Back to resultsSumamos Excelencia 2022
Primary Purpose
Pain, Incontinence, Urinary, Obesity, Childhood
Status
Active
Phase
Not Applicable
Locations
Spain
Study Type
Interventional
Intervention
Continuous quality improvement cycle model
Sponsored by
About this trial
This is an interventional health services research trial for Pain focused on measuring Implementation Science, Evidence-Based Practice, Evidence-Based Nursing, Nursing Care, Quality of Health Care, Clinical Audit
Eligibility Criteria
Inclusion Criteria:
Unit inclusion criteria:
- NHS units and nursing homes which voluntary adhere to the project.
- NHS units and nursing homes providing direct patient care and commit to implement evidence-based recommendations on hand hygiene and one of the following topics: pain assessment and management, urinary incontinence management, obesity prevention and breastfeeding promotion. For the purposes of this study, a "unit" is defined as any service, centre or institution that delivers health services to a homogeneous group of patients who share similar characteristics.
Patient inclusion criteria: The study will include all patients attended in the units participating in the study, who meet the following criteria, depending on the recommendations to be implemented in each unit:
Pain:
- People susceptible to suffering some type of pain regardless of age.
- Patients treated in acute or chronic health institutions (Hospitals, Nursing Homes or Primary Care).
Urinary incontinence:
- Patients 18 years or older.
- Patients with uncomplicated stress, urge or mixed urinary incontinence
- At least 7 days of admission or possibility of continuity of care preferably up to 6 weeks.
Obesity:
- Babies and preschool children up to 12 years old.
- For ages 2 to 12 years (inclusive), children must not be overweight or obese 1 year prior to baseline measurement (in February 2021 or at the closest review to February 2021 at which BMI is recorded).
- Good general health.
Breastfeeding:
- Lactating people.
- Healthy neonates of gestational age greater than 36 weeks, with birth weight greater than or equal to 2500 gr.
- Couples and relatives within the support network.
- Postpartum period and up to 6 months of life of the baby (183 days of life, included).
- In primary care, only non-urgent care will be included.
Hand hygiene:
- All health professionals who care for patients in the units participating in the study.
Exclusion Criteria:
-
Sites / Locations
- Instituto de Salud Carlos III - Unidad de Investigación en Cuidados y Servicios de Salud
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Quasi-experimental uncontrolled, before-and-after.
Arm Description
The intervention will consist of the use of a continuous quality improvement cycle model and implementation of its strategies in clinical practice, according to the study unit in question and the scope of action.
Outcomes
Primary Outcome Measures
Urinary incontinence assessment
Assessment of presence of urinary incontinence. Total number of patients in whom the presence of urinary incontinence has been initially assessed, and who are registered / Total number of patients with positive detection of urinary incontinence during the data collection period) * 100
Voiding diary
Record of all urination and leakage for 3 consecutive days. (Total number of patients with a voiding diary of 3 days recorded / Total number of patients with urinary incontinence discharged or attended during the data collection period) * 100
Scheduled urination
Using verbal and physical prompts or signals to make people pay attention to their dry/wet situation and the need to go to the bathroom. (Total number of patients with a scheduled urination care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Bladder training
Program of education and programmed evacuation in which the intervals of micturition are gradually adjusted. (Total number of patients with a bladder training care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Pelvic floor exercises
The individualized education and training of pelvic floor exercises. (Total number of patients with a pelvic floor exercise care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Severity
Severity of urinary incontinence. Total number of patients with different levels of urinary incontinence 24 hours prior to assessment / Total number of patients with urinary incontinence during the data collection period) x 100
Impact
Impact of urinary incontinence. (Total number of patients whose urinary incontinence has an impact on their quality of life, in the 24 hours prior to the assessment / Total number of patients with urinary incontinence during the data collection period) x 100
Improvement
Perception of improvement in urinary incontinence. (Total number of patients who perceive an improvement 6 weeks after the intervention / Total number of patients with urinary incontinence before the start of the intervention) x100
Detection of pain at admission
Detection of pain at admission. (Total number of patients in whom pain detection was performed upon admission or at the start of care, and it is registered / Total number of patients discharged or attended in the collection period data) x100
Pain related to a procedure likely to cause pain
Detection of pain related to a procedure likely to cause pain. This indicator evaluates whether the assessment of pain linked to the painful procedure is carried out before and after the procedure, it is also recommended to assess pain during the procedure in cases where it is possible. (Total number of patients in whom pain has been detected after a procedure likely to cause pain, and is registered / Total number of patients in whom a procedure likely to cause pain has been performed in the data collection period data) x100
Pain after a change in the patient's clinical situation
Detection of pain after a change in the patient's clinical situation (clinical situation: significant clinical change, in the general condition of the patient or in their pain, which requires the referral of the patient to a professional with the skills to resolve it). (Total number of patients in whom pain has been detected after a change in their clinical situation, and it is registered / Total number of patients with a change in their clinical situation in the data collection period) x100
Pain intensity assessment
Pain assessment measured with a pain intensity assessment tool. (Total number of patients who have an assessment of pain intensity, and it is recorded / Total number of patients with positive detection of pain in the data collection period) x100
Comprehensive pain assessment
