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Almblad, Ann-CharlotteORCID iD iconorcid.org/hanna222
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Publications (4 of 4) Show all publications
Almblad, A.-C., Målqvist, M. & Engvall, G. (2018). From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden. PLoS ONE, 13(11), Article ID e0207744.
Open this publication in new window or tab >>From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207744Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world.

PURPOSE: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden.

DESIGN AND METHODS: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis.

RESULTS: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation.

CONCLUSIONS: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance.

National Category
Pediatrics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-371099 (URN)10.1371/journal.pone.0207744 (DOI)000451325700062 ()30475857 (PubMedID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-01-08Bibliographically approved
Almblad, A.-C., Siltberg, P., Engvall, G. & Målqvist, M. (2018). Implementation of Pediatric Early Warning Score: Adherence to Guidelines and Influence of Context. Journal of Pediatric Nursing: Nursing Care of Children and Families, 38, 33-39
Open this publication in new window or tab >>Implementation of Pediatric Early Warning Score: Adherence to Guidelines and Influence of Context
2018 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 38, p. 33-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe data of Pediatric Early Warning Score (PEWS) registrations and to evaluate the implementation of PEWS by examining adherence to clinical guidelines based on measured PEWS, and to relate findings to work context.

DESIGN AND METHODS: PEWS, as a part of a concept called Early Detection and Treatment-Children (EDT-C) was implemented at three wards at a Children's Hospital in Sweden. Data were collected from the Electronic Patient Record (EPR) retrospectively to assess adherence to guidelines. The Alberta Context Tool (ACT) was used to assess work context among healthcare professionals (n=110) before implementation of EDT-C.

RESULTS: The majority of PEWS registrations in EPR were low whereas 10% were moderate to high. Adherences to ward-specific guidelines at admission and for saturation in respiratory distress were high whereas adherence to pain assessment was low. There were significant differences in documented recommended actions between wards. Some differences in leadership and evaluation between wards were identified.

CONCLUSIONS: Evaluation of PEWS implementation indicated frequent use of the tool despite most scores being low. High scores (5-9) occurred 28 times, which may indicate that patients with a high risk of clinical deterioration were identified. Documentation of the consequent recommended actions was however incomplete and there was a large variation in adherence to guidelines. Contextual factors may have an impact on adherence.

PRACTICE IMPLICATIONS: EDT-C can lead to increased knowledge about early detection of deterioration, strengthen nurses as professionals, optimize treatment and teamwork and thereby increase patient safety for children treated in hospitals.

Keywords
Deterioration, Implementation, PARIHS, Pediatric, Pews
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336550 (URN)10.1016/j.pedn.2017.09.002 (DOI)000423035000019 ()29167078 (PubMedID)
Note

Supplementary data to this article can be found online at https://doi. org/10.1016/j.pedn.2017.09.002

Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-02-28Bibliographically approved
Almblad, A.-C., Målqvist, M. & Engvall, G. From skepticism to assurance and control: implementation of a patient safety system at a pediatric hospital in Sweden.
Open this publication in new window or tab >>From skepticism to assurance and control: implementation of a patient safety system at a pediatric hospital in Sweden
(English)In: Article in journal (Refereed) Submitted
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336557 (URN)
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2017-12-20Bibliographically approved
Almblad, A.-C., Brylid, A., Engvall, G. & Målqvist, M. Increased intensive care admission rate after introduction of Early Detection and Treatment program for Children and the establishment of a pediatric intensive care unit at a tertiary hospital in Sweden.
Open this publication in new window or tab >>Increased intensive care admission rate after introduction of Early Detection and Treatment program for Children and the establishment of a pediatric intensive care unit at a tertiary hospital in Sweden
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Objective: To evaluate the introduction of an Early Detection and Treatment program- Children (EDT-C) including a paediatric early warning score (PEWS) in relation to admission and length of stay at intensive care unit (ICU). Design: Before-after study utilizing data from the Electronic Patient Record (EPR) system, comparing outcomes over a total time period of 60 months between April 2010 and September 2015. Setting: A Swedish tertiary hospital. Patients: A total of 16,283 paediatric patients were included over the study period. Interventions: EDT-C including PEWS Measurements and Main Results: The following variables were extracted from the EPR data: 1) Admissions to paediatric wards 2) Length of stay at paediatric wards 3) Admissions to intensive care units 4) Length of stay at intensive care unit 5) Diagnosis. Intensive care unit admission increased from 5.0% (440/8746) before to 10.2 % (772/7537) after the introduction of the EDT-C (p<0.01). Mean treatment time at ICU did not change (41.0 vs 48.3 hours, p=0.23). Conclusion: The introduction of EDT-C including PEWS, in conjunction with the establishment of a paediatric intensive care unit at the hospital, resulted in an increased intensive care admittance rate among paediatric in-patients.

National Category
Clinical Medicine Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-336775 (URN)
Available from: 2017-12-17 Created: 2017-12-17 Last updated: 2017-12-20
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ORCID iD: ORCID iD iconorcid.org/hanna222

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