Role of communication content and frequency in enabling evidence-based practices.
Role of communication content and frequency in enabling evidence-based practices.
复制标题
沟通内容和频率在实现循证实践中的作用。
DOI：
10.1097/qmh.0000000000000017
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发表时间：
2014
影响因子：
1.2
通讯作者：
Rissing,Peter
中科院分区：
文献类型：
--
作者：
Rangachari,Pavani;Madaio,Michael;Rethemeyer,RKarl;Wagner,Peggy;Hall,Lauren;Roy,Siddharth;Rissing,Peter
许多医院无法成功地实施循证做法。例如，中央管束(CLB)的实施被证明可以预防导管相关的血流感染(CRBSI)，这往往是具有挑战性的。这个问题被广泛地描述为“变更实施失败”。在一个学术卫生中心内的两个重症监护病房(ICU)、一个内科ICU(MICU)和一个儿科ICU(PICU)中进行了一项前瞻性研究。这两个单位对CLB的基线遵从性较低，CRBSI高于预期。这项研究试图通过52周的定期质量改进(QI)干预措施，促进CLB在这两个单位的实施。同时，检查(1)通过医生、护士和管理人员完成的每周“沟通日志”与CLB相关的沟通内容和频率，以及(2)结果，即通过每周病历回顾的CLB依从率。这项研究的目的有两个方面：(1)在单位层面上检查QI干预措施与沟通内容和频率之间的关系，以及(2)在单位层面上审查沟通内容与频率和结果之间的关系。通过对沟通内容和频率的影响，定期的QI干预有望增加CLB的依从性，减少CRBSI。本研究共分析了2638个交际实例。这两个单位在统计上都显示了“主动”沟通的显著增加--即随着时间的推移，旨在降低医生和护士之间感染风险的沟通。在MICU中，主动沟通增加了68%(P<；05)和61%在PICU(P<；05)。在同一时间范围内，两个部门都将CLB遵从率提高到100%。两个单位在(1)留置导管的天数中也显示出显著的下降：MICU下降了34%(P<；05)和30%在PICU(P<；(2)CRBSI率：MICU下降63%(P<；05)和100%在PICU(P<；10)。在一年内减少CRBSI所节省的直接费用估计至少为840,000美元。定期的QI干预在重新构建专业间沟通动力和促成实践变革方面是有效的。前瞻性设计提供了与集体学习和文化变化相关的交流内容和频率的洞察力。这项研究确定了循证管理战略，以促进单位一级积极的实践变革。在过去十年中，预防患者护理并发症的基于证据的实践越来越多。例如，中心管束(CLB)由5个实践组成，当它们一起实施时，被证明可以预防导管相关的血流感染(CRBSI)。CLB包括(1)手卫生，(2)洗必泰皮肤消毒，(3)最大限度的屏障预防，(4)最佳导管插入位置选择，以及(5)每天对导管必要性的审查。1、2相应地，CLB已被提出为中心静脉导管插入和维护的护理标准。3-5
Many hospitals are unable to successfully implement evidence-based practices. For example, implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as a “change implementation failure.” A prospective study was conducted in 2 intensive care units (ICUs), a medical ICU (MICU) and a pediatric ICU (PICU), within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. The study sought to promote CLB implementation in both units through periodic quality improvement (QI) interventions over a 52-week period. Simultaneously, it examined (1) the content and frequency of communication related to CLB through weekly “communication logs” completed by physicians, nurses, and managers, and (2) outcomes, that is, CLB adherence rates through weekly medical record reviews. The aim of the study was 2-fold:(1) to examine associations between QI interventions and communication content and frequency at the unit level, and (2) to examine associations between communication content and frequency and outcomes at the unit level. The periodic QI interventions were expected to increase CLB adherence and reduce CRBSIs through their influence on communication content and frequency. A total of 2638 instances of communication were analyzed. Both units demonstrated a statistically significant increase in “proactive” communications—that is, communication intended to reduce infection risk between physicians and nurses over time. Proactive communications increased by 68% in the MICU (P<. 05) and 61% in the PICU (P<. 05). During the same timeframe, both units increased CLB adherence to 100%. Both units also demonstrated statistically significant declines in (1) catheter days: 34% decline in the MICU (P<. 05) and 30% in the PICU (P<. 05); and (2) CRBSI rates: 63% decline in the MICU (P<. 05) and 100% in the PICU (P<. 10). Direct costs savings from reduced CRBSIs in 1 year were estimated to be at least $840 000. Periodic QI interventions were effective in reframing interprofessional communication dynamics and enabling practice change. The prospective design provides insights into communication content and frequency associated with collective learning and culture change. The study identifies evidence-based management strategies for positive practice change at the unit level.Evidence-based practices for preventing patient care complications have been increasingly available over the past decade. For example, the central line bundle (CLB) consists of 5 practices, which when implemented together, are proven to prevent catheter-related bloodstream infections (CRBSIs). The CLB includes (1) hand hygiene,(2) chlorhexidine skin antisepsis,(3) maximal barrier precautions,(4) optimal catheter insertion site selection, and (5) daily review of catheter necessity. 1, 2 Correspondingly, the CLB has been put forth as the standard of care for central venous catheter insertion and maintenance. 3–5