Comprehensive pain assessment takes into account various factors related to pain, including: location of pain, circumstances related to the onset of pain, type of pain, pain intensity, associated symptoms, effect of pain on activities, effect of pain on patient rest and sleep, treatment, relevant medical history, factors that influence pain management. To be considered a comprehensive assessment, at least 60% of the 10 criteria must be performed and recorded. (Total number of patients who have done a comprehensive pain assessment, and it is registered / Total number of patients with positive pain detection in the data collection period) x100
Pain management care plan
Establishing and implementing a pain management care plan for the patient based on the results of the person's assessment, which would include: pharmacological and non-pharmacological measures, the person's goals and appropriate and effective pain management strategies. (Total number of patients with a care plan for acute or chronic pain, and it is registered / Total number of patients with positive detection of pain or susceptible to have pain in the data collection period) x100
Patient or/and caregiver education on pain
Patient or/and caregiver education on the importance of communicating pain, pharmacological, physical and psychological pain management options, how to take the analgesic medication, manage the possible side effects and how the follow-up will be done and who can be consulted with possible doubts. (Total number of patients, family members or caregivers who have received education on pain management, at least once during the care process, and it is registered / Total number of patients with positive detection of pain or likely to have pain in the data collection period) x100
Intensity of pain on admission or in the first 24 hours after surgery or at the start of care
Intensity of pain on admission or in the first 24 hours after surgery or at the start of care measured in numerical format, with the value that corresponds to the scale used in the unit for the assessment of pain, units must indicate on the form the scale they have used. (Sum of pain intensity of patients with positive pain detection or likely to have pain / Total number of patients with assessed pain intensity in the data collection period)
Maximum pain
Maximum scored reported by patients and registered by nurses after pain intensity assessment using an assessment tool. Units must indicate on the form the assessment tool they have used. (Sum of the maximum intensity of pain during the stay or care of patients with positive detection of pain or likely to have pain / Total number of patients with pain intensity assessed in the data collection period)
Skin-to-skin contact
Skin-to-skin contact is the placement of a newborn, naked or with a diaper and cap, in a prone position on the bare chest of a person, covered with a previously heated blanket to prevent heat loss. It should be facilitated immediately (up to 1 hour) after birth or once the child and the nursing person are clinically stable. (Number of infants performing skin-to-skin immediately after birth or with clinically stable dyad /Total number of infants) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Postpartum assessment of breastfeeding
Assessment of breastfeeding completed within the first 24 hours of the newborn life. The objective is that in the first 24 hours the breastfeeding person is able to identify: proper position and grip, efficient breast milk transfer, support networks, breastfeeding self-efficacy, risks of mood disorders, assessment of the newborn in relation to breastfeeding. To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process in the first 24 hours/Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Assessment of breastfeeding after the first 24 hours and before discharge
Assessment of breastfeeding completed after first 24 hours of the newborn life and before hospital discharge. The objective is that before hospital discharge the breastfeeding person is able to identify: proper position and grip, efficient breast milk transfer, support networks, breastfeeding self-efficacy, risks of mood disorders, assessment of the newborn in relation to breastfeeding. To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process after the first 24 hours and before hospital discharge / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Early assessment of breastfeeding in primary care
In Primary Care, early assessment is considered completed between birth and day 8 of the neonate's life (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed early on the process of breastfeeding (between birth and 8 days of life / Total number of dyads between birth and 8 days of life of the newborn) x 100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Follow-up assessment of breastfeeding in primary care (from 9 days of life to 6 months)
In Primary Care, the follow-up evaluation is carried out between 9 days of life and 6 months/183 days of life of the neonate (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process from 9 days of life to 6 months / Total number of dyads from 9 days of life to 6 months of the newborn) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Breastfeeding education for the breastfeeding person
In Hospital Care, it is considered completed if postpartum training has been carried out and resources have been provided to the mother by the interprofessional team in breastfeeding before hospital discharge. In Primary Care, it is considered completed if training has been carried out and resources have been provided to the mother after hospital discharge by the interprofessional team in breastfeeding, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or in successive visits. (Number of lactating persons receiving education in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Breastfeeding education and support for family members
In hospital care, it is considered completed if education and support in breastfeeding has been carried out for family members before hospital discharge. In Primary Care, it is considered accomplished if breastfeeding education and support has been provided to family members, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or on successive visits. (Number of dyads whose family has received education and support in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Type of breastfeeding of the newborn during the hospital stay
Type of breastfeeding of the newborn during the hospital stay. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed during hospital stay / Total number of infants discharged) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Type of breastfeeding of the newborn in early stage
