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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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Proportion of children receiving targeted pain practice per intervention cycle.
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Fig3: Proportion of children receiving targeted pain practice per intervention cycle.

Mentions: At the completion of the four EPIQ intervention cycles: 18/23 (78%) pain practice aims were met, exceeded, or came within 80% of achievement, while 5/23 (22%) aims were less than 80%; 92% of the pain assessment aims were attained or came within 80% compared to 64% of the pain management aims. However this difference was not statistically significant (p = 0.16), in part due to the small sample size. Over the four EPIQ intervention cycles, a significant improvement in all selected pain assessment and pain management practices was observed. There was an absolute increase of 35% in the proportion of children receiving the targeted pain practices (22% at baseline versus 57% at the end of cycle four), regardless of the pre-determined practice aims or the degree of change units proposed (Figure 3); although a small and non-significant decrease (2%) in the number of patients receiving the targeted pain practices occurred between the 3rd (59.1%) and the final practice change cycle (57.1%).Figure 3


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)

Proportion of children receiving targeted pain practice per intervention cycle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Proportion of children receiving targeted pain practice per intervention cycle.
Mentions: At the completion of the four EPIQ intervention cycles: 18/23 (78%) pain practice aims were met, exceeded, or came within 80% of achievement, while 5/23 (22%) aims were less than 80%; 92% of the pain assessment aims were attained or came within 80% compared to 64% of the pain management aims. However this difference was not statistically significant (p = 0.16), in part due to the small sample size. Over the four EPIQ intervention cycles, a significant improvement in all selected pain assessment and pain management practices was observed. There was an absolute increase of 35% in the proportion of children receiving the targeted pain practices (22% at baseline versus 57% at the end of cycle four), regardless of the pre-determined practice aims or the degree of change units proposed (Figure 3); although a small and non-significant decrease (2%) in the number of patients receiving the targeted pain practices occurred between the 3rd (59.1%) and the final practice change cycle (57.1%).Figure 3

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