■我们最近报道了一项研究的第一部分,该研究测试了数据素养培训对“评估疼痛”的影响,自发的觉醒和呼吸试验,镇痛和镇静的选择,谵妄监测/管理,早期锻炼/活动能力,以及家庭和患者赋权“[ABCDEF[A-F])依从性。本研究的目的,第二部分,通过对临床工作人员进行调查以检查工作人员的知识来评估实施方法的有效性,技能,动机,和组织资源。
方法:使用Clark和Estes差距分析框架来研究知识,动机,和组织(KMO)影响。文献中确定的假设影响被用来设计A-F捆绑实施策略。根据分发给ICU跨专业团队的调查,验证了这些影响。
方法:单中心研究是在一个四级学术医疗中心的8个成人ICU中进行的。
方法:跨专业ICU临床团队。
方法:对386名参与者进行了定量调查,以评估实施后的实施设计。进行了探索性因素分析,以了解KMO影响与验证影响所提出的问题之间的关系。描述性统计数据用于确定维持性能所需的优势和需要改进以提高A-F束依从性的弱点。
结果:调查获得了83%的应答率。探索性因素分析证实,42个问题中有38个与KMO影响有很强的关系,验证调查在评估实施设计有效性方面的效用。总共确定了12个KMO影响因素,8被归类为优势,4被归类为实施的弱点。
结论:我们的研究使用了一个基于证据的差距分析框架来证明提高A-F束依从性所需的关键实施方法。建议将以下驱动因素作为成功实施协议所需的基本方法:数据素养培训和绩效监控,组织支持,价值主张,多学科合作,和跨专业的团队合作活动。我们相信,在这个由两部分组成的研究中产生的学习适用于A-F束之外的实现设计。
UNASSIGNED: We recently reported the first part of a study testing the impact of data literacy training on \"assessing pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium monitoring/management, early exercise/mobility, and family and patient empowerment\" [ABCDEF [A-F]) compliance. The purpose of the current study, part 2, was to evaluate the effectiveness of the implementation approach by surveying clinical staff to examine staff knowledge, skill, motivation, and organizational resources.
METHODS: The Clark and Estes Gap Analysis framework was used to study knowledge, motivation, and organization (KMO) influences. Assumed influences identified in the literature were used to design the A-F bundle implementation strategies. The influences were validated against a survey distributed to the ICU interprofessional team.
METHODS: Single-center study was conducted in eight adult ICUs in a quaternary academic medical center.
METHODS: Interprofessional ICU clinical team.
METHODS: A quantitative survey was sent to 386 participants to evaluate the implementation design postimplementation. An exploratory factor analysis was performed to understand the relationship between the KMO influences and the questions posed to validate the influence. Descriptive statistics were used to identify strengths needed to sustain performance and weaknesses that required improvement to increase A-F bundle adherence.
RESULTS: The survey received an 83% response rate. The exploratory factor analysis confirmed that 38 of 42 questions had a strong relationship to the KMO influences, validating the survey\'s utility in evaluating the effectiveness of implementation design. A total of 12 KMO influences were identified, 8 were categorized as a strength and 4 as a weakness of the implementation.
CONCLUSIONS: Our study used an evidence-based gap analysis framework to demonstrate key implementation approaches needed to increase A-F bundle compliance. The following drivers were recommended as essential methods required for successful protocol implementation: data literacy training and performance monitoring, organizational support, value proposition, multidisciplinary collaboration, and interprofessional teamwork activities. We believe the learning generated in this two-part study is applicable to implementation design beyond the A-F bundle.