Type of breastfeeding of the newborn from birth to 8 days of life assessed in Primary care. (Number of newborns who were exclusively breastfed, received mixed breastfeeding or were not breastfed from birth to 8 days of life / Total number of newborns between 0 and 8 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Type of breastfeeding of the newborn in follow-up 1
Type of breastfeeding of the newborn from 9 to 90 days of life, assessed in Primary Care. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed from 9 days to 90 days of life / Total number of infants from 9 to 90 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Type of breastfeeding of the newborn in follow-up 2
Type of breastfeeding of the newborn from 91 to 182 days of life assessed in Primary care (Number of newborns who received exclusive breastfeeding, receiving mixed breastfeeding or not breastfed from 91 days to 182 days of life / Total number of newborns from 91 to 182 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Exclusive breastfeeding at 6 months
Number of newborns who received exclusive breastfeeding on day 183 of life (Number of newborns who received exclusive breastfeeding on day 183 of life / Total number of newborns with 183 days completed) x100
Training of health professionals
Number of health professionals who have received advanced training and/or continuing education in breastfeeding. The training must have a minimum of 18 hours and include theoretical training and practical application of skills. (Number of health professionals who have received advanced training and/or continuing education in breastfeeding / Total number of health professionals) x100
Assessment to prevent obesity
At least one comprehensive assessment including the assessment of nutrition, physical activity, sedentary behaviour, growth and family environment has been completed in infants from birth to 12 years of age. (Total number of children from birth to 12 years of age who have undergone a comprehensive assessment to prevent obesity, and are registered / Total number of children from birth to 12 years of age with one or more well-child follow-up visits in the previous year) x100
Education and support for parents/primary caregivers
Parents or primary caregivers have received education and support including: breastfeeding, role modelling, children's eating practices, family physical activity, screen time, physical activity, healthy eating; and it is documented. (Total number of children from birth to 12 years of age whose parents or caregivers have received education to promote healthy eating or physical activity habits, by child's age, and is registered / Total number of children from birth to 12 years with one or more well-child follow-up visits in the previous year) x100
Exclusive breastfeeding, children from birth to 6 months of age
Children from 0 to 183 days inclusive who have received exclusive breastfeeding, directly from the breast or stored. (Number of children 0-6 months (or-183 days) who received EXCLUSIVE breastfeeding in the previous 24 hours, and is registered / Total number of children 0-6 months with one or more visits well-infant-child follow-up in the previous year) x100
Breastfeeding, children from 6 months of age up to 2 years
Children with more than 183 days of life who received breastfeeding directly from the breast or stored. (Number of children >6 months and up to 2 years (more than 183 days-2 years) who received breastfeeding in the previous 24 hours, and is registered / Total number of children >6 months - and up 2 years with one or more well-infant-child follow-up visits in the previous year) x100
Sedentary behaviour
Number of children from birth to 12 years old who spent the recommended time for their age in front of a screen. (Number of children from birth to 12 years old, whose daily screen time is the recommended for their age, as of parents' declaration, and is registered / Total number of children from births up to 12 years of age with one or more follow-up visits to the well-child infant in the previous year, with assessment of screen time or comprehensive assessment) x100
Daily physical activity
Number of children from birth to 12 years of age who meet the recommendations on amount of daily physical activity. (Number of children from birth to 12 years of age who meet the recommendations on amount of daily exercise, and are registered / Total number of children from birth to 12 years of age with one or more follow-up visits of the healthy infant-child in the previous year, with assessment of physical activity or comprehensive assessment) x100
Incidence of childhood obesity
Incidence of childhood obesity. (Number of children between 2 and 12 years old (included) whose BMI for their age exceeds the percentile to be considered obese according to WHO standards, at the LAST follow-up VISIT of the infant/well-child, and is registered / Number of children between 2 and 12 years of age (included) with one or more well-child infant follow-up visits in the previous year, whose BMI has been assessed in the measurement period) x100
ICU beds with alcohol-based preparations at the point of care
Availability of the alcohol-based preparations in the Intensive Care Units (Hospital care) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of ICU beds in the unit, with base alcoholic preparations at the point of care / Number of ICU beds in the unit) x100
Hospital beds with alcohol-based preparations at the point of care
Availability of the alcohol-based preparations in the hospital units (excluding ICU beds) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of hospitalization beds in the unit, with alcohol-based preparations at the point of care)/(Number of beds in the unit) x100
Consumption of alcohol-based preparations in hospitalization
Litres of alcohol-based preparations consumed in hospitalization units with admission, including ICU (Number of litres of alcohol-based preparations delivered / Total number of stays in the evaluated period) x1000 Total number of stays in the evaluated period: It refers to the stays of hospitalized patients, where stay = Date of discharge - Date of admission, during the indicator calculation period.
Consumption of alcohol-based preparations in Primary Care centers
Litres of alcohol-based preparations consumed in primary care centres. (Number of liters of alcohol-based preparations delivered in primary care / Total number of consultations in the evaluated period) x10000
Consumption of alcohol-based preparations in hospital units without admission
Litres of alcohol-based preparations consumed in hospital units without admission (outpatient consultations, day hospital, etc.). (Number of liters of alcohol-based preparations@delivered in a hospital unit without admission / Total number of consultations in the evaluated period) x1000
Consumption of alcohol-based preparations in Nursing Homes.
