Introduction: Oral health is an important aspect of general health, which affects the wellbeing and quality of life of older adults. Residents in aged care facilities often suffer from overall dental neglect and insufficient oral healthcare, leading to moderate-to-high levels of oral diseases. Furthermore, physical or mental health concerns may result in difficulties in maintaining good oral health. Objectives: This implementation project aims to audit and improve the oral healthcare status of the elderly living in a residential care home in Isfahan, Iran using the JBI evidence summary. Methods: The methods are preimplementation and postimplementation design using audit and feedback with a situational analysis to guide implementation planning. Seven evidence-based quality indicators were used to measure preintervention compliance with the best practice. Situational analysis was used to identify and target barriers through locally developed practice change strategies following which a repeat audit was conducted at 4 months. Four nursing staff, 11 caregivers, and 38 residents were interviewed for both the baseline and the follow-up audit. Results: Compliance rates improved for all seven criteria except the use of a soft-bristled toothbrush (criterion 6). All eight categories of criterion 2 measuring assessment of oral health improved by at least 10%, with the largest improvements in saliva assessment and gingiva assessment. Criterion 1 (oral health training for caregivers) reached the greatest compliance rate (100%). Conclusion: The implemented strategies included improving knowledge and changing the attitudes of the caregivers through organizing educational sessions. These strategies were developed to address process and structural barriers to best practice and were helpful for staff uptake of evidence.
Objectives: This study aims to assess compliance with evidence-based criteria regarding oral hygiene principle education provided for children and adolescents in the Tabriz Faculty of Dentistry. Introduction: Oral health problems might lead to lowering the quality of life amongst children and adolescents; so, providing education regarding oral health principles is of great importance. Methods: Eight audit criteria were assessed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. Barriers were identified and dental students and staff were instructed by the team members and asked to educate children and adolescents referred to orthodontic department about oral hygiene practices. Changes in audit criteria were collected by direct observation and interview and reported using descriptive statistics. Results: In the follow-up phase, the percentage of patients who were advised to brush their teeth with fluoride toothpaste twice a day, floss daily, and seek regular dental check-ups increased, as compared with the baseline audit (37, 43 and 33%, respectively). Professional fluoride application, fissure sealant and individualized intervention and/or prevention treatment plans increased by 30, 35 and 15%, respectively in the follow-up phase; while advice on diet and risks of alcohol, tobacco and smoking increased by 93%. Conclusion: The use of standard clinical audit tools in dentistry wards causes improvement in the compliance with providing oral hygiene principle instructions among dental students and staff. Standard tools can increase the effectiveness of corrective interventions by identifying weaknesses in the patient care process correctly.
Introduction:The first case of the novel coronavirus disease (COVID-19) in Iran was officially announced on February 19, 2020, in Qom city. The prevalence of COVID-19 is higher among frontline healthcare workers (HCWs) due to their occupational exposure.Objective:The aim of this evidence implementation project was to improve the protection of nurses against COVID-19 in the emergency department of a teaching hospital in Tabriz, Iran.Methods:A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Ten audit criteria, representing the best practice recommendations for the protection of HCWs in the emergency department were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice.Results:The baseline audit results showed that the compliances for four (out of ten) audit criteria (criteria 4, 7, 8 and 9), were under 75%, which indicated poor and moderate compliance with the current evidence. After implementing plans such as running educational programs and meetings, major improvement was observed in 3 criteria, criterion 4 was improved from low to excellent (41–81%), criterion 7 was promoted from low to moderate (30–62%), criterion 8 was not promoted considerably (22–27%) and criterion 9 was improved from moderate to excellent (70–84%).Conclusion:The results of the audit process increased COVID-19 protection measures for nurses in the emergency department. It can be concluded that educational programs and tools, such as face-to-face training, educational pamphlets, workshops and meetings can facilitate the implementation of evidence into practice.
Introduction: Informed consent is a continuous and dynamic process. It is a crucial part of healthcare procedures that becomes more complex in a pediatric clinical practice, where parents must make decisions for their children. Objectives: The aim of this implementation project was to evaluate the current practice and implement the best practice related to obtaining informed consent in a children's hospital in Tabriz, Iran. Methods: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Five audit criteria representing the best-practice recommendations for informed consent were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to determine change in practice. Results: The compliance rate of all criteria improved from baseline to follow-up audit. Criteria 1 (obtaining informed consent prior to all nursing procedures) and 5 (provision of information related to the necessity of the treatment) reached 97% compliance in the follow-up cycle. Criterion 4 (provision of information related to the nature and effect of the treatment) achieved 74% compliance. Both criteria 2 and 3 (provision of information related to alternative treatments and consequences of refusing treatment) reached 57% in the follow-up cycle. To improve compliance, meetings were organized with the heads of departments, nurses and residents regarding informed consent. Also, staff were encouraged to report cases where informed consent was not obtained. Conclusion: The audit results indicated an improvement in obtaining informed consent in the included departments. The interventions that were employed can facilitate the implementation of evidence into clinical practice.
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