McNett Molly, O'Mathúna Dónal, Tucker Sharon, Roberts Haley, Mion Lorraine C, Balas Michele C
Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University, Columbus, OH.
College of Nursing, The Ohio State University, Columbus, OH.
Crit Care Explor. 2020 Dec 16;2(12):e0301. doi: 10.1097/CCE.0000000000000301. eCollection 2020 Dec.
The purpose of this scoping review is to provide a synthesis of the available literature on implementation science in critical care settings. Specifically, we aimed to identify the evidence-based practices selected for implementation, the frequency and type of implementation strategies used to foster change, and the process and clinical outcomes associated with implementation.
A librarian-assisted search was performed using three electronic databases.
Articles that reported outcomes aimed at disseminating, implementing, or sustaining an evidence-based intervention or practice, used established implementation strategies, and were conducted in a critical care unit were included.
Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system.
Of 1,707 citations, 82 met eligibility criteria. Studies included prospective research investigations, quality improvement projects, and implementation science trials. The most common practices investigated were use of a ventilator-associated pneumonia bundle, nutritional support protocols, and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility bundle. A variety of implementation strategies were used to facilitate evidence adoption, most commonly educational meetings, auditing and feedback, developing tools, and use of local opinion leaders. The majority of studies (76/82, 93%) reported using more than one implementation strategy. Few studies specifically used implementation science designs and frameworks to systematically evaluate both implementation and clinical outcomes.
The field of critical care has experienced slow but steady gains in the number of investigations specifically guided by implementation science. However, given the exponential growth of evidence-based practices and guidelines in this same period, much work remains to critically evaluate the most effective mechanisms to integrate and sustain these practices across diverse critical care settings and teams.
本范围综述的目的是综合重症监护环境中实施科学的现有文献。具体而言，我们旨在确定为实施而选择的循证实践、用于促进变革的实施策略的频率和类型，以及与实施相关的过程和临床结果。
使用三个电子数据库进行了图书馆员协助的检索。
纳入报告旨在传播、实施或维持循证干预或实践的结果、使用既定实施策略且在重症监护病房进行的文章。
两名评审员独立筛选文章的标题、摘要和全文以确定是否符合资格。使用在系统综述软件系统中预先建立的定制字段进行数据提取。
在1707条引用中，82条符合资格标准。研究包括前瞻性研究调查、质量改进项目和实施科学试验。调查的最常见实践是使用呼吸机相关性肺炎集束干预、营养支持方案，以及觉醒与呼吸协调、谵妄监测/管理和早期运动/活动集束干预。使用了多种实施策略来促进循证实践的采用，最常见的是教育会议、审核与反馈、开发工具以及利用当地意见领袖。大多数研究（76/82，93%）报告使用了不止一种实施策略。很少有研究专门使用实施科学设计和框架来系统地评估实施情况和临床结果。
在实施科学的专门指导下，重症监护领域的调查数量虽增长缓慢但稳步上升。然而，鉴于同期循证实践和指南呈指数级增长，仍有许多工作要做，以严格评估在不同重症监护环境和团队中整合并维持这些实践的最有效机制。