Litres of alcohol-based preparations consumed in Nursing Homes (Number of liters of alcohol-based preparations delivered in Nursing Homes / Total number of residents in the evaluated period) x100
Secondary Outcome Measures
Type of institution
Hospital unit, primary care unit or nursing home unit.
Size of hospital unit
Average number of admissions received per year.
Size of Nursing home
Total number of beds in the nursing home unit.
Size of primary care unit
Average number of appointments per day in the units.
No. Nurses
Total number of nurses working in the unit by November 2021.
No. Healthcare assistants
Total number of healthcare assistants working in the unit by November 2021.
Type of unit
Age, health problems and care required by the patients attended by the unit on a regular basis.
Date of discharge
Patients discharge date in case of hospital admissions.
Date of attention
Date when patients were attended in case of primary care.
Date of residence
Date when patients were a resident in case of socio-healthcare centres.
Age
Age of patients.
Sex
Sex of patients.
Mother´s age
Age of the mother.
Breastfeeding for the first time
First time the mother is facing breastfeeding or not.
Type of birth
Way in which the newborn was born: vaginal delivery, instrumental birth, caesarean section.
Weeks of gestation
Number of weeks of pregnancy.
Weight at birth
Weight of the newborn at birth, measured in grams.
Child weight
Child's weight measured in kilograms.
Size
Height: child's height measured in centimetres.
Reason for admission/consultation
Reason for admission/consultation of patients. Reason for the patient to be admitted to the Hospital or to attend the consultation.
Past-medical history
History of previous illness, surgery or painful experiences of the patient.
Barriers
Barriers for the implementation of evidence-based recommendations in the units assessed using a questionnaire adapted from the TICD checklist.
EBP competencies
Competencies in evidence-based practice of the healthcare professionals working in the units that are implementing evidence-based recommendations, assessed with the questionnaire EBP-COQ Prof©.
Full Information
NCT ID
NCT05466656
First Posted
July 15, 2022
Last Updated
July 20, 2022
Sponsor
Teresa Moreno Casbas
Collaborators
The Spanish Centre for Evidence Based Nursing and Healthcare
1. Study Identification
Unique Protocol Identification Number
NCT05466656
Brief Title
Sumamos Excelencia 2022
Official Title
SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Second Edition)
Study Type
Interventional
2. Study Status
Record Verification Date
July 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 25, 2021 (Actual)
Primary Completion Date
March 2023 (Anticipated)
Study Completion Date
March 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Teresa Moreno Casbas
Collaborators
The Spanish Centre for Evidence Based Nursing and Healthcare
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
There is a gap between research and clinical practice, leading to variability in decision-making. Clinical audits are an effective strategy for improving implementation of best practices. Quasi-experimental, multicentre, before and after. Primary care, hospital units and nursing homes, and the patients attended at both. Implementation of evidence-based recommendations by application of a continuous quality improvement cycle model (process of improvement by reference to a prior baseline clinical audit. Data will be collected at baseline and, during the first year of follow up, at months (3, 6, 12)
Detailed Description
Aim: To assess the effectiveness of implementing evidence-based recommendations using a continuous quality improvement cycle model on patient outcomes and healthcare quality. Design: Quasi-experimental, multicentre, before-and-after. Methods: NHS units and Nursing Homes, patients attended by them and professionals implementing the recommendations. Intervention: implementation of evidence-based recommendation with a continuous quality improvement cycle's model (process of improvement by reference to a prior baseline clinical audit). Variables: Process and outcome criteria with respect to assessment and management of pain, management of urinary incontinence, prevention of child obesity, promotion of breastfeeding, promotion of hand hygiene, competencies in evidence-based practice, barriers to the implementation and strategies for overcoming them. Data will be collected at baseline and, during the first year of follow-up, at months 3, 6 and 12, with data on patients and indicators being drawn from clinical histories and records. Descriptive analysis and comparison of the effectiveness of the intervention by means of inferential analysis and analysis of trends across follow-up. 95% confidence level. This project is partially funded by The Spanish Centre for Evidence Based Nursing and Healthcare. Project duration 2022-2024.
This project is a second edition of The SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (NCT03725774), with a similar design but with changes in some of the themes.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pain, Incontinence, Urinary, Obesity, Childhood, Breastfeeding
Keywords
Implementation Science, Evidence-Based Practice, Evidence-Based Nursing, Nursing Care, Quality of Health Care, Clinical Audit
7. Study Design
Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Quasi-experimental, uncontrolled, before-and-after study
Masking
None (Open Label)
Allocation
N/A
Enrollment
115 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Quasi-experimental uncontrolled, before-and-after.
Arm Type
Experimental
Arm Description
The intervention will consist of the use of a continuous quality improvement cycle model and implementation of its strategies in clinical practice, according to the study unit in question and the scope of action.
