Sumamos Excelencia Project: Implementation of Best Practices in Clinical Practice (Thrid Edition) (SE24)

SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (Thrid Edition)

There is a gap between research and clinical practice, leading to variability in decision-making. Multifaceted implementation strategies are 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 multifaceted implementation strategy (training, audit, context analysis, local strategies design, feedback, facilitation). Data will be collected at baseline and, during the first year of follow up, at months (4,8,12)

Study Overview

• Status: Recruiting
• Conditions: Smoking Cessation; Pain; Fall; Breast Feeding; Obesity, Childhood; Pressure Injury; Incontinence, Urinary
• Intervention / Treatment: Other: Multifaceted implementation strategy

Detailed Description

Aim: To assess the effectiveness of implementing evidence-based recommendations using multifaceted implementation strategy 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 multifaceted implementation strategy (training, audit, context analysis, local strategies design, feedback, facilitation). 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, smoking cessation intervention, pressure injury prevention, fall prevention, 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 4, 8 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 2024-2025.

This project is a third edition of The SUMAMOS EXCELENCIA Project: Assessment of Implementation of Best Practices in a National Health System (NCT05466656), with an improved design and new recommendation topics.

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Leticia Bernués-Caudillo, PhD Candidate; Phone Number: 644617184; Email: l.bernues@isciii.es
• Study Contact Backup: Name: Esther González-María, PhD; Phone Number: 0034918222548; Email: esthergomaria@isciii.es

Study Locations

• Spain
  • Madrid, Spain, 28029
    • Recruiting
    • Instituto de Salud Carlos III - Unidad de Investigación en Cuidados y Servicios de Salud
    • Contact: Leticia Bernués-Caudillo, PhD Candidate; Phone Number: 0034-918222539; Email: l.bernues@isciii.es
    • Contact: Esther González-María, Doctor; Phone Number: 0034918222548; Email: esthergomaria@isciii.es

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

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, Smoking Cessation, falls prevention, pressure injuries prevention. 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. Smoking Cessation:

      - ≥ 18 years of age

      • Smokers

   6. Pressure injury prevention:

      - Adults population (≥ 18 years).

      • Admitted to hospitals, nursing homes or included in home care programmes.
      • Patients at risk of developing pressure injuries.

   7. Falls prevention:

      • Adults aged 65 years or older, and adults aged 18 years or older who may potentially present problems in walking as a result of neurological or traumatic diseases, medication, or who suffer from loss of strength or drowsiness.

   8. Hand hygiene:

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

      Exclusion Criteria:

      -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Experimental: Quasi-experimental uncontrolled, before-and-after.; The intervention will consist of the use of a multifaceted implementation strategy based in the continuous quality improvement cycle model and in implementation science theories, model and frameworks to be developed in clinical practice according to the study unit in question and the scope of action.

