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Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

Stevens BJ, Yamada J, Promislow S, Stinson J, Harrison D, Victor JC, Members of the CIHR Team in Children’s Pa - Implement Sci (2014)

Bottom Line: The most effective single or combination of KT strategies has not been found.Units successful in achieving their aims implemented more KT strategies than units that did not.Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

View Article: PubMed Central - PubMed

Affiliation: The Hospital for Sick Children and University of Toronto, 686 Bay Street, Room 06.9712, Toronto, Ontario, M5G 1X8, Canada. b.stevens@utoronto.ca.

ABSTRACT

Background: Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation.

Methods: Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period.

Results: Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies.

Conclusions: Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

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Related in: MedlinePlus

Examples of knowledge translation strategies by type.
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Fig2: Examples of knowledge translation strategies by type.

Mentions: In the Implementation and Change Phase of EPIQ, Research Practice Councils, in collaboration with the site research nurses, planned, developed, implemented and evaluated their practice change aims, employing evidence based KT strategies tailored to their unit, including: educational materials (e.g., posters, newsletters), educational outreach activities (e.g., one-on-one instruction, patient care rounds), reminders (e.g., posters, stickers, buttons, screen savers), and audit and feedback (e.g., surveys, chart audits, feedback reports). While other potential KT strategies exist, these four types were selected by the research team based on their effectiveness at the time of the study. All interventions used to achieve the practice change aims were evidence-based. Examples of KT strategies included: Educational posters based on Cochrane reviews of pain management interventions (e.g., distraction, topical anesthetics), reminders about targeted practices strategically posted on the units or patient charts; laminated validated pain assessment scales placed at the patients’ bedside; educational instruction on the targeted pain practices in orientation sessions for new and returning staff; educational outreach to engage clinicians during reports on patient pain during patient care rounds; and summaries of high impact published articles on pain practices in unit newsletters (Figure 2).Figure 2


Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

Stevens BJ, Yamada J, Promislow S, Stinson J, Harrison D, Victor JC, Members of the CIHR Team in Children’s Pa - Implement Sci (2014)

Examples of knowledge translation strategies by type.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4263210&req=5

Fig2: Examples of knowledge translation strategies by type.
Mentions: In the Implementation and Change Phase of EPIQ, Research Practice Councils, in collaboration with the site research nurses, planned, developed, implemented and evaluated their practice change aims, employing evidence based KT strategies tailored to their unit, including: educational materials (e.g., posters, newsletters), educational outreach activities (e.g., one-on-one instruction, patient care rounds), reminders (e.g., posters, stickers, buttons, screen savers), and audit and feedback (e.g., surveys, chart audits, feedback reports). While other potential KT strategies exist, these four types were selected by the research team based on their effectiveness at the time of the study. All interventions used to achieve the practice change aims were evidence-based. Examples of KT strategies included: Educational posters based on Cochrane reviews of pain management interventions (e.g., distraction, topical anesthetics), reminders about targeted practices strategically posted on the units or patient charts; laminated validated pain assessment scales placed at the patients’ bedside; educational instruction on the targeted pain practices in orientation sessions for new and returning staff; educational outreach to engage clinicians during reports on patient pain during patient care rounds; and summaries of high impact published articles on pain practices in unit newsletters (Figure 2).Figure 2

Bottom Line: The most effective single or combination of KT strategies has not been found.Units successful in achieving their aims implemented more KT strategies than units that did not.Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

View Article: PubMed Central - PubMed

Affiliation: The Hospital for Sick Children and University of Toronto, 686 Bay Street, Room 06.9712, Toronto, Ontario, M5G 1X8, Canada. b.stevens@utoronto.ca.

ABSTRACT

Background: Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation.

Methods: Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period.

Results: Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies.

Conclusions: Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

Show MeSH
Related in: MedlinePlus