Intervention Type
Other
Intervention Name(s)
Continuous quality improvement cycle model
Intervention Description
The continuous quality improvement cycle model consist in a process of improvement by reference to a prior baseline clinical audit. It implies a local situation analysis, identifying barriers to improvements in clinical practice, and drawing up and implementing a plan of action for improving adherence to pre-established criteria. The goal is to establish interprofessional processes within the teams, in order to: examine the barriers that hinder the use of evidence in fostering best practices; and contribute to the development of implementation programmes for overcoming such obstacles.
Primary Outcome Measure Information:
Title
Urinary incontinence assessment
Description
Assessment of presence of urinary incontinence. Total number of patients in whom the presence of urinary incontinence has been initially assessed, and who are registered / Total number of patients with positive detection of urinary incontinence during the data collection period) * 100
Time Frame
15 months
Title
Voiding diary
Description
Record of all urination and leakage for 3 consecutive days. (Total number of patients with a voiding diary of 3 days recorded / Total number of patients with urinary incontinence discharged or attended during the data collection period) * 100
Time Frame
15 months
Title
Scheduled urination
Description
Using verbal and physical prompts or signals to make people pay attention to their dry/wet situation and the need to go to the bathroom. (Total number of patients with a scheduled urination care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Time Frame
15 months
Title
Bladder training
Description
Program of education and programmed evacuation in which the intervals of micturition are gradually adjusted. (Total number of patients with a bladder training care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Time Frame
15 months
Title
Pelvic floor exercises
Description
The individualized education and training of pelvic floor exercises. (Total number of patients with a pelvic floor exercise care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100
Time Frame
15 months
Title
Severity
Description
Severity of urinary incontinence. Total number of patients with different levels of urinary incontinence 24 hours prior to assessment / Total number of patients with urinary incontinence during the data collection period) x 100
Time Frame
15 months
Title
Impact
Description
Impact of urinary incontinence. (Total number of patients whose urinary incontinence has an impact on their quality of life, in the 24 hours prior to the assessment / Total number of patients with urinary incontinence during the data collection period) x 100
Time Frame
15 months
Title
Improvement
Description
Perception of improvement in urinary incontinence. (Total number of patients who perceive an improvement 6 weeks after the intervention / Total number of patients with urinary incontinence before the start of the intervention) x100
Time Frame
15 months
Title
Detection of pain at admission
Description
Detection of pain at admission. (Total number of patients in whom pain detection was performed upon admission or at the start of care, and it is registered / Total number of patients discharged or attended in the collection period data) x100
Time Frame
15 months
Title
Pain related to a procedure likely to cause pain
Description
Detection of pain related to a procedure likely to cause pain. This indicator evaluates whether the assessment of pain linked to the painful procedure is carried out before and after the procedure, it is also recommended to assess pain during the procedure in cases where it is possible. (Total number of patients in whom pain has been detected after a procedure likely to cause pain, and is registered / Total number of patients in whom a procedure likely to cause pain has been performed in the data collection period data) x100
Time Frame
15 months
Title
Pain after a change in the patient's clinical situation
Description
Detection of pain after a change in the patient's clinical situation (clinical situation: significant clinical change, in the general condition of the patient or in their pain, which requires the referral of the patient to a professional with the skills to resolve it). (Total number of patients in whom pain has been detected after a change in their clinical situation, and it is registered / Total number of patients with a change in their clinical situation in the data collection period) x100
Time Frame
15 months
Title
Pain intensity assessment
Description
Pain assessment measured with a pain intensity assessment tool. (Total number of patients who have an assessment of pain intensity, and it is recorded / Total number of patients with positive detection of pain in the data collection period) x100
Time Frame
15 months
Title
Comprehensive pain assessment
Description
Comprehensive pain assessment takes into account various factors related to pain, including: location of pain, circumstances related to the onset of pain, type of pain, pain intensity, associated symptoms, effect of pain on activities, effect of pain on patient rest and sleep, treatment, relevant medical history, factors that influence pain management. To be considered a comprehensive assessment, at least 60% of the 10 criteria must be performed and recorded. (Total number of patients who have done a comprehensive pain assessment, and it is registered / Total number of patients with positive pain detection in the data collection period) x100
Time Frame
15 months
Title
Pain management care plan
Description
Establishing and implementing a pain management care plan for the patient based on the results of the person's assessment, which would include: pharmacological and non-pharmacological measures, the person's goals and appropriate and effective pain management strategies. (Total number of patients with a care plan for acute or chronic pain, and it is registered / Total number of patients with positive detection of pain or susceptible to have pain in the data collection period) x100
Time Frame
15 months
Title
Patient or/and caregiver education on pain
Description
Patient or/and caregiver education on the importance of communicating pain, pharmacological, physical and psychological pain management options, how to take the analgesic medication, manage the possible side effects and how the follow-up will be done and who can be consulted with possible doubts. (Total number of patients, family members or caregivers who have received education on pain management, at least once during the care process, and it is registered / Total number of patients with positive detection of pain or likely to have pain in the data collection period) x100
