Sumamos Excelencia 2022

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)

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.

Eligibility Criteria:
Inclusion Criteria:

1. 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.
2. 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:

   1. 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).
   2. 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.
   3. 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.
   4. 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.
   5. Hand hygiene:

      * All health professionals who care for patients in the units participating in the study.

Exclusion Criteria:

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