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Barriers and facilitators to the successful development, implementation and evaluation of care bundles in acute care in hospital: a scoping review

机译:障碍和促进者对医院急性护理中护理束的成功,实施和评估:范围审查

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Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. A scoping review was carried out using the Arksey and O'Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman's rho?=?-?0.47, non-parallel cohort and -?0.65, prospective cohort studies), and between the complexity of elements and compliance (p??0.001, chi-squared?=?23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies. Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity. This review was registered on the PROSPERO database: CRD 42015029963 in December 2015.
机译:护理束是一小一套基于证据的建议,旨在支持实施基于证据的最佳临床实践。然而,关心捆绑的设计和实施有变化,这可能会影响递送的保真度,随后它们的临床效果。使用Arksey和O'Malley框架进行了一个范围审查,以确定关心捆绑的设计,实施和评估的文献报告。在2017年至2017年11月期间出版的造林搜索了Embase,Cinahl,Cochrane和Ovid Medline数据库;还进行了参考和引用的手。在进一步分析和叙事合成之前,最初使用质量评估工具,下降和黑色清单进行评估数据。使用实施变更(埃里克)标准的专家建议分类实施策略。筛选了二十八千六百九十二个出版物,并在全文中检索了348篇文章。包括九十九次评估的定量出版物进行数据提取。这些包括一个随机交叉试验,一个随机聚类试验,一个病例对照研究,20个预期队列研究和76项非平行队列研究。基于下降和黑色清单,二十三个研究的研究被归类为穷人,并报告实施策略缺乏结构。在捆绑和遵守情况下的元素数量(Spearman的Rho? - ? - ?0.47,非平行队列和 - ?0.65,前瞻性队列研究)之间以及元素与依从性的复杂性之间(P?< ?0.001,chi平方?=?23.05)。与改善合规相关的实施策略包括评估和迭代方法,发展利益攸关方关系和教育和培训策略。具有少量简单元素的护理捆绑具有更好的合规性率。实施策略的标准化报告可能有助于以高保真程度实施护理捆绑包。该审查是在Prospero数据库上注册:2015年12月CRD 42015029963。

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