Time Frame
15 months
Title
Intensity of pain on admission or in the first 24 hours after surgery or at the start of care
Description
Intensity of pain on admission or in the first 24 hours after surgery or at the start of care measured in numerical format, with the value that corresponds to the scale used in the unit for the assessment of pain, units must indicate on the form the scale they have used. (Sum of pain intensity of patients with positive pain detection or likely to have pain / Total number of patients with assessed pain intensity in the data collection period)
Time Frame
15 months
Title
Maximum pain
Description
Maximum scored reported by patients and registered by nurses after pain intensity assessment using an assessment tool. Units must indicate on the form the assessment tool they have used. (Sum of the maximum intensity of pain during the stay or care of patients with positive detection of pain or likely to have pain / Total number of patients with pain intensity assessed in the data collection period)
Time Frame
15 months
Title
Skin-to-skin contact
Description
Skin-to-skin contact is the placement of a newborn, naked or with a diaper and cap, in a prone position on the bare chest of a person, covered with a previously heated blanket to prevent heat loss. It should be facilitated immediately (up to 1 hour) after birth or once the child and the nursing person are clinically stable. (Number of infants performing skin-to-skin immediately after birth or with clinically stable dyad /Total number of infants) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Postpartum assessment of breastfeeding
Description
Assessment of breastfeeding completed within the first 24 hours of the newborn life. The objective is that in the first 24 hours the breastfeeding person is able to identify: proper position and grip, efficient breast milk transfer, support networks, breastfeeding self-efficacy, risks of mood disorders, assessment of the newborn in relation to breastfeeding. To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process in the first 24 hours/Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Assessment of breastfeeding after the first 24 hours and before discharge
Description
Assessment of breastfeeding completed after first 24 hours of the newborn life and before hospital discharge. The objective is that before hospital discharge the breastfeeding person is able to identify: proper position and grip, efficient breast milk transfer, support networks, breastfeeding self-efficacy, risks of mood disorders, assessment of the newborn in relation to breastfeeding. To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process after the first 24 hours and before hospital discharge / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Early assessment of breastfeeding in primary care
Description
In Primary Care, early assessment is considered completed between birth and day 8 of the neonate's life (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed early on the process of breastfeeding (between birth and 8 days of life / Total number of dyads between birth and 8 days of life of the newborn) x 100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Follow-up assessment of breastfeeding in primary care (from 9 days of life to 6 months)
Description
In Primary Care, the follow-up evaluation is carried out between 9 days of life and 6 months/183 days of life of the neonate (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process from 9 days of life to 6 months / Total number of dyads from 9 days of life to 6 months of the newborn) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Breastfeeding education for the breastfeeding person
Description
In Hospital Care, it is considered completed if postpartum training has been carried out and resources have been provided to the mother by the interprofessional team in breastfeeding before hospital discharge. In Primary Care, it is considered completed if training has been carried out and resources have been provided to the mother after hospital discharge by the interprofessional team in breastfeeding, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or in successive visits. (Number of lactating persons receiving education in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Breastfeeding education and support for family members
Description
In hospital care, it is considered completed if education and support in breastfeeding has been carried out for family members before hospital discharge. In Primary Care, it is considered accomplished if breastfeeding education and support has been provided to family members, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or on successive visits. (Number of dyads whose family has received education and support in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.
Time Frame
15 months
Title
Type of breastfeeding of the newborn during the hospital stay
Description
Type of breastfeeding of the newborn during the hospital stay. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed during hospital stay / Total number of infants discharged) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Time Frame
15 months
Title
Type of breastfeeding of the newborn in early stage
Description
Type of breastfeeding of the newborn from birth to 8 days of life assessed in Primary care. (Number of newborns who were exclusively breastfed, received mixed breastfeeding or were not breastfed from birth to 8 days of life / Total number of newborns between 0 and 8 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Time Frame
15 months
Title
Type of breastfeeding of the newborn in follow-up 1
Description
Type of breastfeeding of the newborn from 9 to 90 days of life, assessed in Primary Care. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed from 9 days to 90 days of life / Total number of infants from 9 to 90 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Time Frame
15 months
Title
Type of breastfeeding of the newborn in follow-up 2
Description
Type of breastfeeding of the newborn from 91 to 182 days of life assessed in Primary care (Number of newborns who received exclusive breastfeeding, receiving mixed breastfeeding or not breastfed from 91 days to 182 days of life / Total number of newborns from 91 to 182 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food.
Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula.
Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.
