A Scoping Review of Implementation Science in Adult Critical Care Settings

McNett, Molly; O’Mathúna, Dónal P; Tucker, Sharon; Roberts, Haley; Mion, Lorraine C.; Balas, Michele C.

doi:10.1097/cce.0000000000000301

Cited by 28 publications

(18 citation statements)

References 101 publications

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“…Another scoping review for evidence-based practices in critical care in general also found considerable variability in the nomenclature that was used to describe implementation strategies. 85 Standardised and transparent reporting is recommended to compare the effectiveness of certain strategies. 83 86 Corresponding to our critical appraisal, previous reviews also found that most evidence on ICU bundle effects has weak methodological quality.…”

Section: Discussionmentioning

confidence: 99%

Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review

et al. 2023

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ObjectiveCare bundles are considered a key tool to improve bedside quality of care in the intensive care unit (ICU). We explored their effect on long-term patient-relevant outcomes.DesignSystematic literature search and scoping review.Data sourcesWe searched PubMed, Embase, CINAHL, APA PsycInfo, Web of Science, CDSR and CENTRAL for keywords of intensive care, care bundles, patient-relevant outcomes, and follow-up studies.Eligibility criteriaOriginal articles with patients admitted to adult ICUs assessing bundle implementations and measuring long-term (ie, ICU discharge or later) patient-relevant outcomes (ie, mortality, health-related quality of life (HrQoL), post-intensive care syndrome (PICS), care-related outcomes, adverse events, and social health).Data extraction and synthesisAfter dual, independent, two-stage selection and charting, eligible records were critically appraised and assessed for bundle type, implementation strategies, and effects on long-term patient-relevant outcomes.ResultsOf 2012 records, 38 met inclusion criteria; 55% (n=21) were before–after studies, 21% (n=8) observational cohort studies, 13% (n=5) randomised controlled trials, and 11% (n=4) had other designs. Bundles pertained to sepsis (n=11), neurocognition (n=6), communication (n=4), early rehabilitation (n=3), pharmacological discontinuation (n=3), ventilation (n=2) or combined bundles (n=9). Almost two-thirds of the studies reported on survival (n=24), 45% (n=17) on care-related outcomes (eg, discharge disposition), and 13% (n=5) of studies on HrQoL. Regarding PICS, 24% (n=9) assessed cognition, 13% (n=5) physical health, and 11% (n=4) mental health, up to 1 year after discharge. The effects of bundles on long-term patient-relevant outcomes was inconclusive, except for a positive effect of sepsis bundles on survival. The inconclusive effects may have been due to the high risk of bias in included studies and the variability in implementation strategies, instruments, and follow-up times.ConclusionsThere is a need to explore the long-term effects of ICU bundles on HrQoL and PICS. Closing this knowledge gap appears vital to determine if there is long-term patient value of ICU bundles.

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Section: Discussionmentioning

confidence: 99%

Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review

et al. 2023

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“…33 There is a need to implement, at all times, care based on the latest scientific evidence. 33 This improved care must be approached from the set of needs detected by nurses and noted in our findings. This first approach in the Spanish health system environment has given us the possibility of detecting similarities with previous factor analyses in other health environments.…”

Section: Discussionmentioning

confidence: 99%

The training needs of critical care nurses: A psychometric analysis

2022

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Background/Objective: Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. Methods: A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. Results: A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett's Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. Conclusion: The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate.

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“…Implementation science seeks to identify, optimize, and accelerate research into practice 17 . It can be used in healthcare to identify barriers and facilitators, develop interventions to overcome barriers, and translate research into the clinical setting 18 .…”

Section: Framework and Methodsmentioning

confidence: 99%

Implementation of a best‐practice guideline: Early enteral nutrition in a neuroscience intensive care unit

Barhorst

Prior

Kanter

2022

J Parenter Enteral Nutr

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Current evidence suggests that early enteral nutrition is a best practice and leads to improved clinical outcomes. An evidence‐based practice project was implemented in a busy neurointensive care unit in a midwestern tertiary care facility that was designed to improve care by implementing the early nutrition portion of Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and the American Society for Enteral and Parenteral Nutrition. The Registered Nurses’ Association of Ontario's (RNAO) Toolkit: Implementation of Best Practice Guidelines (BPGs) was selected and followed to guide implementation and achieve optimal results. During a 90‐day implementation period, this project resulted in a 100% improvement in early nutrition. Interventions included the use of a series of cards that reminded the team to order enteral nutrition and prepacked bundles of nasogastric tube supplies. The RNAO toolkit served as a structured and effective step‐by‐step methodology for the implementation of a BPG.

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A Scoping Review of Implementation Science in Adult Critical Care Settings

Abstract: Supplemental Digital Content is available in the text.

Cited by 28 publications

References 101 publications

Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review

Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review

The training needs of critical care nurses: A psychometric analysis

Implementation of a best‐practice guideline: Early enteral nutrition in a neuroscience intensive care unit

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