Other: Multifaceted implementation strategy; The multifaceted implementation strategy consist in a process of improvement by reference to a prior baseline clinical audit. It implies a local context analysis, identifying barriers to improvements in clinical practice, and developing and implementing a plan of action for improving adherence to pre-established criteria. The goal is to establish interprofessional processes within the teams, in order to: examine the barriers that hinder the use of evidence in fostering best practices; and contribute to the development of implementation programmes for overcoming such obstacles.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Scheduled urination	Using verbal and physical prompts or signals to make people pay attention to their dry/wet situation and the need to go to the bathroom. (Total number of patients with a scheduled urination care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100	15 months
Bladder training	Program of education and programmed evacuation in which the intervals of micturition are gradually adjusted. (Total number of patients with a bladder training care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100	15 months
Pelvic floor exercises	The individualized education and training of pelvic floor exercises. (Total number of patients with a pelvic floor exercise care plan, and it is registered / Total number of patients with urinary incontinence and a 3-day voiding diary discharged or attended in the data collection period) * 100	15 months
Severity	Severity of urinary incontinence. Total number of patients with different levels of urinary incontinence 24 hours prior to assessment / Total number of patients with urinary incontinence during the data collection period) x 100	15 months
Impact	Impact of urinary incontinence. (Total number of patients whose urinary incontinence has an impact on their quality of life, in the 24 hours prior to the assessment / Total number of patients with urinary incontinence during the data collection period) x 100	15 months
Improvement	Perception of improvement in urinary incontinence. (Total number of patients who perceive an improvement 6 weeks after the intervention / Total number of patients with urinary incontinence before the start of the intervention) x100	15 months
Detection of pain at admission	Detection of pain at admission. (Total number of patients in whom pain detection was performed upon admission or at the start of care, and it is registered / Total number of patients discharged or attended in the collection period data) x100	15 months
Pain related to a procedure likely to cause pain	Detection of pain related to a procedure likely to cause pain. This indicator evaluates whether the assessment of pain linked to the painful procedure is carried out before and after the procedure, it is also recommended to assess pain during the procedure in cases where it is possible. (Total number of patients in whom pain has been detected after a procedure likely to cause pain, and is registered / Total number of patients in whom a procedure likely to cause pain has been performed in the data collection period data) x100	15 months
Pain after a change in the patient's clinical situation	Detection of pain after a change in the patient's clinical situation (clinical situation: significant clinical change, in the general condition of the patient or in their pain, which requires the referral of the patient to a professional with the skills to resolve it). (Total number of patients in whom pain has been detected after a change in their clinical situation, and it is registered / Total number of patients with a change in their clinical situation in the data collection period) x100	15 months
Pain intensity assessment	Pain assessment measured with a pain intensity assessment tool. (Total number of patients who have an assessment of pain intensity, and it is recorded / Total number of patients with positive detection of pain in the data collection period) x100	15 months
Comprehensive pain assessment	Comprehensive pain assessment takes into account various factors related to pain, including: location of pain, circumstances related to the onset of pain, type of pain, pain intensity, associated symptoms, effect of pain on activities, effect of pain on patient rest and sleep, treatment, relevant medical history, factors that influence pain management. To be considered a comprehensive assessment, at least 60% of the 10 criteria must be performed and recorded. (Total number of patients who have done a comprehensive pain assessment, and it is registered / Total number of patients with positive pain detection in the data collection period) x100	15 months
Pain management care plan	Establishing and implementing a pain management care plan for the patient based on the results of the person's assessment, which would include: pharmacological and non-pharmacological measures, the person's goals and appropriate and effective pain management strategies. (Total number of patients with a care plan for acute or chronic pain, and it is registered / Total number of patients with positive detection of pain or susceptible to have pain in the data collection period) x100	15 months
Patient or/and caregiver education on pain	Patient or/and caregiver education on the importance of communicating pain, pharmacological, physical and psychological pain management options, how to take the analgesic medication, manage the possible side effects and how the follow-up will be done and who can be consulted with possible doubts. (Total number of patients, family members or caregivers who have received education on pain management, at least once during the care process, and it is registered / Total number of patients with positive detection of pain or likely to have pain in the data collection period) x100	15 months