Time Frame
15 months
Title
Exclusive breastfeeding at 6 months
Description
Number of newborns who received exclusive breastfeeding on day 183 of life (Number of newborns who received exclusive breastfeeding on day 183 of life / Total number of newborns with 183 days completed) x100
Time Frame
15 months
Title
Training of health professionals
Description
Number of health professionals who have received advanced training and/or continuing education in breastfeeding. The training must have a minimum of 18 hours and include theoretical training and practical application of skills. (Number of health professionals who have received advanced training and/or continuing education in breastfeeding / Total number of health professionals) x100
Time Frame
15 months
Title
Assessment to prevent obesity
Description
At least one comprehensive assessment including the assessment of nutrition, physical activity, sedentary behaviour, growth and family environment has been completed in infants from birth to 12 years of age. (Total number of children from birth to 12 years of age who have undergone a comprehensive assessment to prevent obesity, and are registered / Total number of children from birth to 12 years of age with one or more well-child follow-up visits in the previous year) x100
Time Frame
15 months
Title
Education and support for parents/primary caregivers
Description
Parents or primary caregivers have received education and support including: breastfeeding, role modelling, children's eating practices, family physical activity, screen time, physical activity, healthy eating; and it is documented. (Total number of children from birth to 12 years of age whose parents or caregivers have received education to promote healthy eating or physical activity habits, by child's age, and is registered / Total number of children from birth to 12 years with one or more well-child follow-up visits in the previous year) x100
Time Frame
15 months
Title
Exclusive breastfeeding, children from birth to 6 months of age
Description
Children from 0 to 183 days inclusive who have received exclusive breastfeeding, directly from the breast or stored. (Number of children 0-6 months (or-183 days) who received EXCLUSIVE breastfeeding in the previous 24 hours, and is registered / Total number of children 0-6 months with one or more visits well-infant-child follow-up in the previous year) x100
Time Frame
15 months
Title
Breastfeeding, children from 6 months of age up to 2 years
Description
Children with more than 183 days of life who received breastfeeding directly from the breast or stored. (Number of children >6 months and up to 2 years (more than 183 days-2 years) who received breastfeeding in the previous 24 hours, and is registered / Total number of children >6 months - and up 2 years with one or more well-infant-child follow-up visits in the previous year) x100
Time Frame
15 months
Title
Sedentary behaviour
Description
Number of children from birth to 12 years old who spent the recommended time for their age in front of a screen. (Number of children from birth to 12 years old, whose daily screen time is the recommended for their age, as of parents' declaration, and is registered / Total number of children from births up to 12 years of age with one or more follow-up visits to the well-child infant in the previous year, with assessment of screen time or comprehensive assessment) x100
Time Frame
15 months
Title
Daily physical activity
Description
Number of children from birth to 12 years of age who meet the recommendations on amount of daily physical activity. (Number of children from birth to 12 years of age who meet the recommendations on amount of daily exercise, and are registered / Total number of children from birth to 12 years of age with one or more follow-up visits of the healthy infant-child in the previous year, with assessment of physical activity or comprehensive assessment) x100
Time Frame
15 months
Title
Incidence of childhood obesity
Description
Incidence of childhood obesity. (Number of children between 2 and 12 years old (included) whose BMI for their age exceeds the percentile to be considered obese according to WHO standards, at the LAST follow-up VISIT of the infant/well-child, and is registered / Number of children between 2 and 12 years of age (included) with one or more well-child infant follow-up visits in the previous year, whose BMI has been assessed in the measurement period) x100
Time Frame
15 months
Title
ICU beds with alcohol-based preparations at the point of care
Description
Availability of the alcohol-based preparations in the Intensive Care Units (Hospital care) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of ICU beds in the unit, with base alcoholic preparations at the point of care / Number of ICU beds in the unit) x100
Time Frame
15 months
Title
Hospital beds with alcohol-based preparations at the point of care
Description
Availability of the alcohol-based preparations in the hospital units (excluding ICU beds) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of hospitalization beds in the unit, with alcohol-based preparations at the point of care)/(Number of beds in the unit) x100
Time Frame
15 months
Title
Consumption of alcohol-based preparations in hospitalization
Description
Litres of alcohol-based preparations consumed in hospitalization units with admission, including ICU (Number of litres of alcohol-based preparations delivered / Total number of stays in the evaluated period) x1000 Total number of stays in the evaluated period: It refers to the stays of hospitalized patients, where stay = Date of discharge - Date of admission, during the indicator calculation period.
Time Frame
15 months
Title
Consumption of alcohol-based preparations in Primary Care centers
Description
Litres of alcohol-based preparations consumed in primary care centres. (Number of liters of alcohol-based preparations delivered in primary care / Total number of consultations in the evaluated period) x10000
Time Frame
15 months
Title
Consumption of alcohol-based preparations in hospital units without admission
Description
Litres of alcohol-based preparations consumed in hospital units without admission (outpatient consultations, day hospital, etc.). (Number of liters of alcohol-based preparations@delivered in a hospital unit without admission / Total number of consultations in the evaluated period) x1000
Time Frame
15 months
Title
Consumption of alcohol-based preparations in Nursing Homes.
Description
Litres of alcohol-based preparations consumed in Nursing Homes (Number of liters of alcohol-based preparations delivered in Nursing Homes / Total number of residents in the evaluated period) x100
Time Frame
15 months
Secondary Outcome Measure Information:
Title
Type of institution
Description
Hospital unit, primary care unit or nursing home unit.
Time Frame
15 months
Title
Size of hospital unit
Description
Average number of admissions received per year.
