Impact of advanced practice nurses in hospital units on the implementation of clinical guidelines
| ISRCTN | ISRCTN18259923 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN18259923 |
| Secondary identifying numbers | PI217/2019 |
- Submission date
- 09/02/2022
- Registration date
- 11/02/2022
- Last edited
- 14/12/2022
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English summary of protocol
Background and study aims
The incorporation of best evidence into clinical practice is key for increasing the quality and efficacy of healthcare, though a continuous challenge for healthcare teams. Advanced practices nurses may facilitate this transference due to their influence on other professionals’ performance and attitudes.
This research aims to evaluate whether the inclusion of advanced practice nurses in hospitalization wards teams improves patient indicators and the adherence of other nurses to the best evidence, by monitoring variables related to pressure ulcer prevention and vascular access devices management.
Who can participate?
Adult inpatients aged 18 years and above, admitted to the participating hospital wards, except patients in terminal palliative care.
What does the study involve?
We will include advanced practice nurses in the intervention wards, who will provide support and education to health teams, motivating changes in attitude, skills, knowledge, and abilities regarding two clinical guidelines used in the Balearic Islands health system (pressure ulcer prevention and vascular access devices management). Control wards will continue their current protocols and practice.
We will measure clinical indicators related to both clinical guidelines, by bedside direct observation and review of nursing records.
What are the possible benefits and risks of participating?
The intervention is expected to reduce pressure ulcer and catheter-related complications in the intervention wards, compared to those in which the intervention is not provided. Due to the nature of the intervention (education and support), we do not expect any undesired effects in the patients attended in these units.
Where is the study run from?
The study is managed collaboratively by the Healthcare Office of the Balearic Islands Health Services and the Nursing and Physiotherapy Department of the University of the Balearic Islands (Spain)
When is the study starting and how long is it expected to run for?
February 2018 to September 2019
Who is funding the study?
The study is funded by the College of Nurses of the Balearic Islands (Spain)
Who is the main contact?
Dr Miguel Angel Rodriguez Calero, mianrodriguez@ibsalut.es
Contact information
Principal Investigator
Department of Nursing and Physiotherapy
University of the Balearic Islands (Gillem Cifre building)
Crta Valldemossa, Km 7,5
Palma
07122
Spain
 ORCID ID |
0000-0003-3962-4622 |
|---|---|
| Phone | +34 676090092 |
| sandrapolcas@gmail.com |
Scientific
Department of Nursing and Physiotherapy
University of the Balearic Islands (Gillem Cifre building)
Crta Valldemossa, Km 7,5
Palma
07122
Spain
| Phone | 0034 676090092 |
|---|---|
| sandrapolcas@gmail.com |
Public
Carrer de la Reina Esclaramunda
9. Piso 2
Palma
07003
Spain
| ORCID ID |
0000-0002-2468-5660 |
|---|---|
| Phone | +34 971170097 ext 76557 |
| mianrodriguez@ibsalut.es |
Study information
| Study design | Prospective quasi-experimental study |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Non randomised study |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | Not available in web format, please use contact details to request participant information sheet (originally in Spanish) |
| Scientific title | Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study |
| Study acronym | EPAH |
| Study objectives | The advanced practice nurses will increase the adherence of team nurses to guidelines recommendations regarding pressure lesions and peripheral catheterization. This will reduce complications and improve patient-related indicators. |
| Ethics approval(s) | Approved 27/06/2018, Comité de ética en la investigación de las Islas Baleares [Balearic Islands Research Ethics Committee], (Calle del calçat, 2A, 2ª planta, Polígono de Son Valentí, 07011 Palma, Illes Balears, Spain; +34 971 177 378; ceic_ib@caib.es), ref: IB-3662/18-PI |
| Health condition(s) or problem(s) studied | Prevention of pressure ulcer and catheter-related complications in hospital care |
| Intervention | The intervention consists of the incorporation of an advanced practice nurse within each intervention unit involved, to participate in activities appropriate to the context in question, with a specific interest in providing support to health teams, motivating attitudinal change regarding skills, abilities, and knowledge and seeking to ensure the implementation of guidelines recommendations and the avoidance of low-value practices. Among other actions, the advanced practice nurses extend awareness of the project, assist in the implementation of the guidelines, work with the team to establish objectives, provide training for the health team, contribute to the planning of changes in circuits, materials, techniques, evaluate the results obtained, provide periodic feedback to the health team, adjust the interventions as necessary, and offer support and mentoring. Participating nurses hold monthly meetings with the research team, and took part in a specific training program, not provided to the control wards teams. The control wards do not receive any interventions, continuing with usual protocols and guideline implementation standards. The process and outcome variables are measured once a month, in all inpatients admitted on that day. |
| Intervention type | Behavioural |
| Primary outcome measure | 1. Prevalence of pressure ulcer is measured by in-situ inspection at baseline and monthly during 1 year. 2. Prevalence of catheter-related adverse events s measured by in-situ inspection at baseline and monthly during 1 year. |
| Secondary outcome measures | 1. Overall adherence to pressure ulcer and catheter care recommendations are measured by in-situ follow-up of process indicators. 2. Mean number of recommendations fulfilled for each patient x100 / Total number of guideline recommendations |
| Overall study start date | 01/02/2018 |
| Completion date | 30/09/2019 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | Both |
| Target number of participants | 1198 |
| Total final enrolment | 3742 |
| Key inclusion criteria | Hospitalised adults (>18 years old). |
| Key exclusion criteria | Patients in terminal care |
| Date of first enrolment | 01/04/2019 |
| Date of final enrolment | 30/09/2019 |
Locations
Countries of recruitment
- Spain
Study participating centres
Manacor (Mallorca)
07500
Spain
Palma (Mallorca)
07210
Spain
Inca (Mallorca)
07300
Spain
Sponsor information
Government
Carrer de la Reina Esclaramunda, 9
Palma
07003
Spain
| Phone | +34 971 175600 |
|---|---|
| cvillafafila@ibsalut.es | |
| Website | https://www.ibsalut.es/es/ |
University/education
Ctra Valldemossa, Km 7,5
Palma
07122
Spain
| Phone | +34 971173000 |
|---|---|
| depedro@uib.es | |
| Website | http://www.uib.cat/ |
Funders
Funder type
University/education
No information available
Results and Publications
| Intention to publish date | 01/03/2022 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Published as a supplement to the results publication |
| Publication and dissemination plan | Planned publication in a high-impact peer-reviwed journal |
| IPD sharing plan | The datasets generated and/or analysed during the current study will be published as a supplement to the subsequent results publication |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | 16/05/2020 | 11/02/2022 | Yes | No | |
| Results article | Outcome results | 29/11/2022 | 14/12/2022 | Yes | No |
Editorial Notes
14/12/2022: Publication reference added.
11/02/2022: Trial's existence confirmed by Balearic Islands Research Ethics Committee.