Intensity of pain on admission or in the first 24 hours after surgery or at the start of care	Intensity of pain on admission or in the first 24 hours after surgery or at the start of care measured in numerical format, with the value that corresponds to the scale used in the unit for the assessment of pain, units must indicate on the form the scale they have used. (Sum of pain intensity of patients with positive pain detection or likely to have pain / Total number of patients with assessed pain intensity in the data collection period)	15 months
Maximum pain	Maximum scored reported by patients and registered by nurses after pain intensity assessment using an assessment tool. Units must indicate on the form the assessment tool they have used. (Sum of the maximum intensity of pain during the stay or care of patients with positive detection of pain or likely to have pain / Total number of patients with pain intensity assessed in the data collection period)	15 months
Skin-to-skin contact	Skin-to-skin contact is the placement of a newborn, naked or with a diaper and cap, in a prone position on the bare chest of a person, covered with a previously heated blanket to prevent heat loss. It should be facilitated immediately (up to 1 hour) after birth or once the child and the nursing person are clinically stable. (Number of infants performing skin-to-skin immediately after birth or with clinically stable dyad /Total number of infants) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Follow-up assessment of breastfeeding in primary care (from 9 days of life to 6 months)	In Primary Care, the follow-up evaluation is carried out between 9 days of life and 6 months/183 days of life of the neonate (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process from 9 days of life to 6 months / Total number of dyads from 9 days of life to 6 months of the newborn) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Type of breastfeeding of the newborn during the hospital stay	Type of breastfeeding of the newborn during the hospital stay. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed during hospital stay / Total number of infants discharged) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food. Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula. Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.	15 months
Type of breastfeeding of the newborn in early stage	Type of breastfeeding of the newborn from birth to 8 days of life assessed in Primary care. (Number of newborns who were exclusively breastfed, received mixed breastfeeding or were not breastfed from birth to 8 days of life / Total number of newborns between 0 and 8 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food. Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula. Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.	15 months
Type of breastfeeding of the newborn in follow-up 1	Type of breastfeeding of the newborn from 9 to 90 days of life, assessed in Primary Care. (Number of infants exclusively breastfed, receiving mixed breastfeeding or not breastfed from 9 days to 90 days of life / Total number of infants from 9 to 90 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food. Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula. Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.	15 months
Type of breastfeeding of the newborn in follow-up 2	Type of breastfeeding of the newborn from 91 to 182 days of life assessed in Primary care (Number of newborns who received exclusive breastfeeding, receiving mixed breastfeeding or not breastfed from 91 days to 182 days of life / Total number of newborns from 91 to 182 days of life) x100 Exclusive breastfeeding: The infant receives directly or indirectly breast milk. He does not receive any other type of solid or liquid food. Mixed breastfeeding: The infant receives breast milk as well as other solid and liquid foods (including water), including non-human milk or formula. Non-breastfeeding: The infant receives artificial milk and/or animal milk. The infant does not receive breast milk.	15 months
Exclusive breastfeeding at 6 months	Number of newborns who received exclusive breastfeeding on day 183 of life (Number of newborns who received exclusive breastfeeding on day 183 of life / Total number of newborns with 183 days completed) x100	15 months
Exclusive breastfeeding, children from birth to 6 months of age	Children from 0 to 183 days inclusive who have received exclusive breastfeeding, directly from the breast or stored. (Number of children 0-6 months (or-183 days) who received EXCLUSIVE breastfeeding in the previous 24 hours, and is registered / Total number of children 0-6 months with one or more visits well-infant-child follow-up in the previous year) x100	15 months
Breastfeeding, children from 6 months of age up to 2 years	Children with more than 183 days of life who received breastfeeding directly from the breast or stored. (Number of children >6 months and up to 2 years (more than 183 days-2 years) who received breastfeeding in the previous 24 hours, and is registered / Total number of children >6 months - and up 2 years with one or more well-infant-child follow-up visits in the previous year) x100	15 months
Sedentary behaviour	Number of children from birth to 12 years old who spent the recommended time for their age in front of a screen. (Number of children from birth to 12 years old, whose daily screen time is the recommended for their age, as of parents' declaration, and is registered / Total number of children from births up to 12 years of age with one or more follow-up visits to the well-child infant in the previous year, with assessment of screen time or comprehensive assessment) x100	15 months
