse Integration: A Mixed Method Embedded Design Study.

Individuals with serious mental illness face inequity in receiving primary care services. The Substance Abuse and Mental Health Services Administration (SAMHSA) granted funds to Certified Community Behavioral Health Clinics (CCBHC) to integrate primary care and behavioral health specialties to increase access to care. This mixed method study aimed to measure the SAMHSA-defined levels of reverse integration at a CCBHC at one point in time. Providers and patients provided feedback through semi-structured interviews. Qualitative data was investigated for themes, while the quantitative data was run through inferential analysis with the Kruskal Wallis H test. Clinically meaningful results showed people using primary care at the integrated clinic were more satisfied and were more apt to continue seeing their current providers than those receiving non-integrated care. The CCBHC achieved level 4 integration; factors investigated confirmed proximity alone does not necessitate integration without effective communication and implementation of practice changes.

Medication error reporting attitudes and practices in a regional Australian hospital: a qualitative study

AbstractBackgroundMedication errors are events that may cause or lead to inappropriate medication use or patient harm. Australians living outside metropolitan areas have poorer health outcomes than those living in urban areas. Medication error reporting (MER) practices vary due to the attitude of healthcare professionals (HCPs). MER can improve patient safety in community and hospital settings.AimTo explore HCPs' attitudes, practices, and recommendations towards MER in a regional hospital setting in Australia.MethodSemistructured interviews were employed to identify the attitudes, practices, and recommendations of HCPs for the best utilisation of medication error reports. The study recruited HCPs (nurses, pharmacists, and doctors) working in all clinical areas from November 2021–February 2022. Interviews were recorded and transcribed via thematic analysis. Ethics approval was obtained from the Goulburn Valley Health (GVH) Human Research Ethics Committee (Reference no: GVH 35/21). Informed consent was obtained from participants via an information sheet and completion of a written consent form.ResultsInterviews with twelve HCPs elucidated four themes: barriers and enablers to reporting, and perceived benefits and recommendations for medication error reports. There was good understanding among regional HCPs about the benefits of MER. Attitudes and practices varied, with nurses reporting more medication errors than doctors, and pharmacists being concerned about the impact of reporting on interprofessional relations. Their recommendations involved standardising medication error definition and improving electronic system education.ConclusionDespite HCPs' understanding of the role of MER, their practices varied. We recommend improved protected time for learning, training with the incident reporting software, education about medication errors, and formalisation of test feedback to clinicians. The implementation of workplace cultural practice changes to improve organisational systems and enhance error reporting without fear of repercussions, and the adoption of additional solutions such as electronic prescribing are also encouraged.

Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis

BackgroundMoving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams’ approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science.MethodsWe conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014–2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step.ResultsParticipants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3–7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools.ConclusionsWe identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.

Use of Explainable AI Algorithm Revealing Longitudinal Changes in Practice Patterns and Toxicity Models

Dosimetric constraints evolve as clinicians implement practice changes, requiring modeling approaches to be dynamic. We applied a semi-automated explainable artificial intelligence (eAI) algorithm and dashboard visualizations to model dysphagia and xerostomia for head and neck cancer patients. We coupled a large, comprehensive, "real-world" database to the eAI for discovery of features with the strongest combined statistical and machine learning based evidence and to identify clinically actionable thresholds. Cohort included 758 patients treated 2017-2021 for HN cancer with conventional fractionation. Features included age, sex, diagnosis, staging, chemotherapy, smoking and alcohol status, BMI, weight loss, re-simulation, DVH curves, PTV and OAR volumes. Patients were scored for toxicity within 2 yrs of RT for dysphagia grade ≥ 3 and xerostomia grade ≥ 2. Bootstrap resampling of thresholds, ROC-AUC, PR-ROC, SN, SP, F1 and diagnostic odds ratio was used to statistically profile strength of evidence for candidate features. XGBoost models with 10-fold cross validation were repeated (n = 20) to identify mean and CIs for statistical measures of predictions. DVH metrics included standard template values and those with highest statistical evidence and low cross correlation with other features. Backward feature selection was used to identify the most relevant feature subset, where the least informative feature is iteratively removed from the model. This workflow was repeated by year and overall. Annual incidence of dysphagia averaged 0.13 ± 0.02 overall years. Xerostomia incidence decreased from 0.32 to 0.12 (2017-2021). Box-whisker plots by year showed consistent reductions in standard practice toxicity linked DVH metric values. Median dose to superior constrictors (PCM), contralateral parotid and contralateral submandibular gland (SMG) declined from 2017 to 2021 by 48 to 33 Gy, 17 to 10 Gy, and 28 to 22 Gy respectively. Statistics of XGBoost models of dysphagia for all years were ROC-AUC = 0.72 ± 0.05. Strongest overall years predictors were Oral Cavity (OC) D50%[Gy] < 32, inferior PCM Max [Gy] < 60, contralateral SMG D10%[Gy] < 53 and use of Paclitaxel. Xerostomia models were less predictive with ROC-AUC = 0.65 ± 0.05. Strongest predictors over each year were ipsilateral parotid D30%[Gy] < 35, contralateral SMG D96%[Gy] < 18.4, and overall staging < II. Predictive features varied substantially by year for both, showing the most consistency for SMG doses. For example, OC D50%[Gy] < 27 and contralateral SMG D96%[Gy] < 18 dominated xerostomia model in 2017 but not in 2021 when practice norms shifted to lower doses. As OAR doses were systematically reduced, statistical and AI models evidence highlighted contralateral SMG dose as important to both dysphagia and xerostomia for clinical practice change. The "real-world" database + eAI + visualization dashboards provided a method for continuous learning as clinical practice changes.

