Ren Ying, Luo Xiangrong, Xie Cuihua, Zhang Ping, Meng Min, Song Huijuan
Nanfang Hospital of Southern Medical University, Guangdong, PR China.
PR China Nanfang Nursing Centre for Evidence-based Practice: a Joanna Briggs Institute Affiliated Group.
JBI Database System Rev Implement Rep. 2019 Oct;17(10):2193-2201. doi: 10.11124/JBISRIR-2018-004039.
Pain caused by dressing change has adverse effects on patients with a diabetic foot ulcer, including sleep disturbances, immobility, depression and anxiety. It is crucial that healthcare professionals use a standardized tool to assess and document pain during dressing change and then use this information to inform strategies to alleviate the pain.
The aim of this project was to implement evidence-based practice in assessment and management of pain during dressing change among patients with diabetic foot ulcers in an endocrinology unit in a tertiary hospital.
The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool were used for auditing clinical practice and translating evidence into practice. A baseline audit was performed to assess compliance with six criteria, followed by the implementation of evidence-based interventions to improve compliance. The follow-up audit using the same audit criteria was conducted to assess the effect of targeted strategies on compliance with best practice.
The baseline audit revealed that compliance with evidence-based practice was low, with only one of the six audit criteria achieving a compliance rate above 60%. After brainstorming and synthesizing the literature, the project team identified barriers and strategies for implementing best practice. The follow-up audit showed improvements in compliance across all six criteria, although there was only a small improvement in one of the criteria. The compliance rate of the other five criteria improved to greater than 67%.
A best practice implementation project that involved standardizing pain assessment and management, and delivering education materials to nursing staff and patients was completed using JBI PACES and GRiP. The project improved nurses' compliance with best practice. Nurses attach importance to relieving patients' pain when they perform wound care, while patients with a diabetic foot ulcer gain access to high-quality wound care. Future studies will be conducted to address new barriers that emerged during the follow-up audit.
换药引起的疼痛对糖尿病足溃疡患者有不良影响，包括睡眠障碍、活动受限、抑郁和焦虑。医疗保健专业人员使用标准化工具来评估和记录换药期间的疼痛情况，然后利用这些信息制定减轻疼痛的策略至关重要。
本项目的目的是在一家三级医院的内分泌科对糖尿病足溃疡患者换药期间的疼痛评估和管理实施循证实践。
采用循证卫生保健国际协作中心（JBI）临床证据系统的实际应用（JBI PACES）和将研究成果转化为实践（GRiP）审核与反馈工具来审核临床实践并将证据转化为实践。进行基线审核以评估对六项标准的依从性，随后实施循证干预措施以提高依从性。使用相同的审核标准进行后续审核，以评估针对性策略对最佳实践依从性的影响。
基线审核显示循证实践的依从性较低，六项审核标准中只有一项的依从率高于60%。经过头脑风暴和文献综合分析，项目团队确定了实施最佳实践的障碍和策略。后续审核显示所有六项标准的依从性均有提高，尽管其中一项标准仅略有改善。其他五项标准的依从率提高到了67%以上。
使用JBI PACES和GRiP完成了一个最佳实践实施项目，该项目涉及规范疼痛评估和管理，并向护理人员和患者提供教育材料。该项目提高了护士对最佳实践的依从性。护士在进行伤口护理时重视减轻患者疼痛，而糖尿病足溃疡患者能够获得高质量的伤口护理。未来将开展研究以解决后续审核中出现的新障碍。