ICU beds with alcohol-based preparations at the point of care	Availability of the alcohol-based preparations in the Intensive Care Units (Hospital care) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of ICU beds in the unit, with base alcoholic preparations at the point of care / Number of ICU beds in the unit) x100	15 months
Hospital beds with alcohol-based preparations at the point of care	Availability of the alcohol-based preparations in the hospital units (excluding ICU beds) as close as possible to the place where an activity that requires contact with the patient and/or their immediate environment is going to be carried out and without having to leave the patient's area. Point of care is the place where the patient, the health professional and the care or treatment that involves contact with the patient coincide. (Number of hospitalization beds in the unit, with alcohol-based preparations at the point of care)/(Number of beds in the unit) x100	15 months
Consumption of alcohol-based preparations in Primary Care centers	Litres of alcohol-based preparations consumed in primary care centres. (Number of liters of alcohol-based preparations delivered in primary care / Total number of consultations in the evaluated period) x10000	15 months
Consumption of alcohol-based preparations in hospital units without admission	Litres of alcohol-based preparations consumed in hospital units without admission (outpatient consultations, day hospital, etc.). (Number of liters of alcohol-based preparations@delivered in a hospital unit without admission / Total number of consultations in the evaluated period) x1000	15 months
Consumption of alcohol-based preparations in Nursing Homes.	Litres of alcohol-based preparations consumed in Nursing Homes (Number of liters of alcohol-based preparations delivered in Nursing Homes / Total number of residents in the evaluated period) x100	15 months
Quantification assessment in active smokers	Quantitative assessment of the intensity of tobacco or tobacco products use measured with a validated tool (Total number of patients who have undergone a quantification assessment and it is recorded )/(Total number of patients with positive detection of active smoking @ in the period of data collection ) x100 Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago.	15 months
Comprehensive assessment of active smokers	Assessment carried out with a comprehensive and systematic approach, taking into account various factors related to smoking, such as: Motivation to quit smoking (measured with the Richmond test); Degree of nicotine dependence (measured with the full Fagerström test); Current nicotine withdrawal symptoms; Previous quit attempts; Current need for smoking cessation treatments; Factors influencing patient behaviour change. The criterion is met when at least 50% of the 6 criteria (at least 3) are fulfilled and recorded (Total number of patients who have had a comprehensive smoking assessment performed and recorded)/(Total number of patients with positive screening for active smoking in the data collection period )/(Total number of patients with a positive screening for active smoking in the data collection period ) x100 Active smoker: person who is currently smoking or has smoked in the last 30 days.	15 months
Comprehensive assessment of the non-active smoker	Assessment carried out with a comprehensive and systematic approach, taking into account various factors related to smoking, such as: Existence or not of current nicotine withdrawal symptoms; Relapses; Current stage of change; Other symptoms. The criterion is fulfilled when at least 3 of the 5 criteria are fulfilled and recorded (Total number of patients who have undergone a 'comprehensive non-active smoking assessment' and are recorded) / (Total number of non-active smoking patients in the data collection period) x100 Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago.	15 months
Brief interventions performed	Number of brief interventions (BI) based on the 5 As and 5 Rs carried out in smoking patients. For a BI to be considered as having been carried out, the nurse must at least: convey the advice to 'stop smoking', advise the patient on smoking cessation, offer support and accompaniment and specific comments on the health risks related to smoking and the benefits related to smoking cessation. (Number of smoking patients who have undergone Brief Intervention)/(Total number of smoking patients seen in the data collection period) x100 Brief intervention (BI): Intervention in which there is a brief (less than five minutes) contact between the health care provider and the patient. Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago.	15 months
Derivation of the active smoking patient	Referral to smoking cessation follow-up consultations is considered to be referral to primary care consultations and/or specific monographic smoking cessation consultations. If the unit is capable of carrying out the follow-up, the recommendation will be considered to have been made when the follow-up is planned in the same unit (Number of smoking patients referred for smoking follow-up after being seen/(Total number of smoking patients seen in the period of data collection) x100 Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago.	15 months
Expressed desire to quit smoking (active smokers)	Documented evidence of the patient's expressed desire to quit smoking after the brief intervention (Total number of patients who have expressed an expressed desire to quit smoking after the brief intervention)/(Total number of patients with positive smoking screening who have undergone a BI in the data collection period)/(Total number of patients with positive smoking screening who have undergone a BI in the data collection period)x100 Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago. Brief intervention: Intervention in which there is a brief (less than five minutes) contact between the health care provider and the patient.	15 months
