Kathryn H. Bowles, PhD, RN, FAAN, FACMI
Professor of Nursing and van Ameringen Chair in Nursing Excellence, University of Pennsylvania School of Nursing, and Director of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York
Promoting best practice in discharge following sedation for endoscopic procedures is important for patient safety and well-being, in addition to ensuring patients are not held up by system delays or other issues. Sedation in particular leads to an increased risk of significant events such as cardiac arrest or death, and although rare, these events are 10 times higher when sedation includes propofol. Discharge planning is a critical function, but without specific evaluation, it may not be evidence-based. To optimize discharge planning, a thorough evaluation of current practice against best practice is needed, particularly in clinics with high patient flow, such as the endoscopy clinic where this implementation project was conducted.1
This endoscopy clinic project identified a series of best practice recommendations from JBI evidence, then conducted an audit and feedback project over six months using two key software tools: Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) matrix. PACES supported the baseline audit and found gaps in best practice, and then the multidisciplinary team used GRiP to evaluate barriers and facilitators and to identify the resources needed to improve practice. These methods can be applied to any complex process. The key messages of this podcast include: use a team-based approach, incorporate tools that assist with reflection (such as JBI PACES and GRiP), conduct follow-up evaluations and assessments to measure improvement, and consider areas for future follow-up.
It is important to systematically evaluate your processes, and to set goals for measuring outcomes and determining your successes. Implementation mapping is a useful adjunctive process to audit and feedback to achieve these goals.2
1. Cai X, McArthur A. Discharge following sedation for endoscopic procedures: a best practice implementation project. JBI Evid Synth. 2020;18(2):348-56.
2. Fernandez ME, ten Hoor GA, van Lieshout S, Rodriguez Sa, Beidas RS, Parcel G, et al. Implementation mapping: using intervention mapping to develop implementation strategies. Front Public Health. 2019;7:158.