Charrier Lorena, Allochis Maria Cristina, Cavallo Maria Rita, Gregori Dario, Cavallo Franco, Zotti Carla Maria
Department of Public Health and Microbiology, University of Torino, Torino, Italy.
J Eval Clin Pract. 2008 Oct;14(5):847-53. doi: 10.1111/j.1365-2753.2008.01042.x.
Great emphasis is placed on the need to base assistance activities on efficacy evidence. Nevertheless, it is demonstrated that the mere knowledge of scientific recommendations is not sufficient to determine changes in practice. Many elements can influence the operators' behaviour, so that comprehensive strategies are needed to change wrong or not evidence-based practices.
The aim was to compare the efficacy of two protocol implementation strategies: clinical-organizational integrated audits with feedback and presence of facilitators in the departments versus standard observation.
Cluster-randomized, controlled and open trial methods were used. Implementation was investigated for protocols regarding the prevention of pressure lesions and the management of peripheral and central venous catheters. For both protocols, a checklist with the indicators needed for the evaluation was created. The study was divided into five time points. For the initial and final investigation, evaluators filled-in the checklists for both study groups; for the three intermediate investigations, the checklists were self-filled by the operators of the control group, while the operators of the experimental group received the intervention.
For almost all indicators, the data show an increment in the adoption of correct practices. Nevertheless, the last investigation shows a significant (P < 0.05) difference between the two groups in favour of the experimental group: 12 process indicators versus one for catheter management protocol and seven versus one for protocol on pressure lesions.
The main strong point of the study lies in carrying out an intervention aimed at improving the operators' adoption of two protocols as a whole, rather than of single procedures. The audit intervention allowed to highlight some more subjective criticalities important in determining the success or failure of the implementation of effective practices.
人们非常强调援助活动需基于疗效证据。然而，事实证明，仅仅了解科学建议不足以确定实践中的变化。许多因素会影响操作人员的行为，因此需要全面的策略来改变错误的或缺乏证据支持的做法。
旨在比较两种方案实施策略的效果：临床 - 组织综合审计并反馈以及部门中有协调员参与与标准观察。
采用整群随机、对照和开放试验方法。对预防压疮以及外周和中心静脉导管管理的方案实施情况进行调查。针对这两个方案，都创建了一个包含评估所需指标的检查表。该研究分为五个时间点。在初始和最终调查时，评估人员为两个研究组填写检查表；在三个中间调查时，对照组的操作人员自行填写检查表，而实验组的操作人员接受干预。
几乎所有指标的数据都显示正确做法的采用有所增加。然而，最后一次调查显示两组之间存在显著差异（P < 0.05），有利于实验组：在导管管理方案方面，过程指标为12项，而对照组为1项；在压疮方案方面，过程指标为7项，而对照组为1项。
该研究的主要优点在于实施了一项旨在整体提高操作人员对两个方案（而非单个程序）采用率的干预措施。审计干预能够突出一些在确定有效做法实施成败方面更为主观的关键问题。