Maintenance of willingness to remain smoke-free (non-active smokers)	Documented evidence of the non-active smoker patient's expressed desire to maintain their willingness to remain smoke-free after the comprehensive assessment. (Total number of patients who maintain their willingness to quit smoking after comprehensive assessment of active smoking)/(Total number of non-active smoking patients who have undergone a comprehensive assessment in the data collection period)x100 Active smoker: person who is currently smoking or has smoked in the last 30 days. Non-active smoker: smoked the last cigarette or similar product more than 30 days but less than 183 days (6 months) ago.	15 months
Pressure injuries risk assessment at the initiation of care	Assessment of the risk of pressure injuries in the first 24 hours of admission, after the initiation of care or the first visit in primary care with a structured, validated and reliable tool, together with clinical judgement (Total number of people with complete assessment of pressure injuries at admission or initiation of care)/(Total number of people with health care provision) x100.	15 months
Reassessment of the risk of pressure injuries	Reassessment of the risk of PBI: reassessment of the risk of developing pressure sores upon a significant clinical change in the person's general condition, change of caregiver, change of setting or care unit and at discharge; with a structured, validated and reliable tool, together with clinical judgement. (Total number of people with reassessment of pressure sores)/(Total number of people with health care provision) x100.	15 months
Nutritional screening of the person at risk of pressure injuries	Nutritional screening of the person at risk of developing pressure injuries with a structured, validated and reliable tool. (Total number of persons at risk of pressure injuries who have been nutritionally screened)/(Total number of persons at risk of pressure injuries) x100.	15 months
Support surfaces for the prevention of pressure injuries	Recording whether a support surface that meets the person's needs has been used to prevent the occurrence of pressure injuries (Total number of persons at risk of pressure injuries who have a support surface applied)/(Total number of persons at risk of pressure injuries) x100	15 months
Pressure injury prevention care plan	Establishing and implementing a pressure injury prevention care plan for the patient based on the results of the person's assessment, which would include: comprehensive skin and tissue assessment; preventive skin and tissue care; early mobilisation; use of pressure relief devices/support surfaces; health education. (Total number of people with a pressure injury prevention care plan)/(Total number of people at risk of pressure injuries) x100	15 months
Prevalence of pressure injuries	Number of patients presenting with a pressure injury at the start of care (Total number of people with one or more pressure injuries)/(Total number of people with health care provision) x100	15 months
Pressure injuries associated with care	Total number of people who develop one or more pressure injuries during care (Total number of people who develop one or more pressure injuries since admission or start of care)/(Total number of people with health care provision ) x 100	15 months
Healthcare-associated pressure injuries in persons at risk	Total number of persons who develop one or more pressure injuries during care and who had been assessed as being at risk of developing pressure injuries (Total number of persons developing one or more pressure injuries since admission or start of care)/(Total number of persons at risk of PBI with healthcare provision) x 100	15 months
Stage of most severe pressure injury:	Stage of the most severe pressure injury developed by patients classified as at risk or not at risk of developing pressure injuries.	15 months
Falls risk screening	Falls risk screening carried out on all patients aged 65 years and over to determine their risk of falling. (Total number of people with falls risk screening recorded)/(Total number of people) x100.	15 months
Multifactorial falls risk assessment	Multifactorial falls risk assessment carried out on patients at high risk of falls. This should include at least: mobility, activities of daily living and cognitive function (Total number of people with recorded falls risk assessment)/(Total number of people at risk of falls) x100.	15 months
Falls prevention care plan	Individualised falls and injury prevention plan for people at risk of falling, taking into account the scope of care and its possibilities, patient preferences and multifactorial assessment by professionals (Total number of people at high risk of falls with a recorded falls prevention care plan)/(Total number of people at high risk of falls) x100	15 months
Falls risk reassessment	Risk reassessments made after any significant change in health following a fall, at 30-90 days for people at high risk of falls or one year since the last reassessment for people at low risk. (Total number of people with falls risk reassessment recorded)/(Total number of people eligible for risk reassessment) x100	15 months
Exercise interventions	Considers whether people at risk of falls have been referred to a specialist for exercise or whether exercise interventions have been implemented. (Number of people at high risk of falls who have participated in @exercise and physical training interventions)/(Total number of people at high risk of falls where the indicator applies) x100	15 months