Development and Implementation of Workshops to Optimize the Delivery of Vaccination Services in Community Pharmacies: Thinking beyond COVID-19.

Vaccines are widely recognized as the most economically efficient strategy to combat infectious diseases. Community pharmacists, being highly accessible healthcare professionals, have the potential to significantly contribute to the promotion and facilitation of vaccination uptake. In Canada, the jurisdiction of healthcare falls under provincial legislation, leading to variations in the extent of pharmacist practice throughout the country. While some pharmacists in Canada already functioned as immunizers, Québec pharmacists gained the authority to prescribe and administer vaccines in March 2020 amidst the COVID-19 pandemic. Our workshop aimed to equip pharmacists in Québec with the necessary guidance to optimize vaccinations, emphasizing the importance of maintaining and expanding immunization services beyond influenza and COVID-19 vaccines in the future. During the workshop, pharmacists had the opportunity to exchange valuable insights and best practices regarding workflow optimization, identifying areas for improvement in competency, effectively reaching vulnerable population groups, and integrating allied team members into their practice. Participants were also asked to develop a plan of action to help implement practice change beyond the workshop. Interactive workshops centered around discussions like these serve as catalysts for advancing the pharmacy profession, uniting professionals with a collective aim of enhancing patient care.

Does Digitalization Supports Project Management Effectiveness? New Insight on the Role of Intellectual Capital

The challenges of the fourth industrial revolution faced by project managers are not only related to continuous adaptation to new technologies and the application of the optimal technical solution within each project but also imply the implementation of systemic changes in project management practice. There is no clear evidence in the literature about project management effectiveness in the digital economy or readiness for digital transformation in project-oriented organizations. The purpose of this paper is to identify the influence of intellectual capital components on project management effectiveness in the context of changes that are stimulated by digitalization, as well as the indirect impact of the company’s readiness for digital transformation. Using 147 fully matched pairs of questionnaires collected from project managers and end-users of construction projects, it is proven that digital transformation readiness is relevant as a mediator and moderator between intellectual capital components and project management effectiveness. The contribution of this research is reflected in highlighting the importance of assessing project management effectiveness in order to assure project success. The digital transformation readiness of project-oriented organizations is an important element for increasing project team motivation, building trust, and developing effective communication channels.

118-OR: From Learning to Planning for Change—How Continuing Medical Education Drives Clinician Intention to Implement Changes in Diabetes Care

Objective: The effectiveness of continuing medical education (CME) in improving clinician knowledge and competence in the management of type 2 diabetes (T2DM) has been widely demonstrated. The current study builds upon existing literature by investigating the pathway by which CME drives clinician intention to implement changes in T2DM management. Methods: Data from 6 accredited online T2DM CME programs targeting global diabetologists/endocrinologists (diab/endos) and primary care physicians (PCPs) launched in 2021 were analyzed. An objective knowledge/competence assessment was completed by a control group sampled from the target audience prior to the launch of each of the programs (n=301) and by a test group sampled from learners following participation (n=304). Post-education confidence improvement and intention to change were also measured in the test group. Significance of all between-group differences reported was tested using chi-square statistics. Results: The education had a large effect size in improving clinician knowledge and competence managing T2DM (control vs test group correct response rate: 63% vs 92%, P &amp;lt; .001; Cohen’s d=1.21). Within the test group, 81% increased confidence in managing T2DM, and 73% planned to make clinical practice changes. Knowledge/competence did not directly predict intention to change, but those with improved confidence were more likely to plan for clinical practice change (79% vs 45%; P &amp;lt; .001). While knowledge/competence did not predict confidence improvement for diab/endos, PCPs who answered all questions correctly were more likely to report improved confidence (82% vs 56%; P &amp;lt; .01). Conclusions: CME may indirectly drive clinician intention to implement practice changes via its impact on confidence for both diab/endos and PCPs. The role that knowledge and competence play in the pathway from CME to intention to change may vary for these two groups of clinicians. Disclosure P.Chen: None. C.Mardis: None. S.Gawade: None. A.Wiggins: None. Y.Oliver: None. Funding Eli Lilly and Company

