3,821 research outputs found

    Identify facilitators and challenges in computerized checklist implementation

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    Safety checklists have been considered as a promising tool for improving patient safety for decades. Computerized checklists have better performance compared with paper-based checklists, though there are barriers to their adoption. Given previous literature, it is still unclear what assists implementations and their challenges. To address this issue, this paper summarizes the implementation of two successful computerized checklist implementations in two countries for two different clinical scenarios and analyzes their facilitators and challenges.</p

    Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

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    Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

    The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

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    Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

    A systematic review of interventions used to enhance implementation of and compliance with the World Health Organization Surgical Safety Checklist in adult surgery

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    This systematic review aimed to identify and synthesize the evidence for effectiveness of interventions on compliance of the WHO Surgical Safety Checklist (SSC) in adult surgery. Databases searched included CINAHL, MEDLINE, PsycINFO and Cochrane Central. Our review was limited to 24 peer-reviewed articles with quantitative (N=17), qualitative (N=4) and mixed methods design (N=3) published in English from 2008 to 2020. Intervention models were: 1) Modifying the ways of delivering the SSC; 2) Integrating or tailoring SSC to local contexts or existing practice; 3) Promoting clinician awareness and engagement; 4) Institutional policy management. Despite a lack of common outcome measures, all 17 quantitative studies and three mixed method studies found a significant intervention effect on SSC compliance. A few studies reported insignificant or negative changes in certain aspects with the interventions. Further studies must address compliance measures and outcomes in developing countries

    Pediatric Survivors of Severe Malaria: Academic Performance Following a Cognitive Intervention in Uganda

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    Background: Severe malarial infection manifests in sub-Saharan pediatric populations in two ways – severe malaria anemia and cerebral malaria. Both cause damage to brain physiology, causing deficits in cognitive functions such as memory, attention, problem solving, and motor control. Malaria mortality has decreased due to increased pharmaceutical availability, but damage is often already done prior to accessing treatment. Consistently high rates of malaria have resulted in malaria becoming a leading cause of cognitive impairment in sub-Saharan Africa. Though efforts must be made in illness prevention, it is necessary for effective tertiary therapies to exist until prevention is more effective. Computerized cognitive rehabilitation therapy (CCRT) offers promising, low-cost, acceptable cognitive benefits for children surviving severe malaria, but validation for real world impact is lacking. Objectives: The objectives of this research are to evaluate the desirability and functional impact of CCRT among pediatric survivors of severe malaria. The hypothesis driving this objective is that CCRT-based cognitive improvements evident in children, will lead to improved performance in the academic setting. Evidence of academic improvements resulting from exposure to CCRT would indicate that translational effects of such an intervention are valid in regards to a measure of everyday functioning (school work). This information has the potential to provide a rationale for the continued use of cognitive training to improve long-term outcomes. Methods: Three studies were conducted to address the objectives. First, a qualitative analysis of the Ugandan perspective of CCRT. Ugandan professionals familiar with CCRT were interviewed regarding facilitators and barriers to CCRT and its implementation. Second, a descriptive study of academic performance differences between healthy children and survivors of severe malaria. Third, an analysis of change in academic performance over one year, following training with CCRT. All analyses take into account moderating variables that may influence CCRT’s functional impact (i.e., socio-economic status, home environment, age, and gender). The second and third studies were a post hoc analysis of school reports collected from participants enrolled in a randomized controlled trial in Uganda. Results: The qualitative analysis identified potential facilitators and barriers that may be encountered regarding CCRT implementation. Ugandan professionals demonstrated the hope and opportunity for the implementation while acknowledging that challenges, such as geography and resource availability, must be considered. The baseline study found no statistically significant difference between healthy children and survivors of severe malaria in academic domains of Arithmetic, English, Reading, Writing, and Luganda. The final study also found no statistically significant differences in academic performance over time following training with CCRT. Conclusion: Ugandan teachers, researchers, and health providers see great potential and desirability for implementing CCRT in the academic setting. Their unique areas of expertise can inform future endeavors of dissemination through identifying barriers, such as resource availability, and facilitators, such as perceived value. Stakeholders place value on this intervention, however, the second study was not able to identify differences in academic performance between survivors of severe malaria and healthy children. The lack of differences may indicate the impact of malaria on cognitive outcomes is not as severe as previously thought, but it may also indicate the limitations of the measure. Finally, evidence of academic change over time was lacking in the third study. These results may indicate CCRT has no direct influence upon academic performance, or as noted before, may result from limitation of the measure of academic performance.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/144150/1/kgfinn_1.pd

    Healthcare professionals' perceptions of the facilitators and barriers to implementing electronic systems for the prescribing, dispensing and administration of medicines in hospitals: a systematic review.

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    Abstract Objective To identify, critically appraise, synthesise and present the available evidence on healthcare professionals' perceptions of the facilitators and barriers to implementing electronic prescribing, dispensing and/or administration of medicines in the hospital setting. Methods A systematic search of studies focusing on healthcare professionals' perceptions of technologies for prescribing, dispensing and administering medicines in the hospital setting was performed using MEDLINE, Cumulative Index to Nursing and Allied Health, International Pharmaceutical Abstracts, PsycARTICLES, PsycINFO, Cochrane Database of Systematic Reviews and Centre for Reviews and Dissemination. Grey literature inclusive of manual searching of core journals, relevant conference abstracts and online theses were also searched. Independent duplicate screening of titles, abstracts and full texts was performed by the authors. Data extraction and quality assessment were undertaken using standardised tools, followed by narrative synthesis. Key findings Five papers were included in the systematic review after screening 2566 titles. Reasons for exclusion were duplicate publication; non-hospital setting; a lack of investigation of healthcare professionals' perceptions and a lack of focus on implementation processes or systems specific to electronic prescribing, dispensing or administration of medicines. Studies were conducted in the USA, Sweden and Australia. All studies used qualitative interview methods. Healthcare professionals perceived systems improved patient safety and provided better access to patients' drug histories and that team leadership and equipment availability and reliability were essential for successful implementation. Key barriers included hardware and network problems; altered work practices such as time pressure on using the system and remote ordering as a potential risk for errors; and weakened interpersonal communication between healthcare professionals and with patients. Conclusions Few studies were identified on healthcare professionals' perceptions of the facilitators and barriers to system implementation in hospitals. Key facilitators included a perception of increased patient safety and better access to patients' drug history while key barriers involved technical problems, changes to routine work practices and weakened interpersonal communication. Investigating this area further will assist in improving patient safety and reducing medication costs by informing and strengthening implementation strategies

    Dynamic checklists:design, implementation and clinical validation

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    Dynamic checklists:design, implementation and clinical validation

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