Number of falls	Number of falls that have occurred during the hospital stay or duration of care.(Total number of people who have fallen)/(Total number of people) x100	15 months
Injuries resulting from falls	Injuries resulting from the fall, according to the following scale: None, slight injury, moderate injury, severe injury, fear of falling, death. (Total number of persons with fall/s that have had consequences)/(Total number of persons who have fallen) x100	15 months
Urinary incontinence initial assessment	Initial assessment of presence of urinary incontinence. Total number of patients in whom the presence of urinary incontinence has been initially assessed, and who are registered / Total number of patients with positive detection of urinary incontinence during the data collection period) * 100	15 months
Voiding diary	Record of all urination and leakage for 3 consecutive days before and after the intervention. (Total number of patients with a voiding diary of 3 days recorded / Total number of patients with urinary incontinence discharged or attended during the data collection period) * 100	15 months
Comprehensive assessment (obesity)	Requires realization and documentation of a comprehensive assessment of children from birth to 12 years has been carried out considering all of the following elements: Growth; Feeding / breastfeeding (as appropriate); Physical activity; Sedentary behaviour / screen time; Family environment. (Number of children from birth to 12 years (and parents or carers) who have had a full assessment)/(Number of children from birth to 12 years ) x100.	15 months
Promotion of healthy behaviours	Delivery and documentation of age-appropriate healthy behaviour promotion recommendations (e.g.: Support for breastfeeding, exclusive or complementary feeding (if appropriate); Healthy behaviour promotion on feeding; Healthy behaviour promotion on physical activity; Healthy behaviour promotion on sedentary/ screen time. (Number of children from birth to 12 years (and parents/caregivers) who have received healthy behaviour promotion interventions)/(Number of children from birth to 12 years) x100	15 months
Education and support	Requires documented evidence that parents/primary caregivers have received age-appropriate education on any of the following topics: breastfeeding, role modelling, child feeding practices, family physical activity; screen time, physical activity, healthy eating. (Number of parents or caregivers of children from birth to 12 years who have been provided with education and support to maintain healthy habits)/(Number of children from birth to 12 years ) x100	15 months
Daily physical activity	Number of children from birth from 0 to 12 years of age who meet the recommendations on amount of daily physical activity. (Number of children from birth to 12 years of age who meet the recommendations on amount of daily exercise, and are registered / Total number of children from birth to 12 years of age with one or more follow-up visits of the healthy infant-child in the previous year, with assessment of physical activity or comprehensive assessment) x100	15 months
Fruit and vegetable intake	Number of children aged 2-12 consuming fruit and vegetables daily and up to 5 times a day, and recorded (Number of children aged 2-12 consuming fruit and vegetables daily or up to 5 times a day)/(Number of children aged 2-12 ) x100	15 months
Assessment of mother's intention to breastfeed	Requires that mothers of newborns have been assessed for their intention to breastfeed during hospital admission for delivery (Number of mothers assessed for their intention to breastfeed)/(Total number of mothers) x100	15 months
Postpartum assessment of breastfeeding	Assessment of breastfeeding completed within the first 24 hours of the newborn life. It should include all of the following components: knowledge and attitudes; level of self-efficacy or self-confidence regarding breastfeeding; concerns; support network; breastfeeding technique in relation to positioning, latch-on, effective milk transfer; assessment of the newborn/infant (regarding breastfeeding). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed on the breastfeeding process in the first 24 hours/Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Information and education on breastfeeding, and support for the breastfeeding process (hospital).	In Hospital Care, it is considered completed if postpartum training and resources have been provided to the mother by the interprofessional team on breastfeeding before hospital discharge. The specific components are: Latching/postpartum and latch-on; Milk transfer; Breastfeeding based on infant cues; Other. ((Number of mothers receiving information and education on breastfeeding and support for the breastfeeding process)/ Total number of dyads) x100 Dyad: Pair consisting of mother and breastfeeding infant who form a bond with each other.	15 months
Breastfeeding education and support for family members (hospital)	In hospital care, it is considered completed if education and support in breastfeeding has been carried out for family members before hospital discharge. (Number of dyads whose family has received education and support in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Breastfeeding at first feeding	Requires the infant to have been breastfed for the first feeding after birth (Number of infants who were breastfed for the first feeding)/(Total number of infants discharged) x100	15 months
