Maia Flávia de Oliveira Motta, Cruz Diná de Almeida Lopes Monteiro da, Shimoda Gilceria Tochika, Sichieri Karina, Iida Luciana Inaba Senier
University Hospital of the University of São Paulo, São Paulo, Brazil.
The Brazilian Centre for Evidence-informed Health Care: a Joanna Briggs Institute Centre of Excellence.
JBI Database System Rev Implement Rep. 2018 Aug;16(8):1720-1736. doi: 10.11124/JBISRIR-2017-003556.
The main objective of this project was to reduce the incidence and harm from falls that occur among patients admitted in the acute Internal Medicine Unit and Intensive Care Unit in a public teaching hospital in São Paulo, Brazil.
Falls are a challenge for health professionals and healthcare services as they may result in high-impact outcomes for patients, such as functional decline, increase in length of hospital stay, increase in the cost of healthcare services, and death. In an attempt to promote safe care the World Health Organization (WHO) launched the World Alliance for Patient Safety in 2004 that encourages the adoption of best practice to reduce adverse events in healthcare services.
The project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in health practice. A baseline audit was conducted measuring eight best practice criterias, followed by the implementation of target strategies and a follow-up audit.
The results of the baseline audit identified large gaps between current practice and overall compliance with best practice. The GRiP module helped identify strategies related to education programs for patients, families and nursing teams, and a falls risk assessment with an accurate tool to address the gaps in compliance. The follow-up audit cycle was satisfactory as all best practice audit criteria showed an improvement as an aggregated result.
The project used the audit and feedback strategy to translate evidence into practice. Some of the measured criteria improved to moderate-high compliance with best practice. The results showed that implementation of evidence-based practice leads to an improvement in falls prevention. Future audits are required to sustain improvements.
本项目的主要目标是降低巴西圣保罗一家公立教学医院急性内科病房和重症监护病房收治患者的跌倒发生率及跌倒危害。
跌倒对医疗专业人员和医疗服务而言是一项挑战，因为它们可能给患者带来严重后果，如功能衰退、住院时间延长、医疗服务成本增加以及死亡。为促进安全护理，世界卫生组织（WHO）于2004年发起了世界患者安全联盟，鼓励采用最佳实践以减少医疗服务中的不良事件。
该项目使用了乔安娜·布里格斯循证实践应用研究所（JBI-PACES）和将研究转化为实践（GRiP）审核工具来推动医疗实践的变革。进行了一次基线审核，衡量八项最佳实践标准，随后实施目标策略并进行跟进审核。
基线审核结果表明，当前实践与最佳实践的总体合规情况之间存在巨大差距。GRiP模块有助于确定与针对患者、家属和护理团队的教育计划相关的策略，以及使用准确工具进行跌倒风险评估，以弥补合规方面的差距。跟进审核周期令人满意，因为所有最佳实践审核标准的综合结果均有所改善。
该项目采用审核与反馈策略将证据转化为实践。一些衡量标准的合规情况改善至中等偏高水平。结果表明，实施循证实践可改善跌倒预防工作。需要进行未来审核以维持改进效果。
