Plain English Summary
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
Study website
Contact information
Type
Principal Investigator
Contact name
Mrs Sandra Pol-Castañeda
ORCID ID
http://orcid.org/0000-0003-3962-4622
Contact details
Department of Nursing and Physiotherapy
University of the Balearic Islands (Gillem Cifre building)
Crta Valldemossa
Km 7,5
Palma
07122
Spain
+34 676090092
sandrapolcas@gmail.com
Type
Scientific
Contact name
Mrs Palma Pol-Castañeda
ORCID ID
Contact details
Department of Nursing and Physiotherapy
University of the Balearic Islands (Gillem Cifre building)
Crta Valldemossa
Km 7,5
Palma
07122
Spain
0034 676090092
sandrapolcas@gmail.com
Type
Public
Contact name
Dr Miguel Angel Rodriguez-Calero
ORCID ID
http://orcid.org/0000-0002-2468-5660
Contact details
Carrer de la Reina Esclaramunda
9. Piso 2
Palma
07003
Spain
+34 971170097 ext 76557
mianrodriguez@ibsalut.es
Additional identifiers
EudraCT/CTIS number
Nil known
IRAS number
ClinicalTrials.gov number
Nil known
Protocol/serial number
PI217/2019
Study information
Scientific title
Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study
Acronym
EPAH
Study hypothesis
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
Study design
Prospective quasi-experimental study
Primary study design
Interventional
Secondary study design
Non randomised study
Study setting(s)
Hospital
Study type
Other
Patient information sheet
Not available in web format, please use contact details to request participant information sheet (originally in Spanish)
Condition
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
Overall study end date
30/09/2019
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Hospitalised adults (>18 years old).
Participant type(s)
Patient
Age group
Adult
Lower age limit
18 Years
Sex
Both
Target number of participants
1198
Total final enrolment
3742
Participant exclusion criteria
Patients in terminal care
Recruitment start date
01/04/2019
Recruitment end date
30/09/2019
Locations
Countries of recruitment
Spain
Study participating centre
Hospital Manacor
Ctra Manacor-Alcudia s/n
Manacor (Mallorca)
07500
Spain
Study participating centre
Hospital Universitario Son Espases
Ctra Valldemossa, 79
Palma (Mallorca)
07210
Spain
Study participating centre
Hospital Comarcal de Inca
Ctra Vieja de LLubí, s/n
Inca (Mallorca)
07300
Spain
Sponsor information
Organisation
Balearic Islands Health Services
Sponsor details
Carrer de la Reina Esclaramunda
9
Palma
07003
Spain
+34 971 175600
cvillafafila@ibsalut.es
Sponsor type
Government
Website
Organisation
University of the Balearic Islands
Sponsor details
Ctra Valldemossa
Km 7,5
Palma
07122
Spain
+34 971173000
depedro@uib.es
Sponsor type
University/education
Website
Funders
Funder type
University/education
Funder name
Nursing College of the Balearic Islands
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer-reviwed journal
Intention to publish date
01/03/2022
Individual participant data (IPD) sharing plan
The datasets generated and/or analysed during the current study will be published as a supplement to the subsequent results publication
IPD sharing plan summary
Published as a supplement to the 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 |