Early assessment of breastfeeding in primary care	In Primary Care, early assessment is considered completed between hospital discharge and day 8 of the neonate's life (included). To carry out the assessment, a breastfeeding assessment tool may be used. (Number of dyads assessed early on the process of breastfeeding (between hospital discharge and 8 days of life / Total number of dyads between hospital discharge and 8 days of life of the newborn) x 100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Breastfeeding education for the breastfeeding person (Primary care)	In Primary Care, it is considered completed if training has been carried out and resources have been provided to the mother after hospital discharge by the interprofessional team in breastfeeding, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or in successive visits. (Number of lactating persons receiving education in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months
Breastfeeding education and support for family members	In Primary Care, it is considered accomplished if breastfeeding education and support has been provided to family members, at least once in the period after discharge to 8 days or in the period from 9 days to 6 months, in the same visit or on successive visits. (Number of dyads whose family has received education and support in breastfeeding / Total number of dyads) x100 Dyad: A couple formed by the mother and the nursing baby who form a bond with each other.	15 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Type of institution	Hospital unit, primary care unit or nursing home unit.	15 months
Type of unit	Age, health problems and care required by the patients attended by the unit on a regular basis.	15 months
Date of discharge	Patients discharge date in case of hospital admissions.	15 months
Date of attention	Date when patients were attended in case of primary care.	15 months
Date of residence	Date when patients were a resident in case of socio-healthcare centres.	15 months
Mother´s age	Age of the mother.	15 months
Breastfeeding for the first time	First time the mother is facing breastfeeding or not.	15 months
Type of birth	Way in which the newborn was born: vaginal delivery, instrumental birth, caesarean section.	15 months
Weeks of gestation	Number of weeks of pregnancy.	15 months
Weight at birth	Weight of the newborn at birth, measured in grams.	15 months
Child weight	Child's weight measured in kilograms.	15 months
Reason for admission/consultation	Reason for admission/consultation of patients. Reason for the patient to be admitted to the Hospital or to attend the consultation.	15 months
Team Leader rol	Supervisor, mid-level leader, high-level leader, clinical nurse, other rol in the institution	15 monthts
Team members rol	Supervisor, mid-level leader, high-level leader, clinical nurse, other rol in the institution	15 months
Patients Age	Age of patients.	15 months
Patients Sex	Sex of patients.	15 months
Type of incontinence	Type of incontinence presented by the patient who has been assessed as an incontinent patient. It may be stress, urge or mixed incontinence.	15 months
Incontinence triggering factors.	Factors that cause the patient to experience episodes of incontinence. They may be: Multifactorial causes (cognitive, previous urinary problems, neurological causes, malignancy, surgery); Medication; Overweight/Obesity; Tobacco use; Lifestyle and fluid intake.	15 months
Child's height	Child's height measured in centimetres.	15 months
Previous history of pain	History of previous painful experiences of the patient.	15 months
Type of smoker	Currently smoking or have quit less than 1 month ago or non-active if quit more than 1 month ago but less than 6 months ago.	15 months
Smoking relapses	Number of relapses since patient stopped smoking	15 months
Previous of pressure injuries	Numbers of pressure injuries that the patient had at the start of care	15 months
Stage of change	Patient's stage of change according to Prochaska y Diclemente	15 months
Tobacco use	Number of cigarettes or derivatives consumed by the patient per day and year	15 months
Barriers	Barriers for the implementation of evidence-based recommendations in the units assessed using a questionnaire adapted from the The comprehensive, integrated checklist of determinants of practice (TICD checklist) and the Consolidated Framework for Implementation Research.	15 months
Strategies	Strategies designed for the implementation of evidence-based recommendations in the units assessed using a questionnaire adapted from the Expert Recommendations for Implementing Change (ERIC).	15 months
Evidence Based Practice competencies	Competencies in evidence-based practice of the healthcare professionals working in the units that are implementing evidence-based recommendations, assessed with the questionnaire EBP-COQ Prof©.	15 months
Clinical leadership skills	Clinical leadership skills of the healthcare professionals working in the units that are implementing evidence-based recommendations, assessed with the clinical leadership survey©.	15 months
Empowerment	Empowerment of the healthcare professionals working in the units that are implementing evidence-based recommendations, assessed with the Conditions for Work Effectiveness Questionnaire - II ©.	15 months
Evidence Based Practice (EBP) climate and leadership	EBP climate and leadership in the units participating in the project measured with the evidence-based practice nursing leadership and work environment scales ©.	15 months
Professional's sex	Sex of the professionals participating in the local implementation team	15 months
Professional's age	Age of the professionals participating in the local implementation team	15 months
Professional's qualifications	Professional's qualifications of the professionals participating in the local implementation team	15 months
Professional's experience	Professional's experience of the professionals participating in the local implementation team	15 months