Time Frame
15 months
Title
Size of Nursing home
Description
Total number of beds in the nursing home unit.
Time Frame
15 months
Title
Size of primary care unit
Description
Average number of appointments per day in the units.
Time Frame
15 months
Title
No. Nurses
Description
Total number of nurses working in the unit by November 2021.
Time Frame
15 months
Title
No. Healthcare assistants
Description
Total number of healthcare assistants working in the unit by November 2021.
Time Frame
15 months
Title
Type of unit
Description
Age, health problems and care required by the patients attended by the unit on a regular basis.
Time Frame
15 months
Title
Date of discharge
Description
Patients discharge date in case of hospital admissions.
Time Frame
15 months
Title
Date of attention
Description
Date when patients were attended in case of primary care.
Time Frame
15 months
Title
Date of residence
Description
Date when patients were a resident in case of socio-healthcare centres.
Time Frame
15 months
Title
Age
Description
Age of patients.
Time Frame
15 months
Title
Sex
Description
Sex of patients.
Time Frame
15 months
Title
Mother´s age
Description
Age of the mother.
Time Frame
15 months
Title
Breastfeeding for the first time
Description
First time the mother is facing breastfeeding or not.
Time Frame
15 months
Title
Type of birth
Description
Way in which the newborn was born: vaginal delivery, instrumental birth, caesarean section.
Time Frame
15 months
Title
Weeks of gestation
Description
Number of weeks of pregnancy.
Time Frame
15 months
Title
Weight at birth
Description
Weight of the newborn at birth, measured in grams.
Time Frame
15 months
Title
Child weight
Description
Child's weight measured in kilograms.
Time Frame
15 months
Title
Size
Description
Height: child's height measured in centimetres.
Time Frame
15 months
Title
Reason for admission/consultation
Description
Reason for admission/consultation of patients. Reason for the patient to be admitted to the Hospital or to attend the consultation.
Time Frame
15 months
Title
Past-medical history
Description
History of previous illness, surgery or painful experiences of the patient.
Time Frame
15 months
Title
Barriers
Description
Barriers for the implementation of evidence-based recommendations in the units assessed using a questionnaire adapted from the TICD checklist.
Time Frame
15 months
Title
EBP competencies
Description
Competencies in evidence-based practice of the healthcare professionals working in the units that are implementing evidence-based recommendations, assessed with the questionnaire EBP-COQ Prof©.
Time Frame
15 months
10. Eligibility
Sex
All
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Unit inclusion criteria:
NHS units and nursing homes which voluntary adhere to the project.
NHS units and nursing homes providing direct patient care and commit to implement evidence-based recommendations on hand hygiene and one of the following topics: pain assessment and management, urinary incontinence management, obesity prevention and breastfeeding promotion. For the purposes of this study, a "unit" is defined as any service, centre or institution that delivers health services to a homogeneous group of patients who share similar characteristics.
Patient inclusion criteria: The study will include all patients attended in the units participating in the study, who meet the following criteria, depending on the recommendations to be implemented in each unit:
Pain:
People susceptible to suffering some type of pain regardless of age.
Patients treated in acute or chronic health institutions (Hospitals, Nursing Homes or Primary Care).
Urinary incontinence:
Patients 18 years or older.
Patients with uncomplicated stress, urge or mixed urinary incontinence
At least 7 days of admission or possibility of continuity of care preferably up to 6 weeks.
Obesity:
Babies and preschool children up to 12 years old.
For ages 2 to 12 years (inclusive), children must not be overweight or obese 1 year prior to baseline measurement (in February 2021 or at the closest review to February 2021 at which BMI is recorded).
Good general health.
Breastfeeding:
Lactating people.
Healthy neonates of gestational age greater than 36 weeks, with birth weight greater than or equal to 2500 gr.
Couples and relatives within the support network.
Postpartum period and up to 6 months of life of the baby (183 days of life, included).
In primary care, only non-urgent care will be included.
Hand hygiene:
All health professionals who care for patients in the units participating in the study.
Exclusion Criteria:
-
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
María Teresa Moreno-Casbas, Doctor
Organizational Affiliation
Instituto de Salud Carlos III
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Esther González-María, Doctor
Organizational Affiliation
Instituto de Salud Carlos III
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Leticia Bernués-Caudillo, PhD Candidate
Organizational Affiliation
Instituto de Salud Carlos III
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Candela Cameselle-Lago, PhD Candidate
Organizational Affiliation
Instituto de Salud Carlos III
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Laura Albornos-Muñoz, PhD Candidate
Organizational Affiliation
Instituto de Salud Carlos III
Official's Role
Study Chair
Facility Information:
Facility Name
Instituto de Salud Carlos III - Unidad de Investigación en Cuidados y Servicios de Salud
City
Madrid
Country
Spain
12. IPD Sharing Statement
Plan to Share IPD
No
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Links:
URL
https://evidenciaencuidados.es/
Description
website fron the The Spanish Centre for Evidence Based Nursing and Healthcare with the project information
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