International journal of evidence-based healthcare
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Int J Evid Based Healthc · Mar 2013
Nursing inter-shift handover process in mental health settings: a best practice implementation project.
Nursing inter-shift handover remains an important traditional ritual in nursing. Timely and effective handover of critical information ensure continuity of patient care and safe delivery. This project took place in a tertiary mental health institution in Singapore. The project aims to (i) examine existing handover practices/process in the tertiary mental health institution; (ii) determine the strengths and limitations of the existing handover practice/process; and (iii) identify, implement and evaluate an evidence-based nursing inter-shift handover process to enhance patient safety and service delivery. ⋯ This project had shown that handover sessions can be made effective by translating evidence into practice through ongoing evidence-based audit. Continuous evidence-based evaluation, identification and implementation of nursing inter-shift handover process are imperative to enhance patient safety and service delivery.
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Int J Evid Based Healthc · Mar 2013
Review Meta AnalysisRecognition of the health assistant as a delegated clinical role and their inclusion in models of care: a systematic review and meta-synthesis of qualitative evidence.
Assistants have been utilised worldwide in healthcare as a means to ensure the provision of adequate and efficient healthcare in the midst of increased pressures on health services for many years. This review aimed to synthesise available qualitative evidence regarding the appropriateness of strategies used to establish the health assistant role as a recognised delegated clinical role and to promote their inclusion in models of care. This review focused on how to make strategies appropriate for health assistants and professionals. Health assistants were defined as those who provide assistance and support to health professionals by whom they are directly or indirectly supervised in all healthcare and health education sectors. ⋯ Qualitative meta-synthesis was performed providing a unique perspective on the role of health assistants and strategies used to include them in models of care. These synthesised findings can be used to guide practice in healthcare organisations considering strategies for implementing the assistant role, or where assistants are currently utilised.
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Int J Evid Based Healthc · Mar 2013
Implementing the best available evidence in early delirium identification in elderly hip surgery patients.
Delirium is a frequent complication in the surgical experience of elderly hip surgery patients. Its impact can be severe and may even include death. Implementation of a delirium predictor tool might focus attention on early recognition of delirium, thereby potentially decreasing its impact. A related aim is to evaluate best practices in implementation strategies in this project. ⋯ The delirium predictor tool shows promise as a prompt for best practices in prevention of delirium. This study showed a change in delirium rates as a result of its use. Although the results were not statistically significant, they may be clinically meaningful. Comprehensive assessment and implementation planning by a multidisciplinary team contributed to only 56% compliance in use. Despite this low rate, delirium identification rates were higher.
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Diabetic neuropathy is the most common complication of diabetes as it affects a significant number of patients. The management of patients with diabetic neuropathy is complicated by several factors including the varied symptoms and response to the various treatments available. Strict blood glucose control remains the key to the management thus far nonetheless; it is associated with complications such as hypoglycaemia. ⋯ Other treatment modalities such as the use of alpha-lipoic acid as an antioxidant and evening primrose oil through increased PGE1 synthesis have also been trialled with evidence of improvement in neuropathic pain. Evidence also supports non-pharmacological treatment such as the use of percutaneous electrical nerve stimulation. There is a scope for further improvement of the reporting of rating pain scales and including various outcomes measures such as quality of life and physical function when trialling new therapies for better evaluation of future treatments.
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Int J Evid Based Healthc · Dec 2012
Patient handover in the oncology setting: an evidence utilisation project.
Handover is an essential activity in nursing and is an integral part of communication as it will improve and ensure quality patient care in clinical practice. However, handover could be ineffective and harmful to patients and nurses if the information communicated is incorrect, irrelevant or omitted. Thus to achieve optimal care as well as to maintain patient safety, these information needs to be accurately communicated. In recent time, registered nurses in the ward have been staying late beyond their working hours as handover is taking more time than is required. The nurses were taking almost an hour to hand over their reports to the oncoming staff. There was also a lot of distraction and interruption which further prolonged the time spent handing over. This has led to much unhappiness and dissatisfaction in the ward. In addition, it also took the registered nurses away from direct clinical care. ⋯ This project not only showed a significant improvement in the inter-shift patient handover, but also shortened the duration of handover by 21.67 min per registered nurse. This project also showed that commitment, acceptance, enthusiasm and support from all the registered nurses and stakeholders are essential contributing factors towards the success of improving clinical practice. Utilising the JBI PACES approach of audit and feedback has helped in reducing the time spent on handover. It has demonstrated that the use of evidence to improve clinical practice is possible in a challenging acute care environment.