Barriers and enablers to implementing intranasal ketamine for Primary Care Paramedics in Canada – A parallel convergent mixed methods study

Introduction British Columbia Emergency Health Service trialled the use of intranasal (IN) ketamine given by Primary Care Paramedics (PCPs). Prior to this practice change, the PCPs had not performed weight-based drug calculations, given medications intranasally, nor been responsible for controlled and targeted substances. This study aimed to use the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domain Framework (TDF) to identify enablers and barriers to implementing IN paramedic administered ketamine analgesia (iPAKA) for PCPs. Methods This was a parallel convergent mixed methods study with two phases. The quantitative phase consisted of longitudinal staff surveys to assess PCP knowledge and perceptions of ketamine and controlled and targeted substances policies. The qualitative phase involved staff focus groups on programme implementation. Descriptive statistics of survey results were integrated with coded focus group data and analysed using the COM-B model and TDF. Evidence-based behavioural change techniques were mapped to each TDF domain. Findings Our analysis revealed barriers and enablers across several TDF domains. Implementing ketamine was enabled by quality education, strong organisational support and the availability of cognitive aides. Trial success was attributed in part to participant's feelings of optimism and their increased job satisfaction. Key barriers included a knowledge gap involving drug dosage calculations, negative emotions associated with performance anxiety and a lack of field education and supervision to monitor paramedic practice. Conclusion The use of theoretical frameworks and models like COM-B/TDF serves to improve the sustainable implementation of behaviour and clinical practice change in paramedicine. When project teams use theory to guide design and implementation, they can systematically identify and target individual and organisational enablers and barriers to adopting routine practices. The iPAKA study reveals key barriers and facilitators in several TDF domains and presents theory-linked targeted behavioural techniques to support on-going implementation of PCP-administered IN ketamine for analgesia.

Effect of a CME Symposium on the Obstetrician–Gynecologist's Knowledge and Confidence Related to CGM Use in Pregnant Patients [ID: 1368750

INTRODUCTION: We sought to measure the effect of a live symposium at the American College of Obstetricians and Gynecologists followed by enduring on Medscape related to real-time continuous glucose monitoring (rtCGM) use in pregnant patients. METHODS: Pre and post questions assessed changes in knowledge and confidence. Absolute differences were calculated for the live activity. For the enduring, completers of all pre and post questions were linked and analyzed. RESULTS: There were 61 live participants: 68% were physicians, 3% NPs, 3% pharmacists, and 3% nurses. There was a 21% increase in learners who recognized time in range goals for pregnant patients with diabetes, and a 26% increase in those who reported being very or somewhat confident in using rtCGM in their patients with diabetes (24% less were not confident with this concept). 100% declared the content learned will affect their practice, and 91% reported being committed/very committed to implementing practice changes. There are 3,595 enduring learners to date (October 9, 2022), and 83 completers of all questions by August 30, 2022. 16% of ob-gyn learners improved at recognizing time in range goals for pregnant patients with diabetes. Eighteen percent of ob-gyn learners improved at recognizing the benefit of rtCGM in pregnant patients with diabetes. Thirty-nine percent of ob-gyn learners had increased confidence in using rtCGM in pregnant patients with diabetes for an average confidence shift of +79% among those with increased confidence. CONCLUSION: The outcomes gathered in this assessment are a strong indicator that live, in-person CME symposia followed by online enduring is successful at improving knowledge and confidence related to rtCGM use in pregnant patients with diabetes, and possibly promote improvements in clinical practice.

Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

BackgroundThe Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or ‘pathways’ designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation. Objective(s)To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change. MethodsAn online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed. ResultsThree-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change. ConclusionsImplementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.

Supporting post-stroke access to services and resources for individuals with low income: understanding usual care practices in acute care and rehabilitation settings

Purpose Following stroke, individuals who live in a low-income or are at risk of living in a low-income situation face challenges with timely access to social services and community resources. Understanding the usual care practices of stroke teams, specifically, how they support this access to services and resources, is an important first step in promoting the implementation of practice change. Method A qualitative multiple-case study of acute care, inpatient, and outpatient rehabilitation stroke teams in an urban area of Canada. Semi-structured interviews and questionnaires about the workplace context were conducted with 19 professionals (social workers, occupational therapists, physiotherapists, speech-language pathologists) at four sites. Results In their usual practice, stroke teams prioritized immediate care needs. The stroke team professionals did not address income or resources unless it directly affected discharge. Usual care was influenced by factors such as time constraints, lack of knowledge about services and resources, and social service system limitations. Conclusion To better support post-stroke access to social services and resource for low-income individuals, a multidisciplinary approach, with actions beginning earlier on and extending throughout the continuum of care, is recommended, in addition to system-level advocacy.