Collaborators and Investigators

• Sponsor: Instituto de Salud Carlos III
• Collaborators: The Spanish Centre for Evidence Based Nursing and Healthcare
• Investigators: Study Chair: Leticia Bernués-Caudillo, PhD Candidate, Instituto de Salud Carlos III; Study Director: María Teresa Moreno-Casbas, PhD, Instituto de Salud Carlos III; Principal Investigator: Esther González-María, PhD, Instituto de Salud Carlos III; Study Chair: Laura Albornos-Muñoz, PhD, Instituto de Salud Carlos III; Study Chair: Alba Ayala, PhD, Instituto de Salud Carlos III

Publications and helpful links

General Publications

• Duenas M, Salazar A, Ojeda B, Fernandez-Palacin F, Mico JA, Torres LM, Failde I. A nationwide study of chronic pain prevalence in the general spanish population: identifying clinical subgroups through cluster analysis. Pain Med. 2015 Apr;16(4):811-22. doi: 10.1111/pme.12640. Epub 2014 Dec 19.
• Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259. doi: 10.1002/14651858.CD000259.pub3.
• Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20. doi: 10.1258/jrsm.2011.110180.
• Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD005470. doi: 10.1002/14651858.CD005470.pub2.
• Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, Glass JE, York JL. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012 Apr;69(2):123-57. doi: 10.1177/1077558711430690. Epub 2011 Dec 26.
• Flottorp SA, Oxman AD, Krause J, Musila NR, Wensing M, Godycki-Cwirko M, Baker R, Eccles MP. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implement Sci. 2013 Mar 23;8:35. doi: 10.1186/1748-5908-8-35.
• Kreindler SA. What if implementation is not the problem? Exploring the missing links between knowledge and action. Int J Health Plann Manage. 2016 Apr;31(2):208-26. doi: 10.1002/hpm.2277. Epub 2014 Nov 25.
• Squires JE, Estabrooks CA, Gustavsson P, Wallin L. Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011 Jan 5;6:1. doi: 10.1186/1748-5908-6-1.
• Meijers JM, Janssen MA, Cummings GG, Wallin L, Estabrooks CA, Y G Halfens R. Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review. J Adv Nurs. 2006 Sep;55(5):622-35. doi: 10.1111/j.1365-2648.2006.03954.x.
• Ortuno-Soriano I, Munoz-Jimenez D, Moreno-Casbas T, Albornos-Munoz L, Gonzalez-Maria E; en nombre del Grupo de Trabajo del Programa de implantacion de buenas practicas en Centros Comprometidos con la Excelencia en Cuidados(R). Evaluation of implementation strategies of the Best Practices Spotlight Organisations (BPSO) Project in Spain. Enferm Clin (Engl Ed). 2020 May-Jun;30(3):222-230. doi: 10.1016/j.enfcli.2019.10.027. Epub 2020 May 7. English, Spanish.
• Powell BJ, Fernandez ME, Williams NJ, Aarons GA, Beidas RS, Lewis CC, McHugh SM, Weiner BJ. Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda. Front Public Health. 2019 Jan 22;7:3. doi: 10.3389/fpubh.2019.00003. eCollection 2019.
• Lewis CC, Boyd MR, Walsh-Bailey C, Lyon AR, Beidas R, Mittman B, Aarons GA, Weiner BJ, Chambers DA. A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci. 2020 Apr 16;15(1):21. doi: 10.1186/s13012-020-00983-3.
• Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, Mettert KD, Dorsey CN, Purtle J, Kepper MM, Baumann AA, Brownson RC. Quantitative measures of health policy implementation determinants and outcomes: a systematic review. Implement Sci. 2020 Jun 19;15(1):47. doi: 10.1186/s13012-020-01007-w.
• Moreno-Casbas T. Perspectives: Implementation strategies to adopt and integrate evidence-based nursing. What are we doing? J. Res. Nurs. 2015;20:729-33.
• Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E. Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016 Mar 22;11:40. doi: 10.1186/s13012-016-0396-4.
• Almazrou SH, Alfaifi SI, Alfaifi SH, Hakami LE, Al-Aqeel SA. Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review. Healthcare (Basel). 2020 Dec 15;8(4):564. doi: 10.3390/healthcare8040564.
• Davies B, Edwards N, Ploeg J, Virani T. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings. BMC Health Serv Res. 2008 Feb 2;8:29. doi: 10.1186/1472-6963-8-29.
• Ploeg J, Davies B, Edwards N, Gifford W, Miller PE. Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid Based Nurs. 2007;4(4):210-9. doi: 10.1111/j.1741-6787.2007.00106.x.
• Mickan S, Burls A, Glasziou P. Patterns of 'leakage' in the utilisation of clinical guidelines: a systematic review. Postgrad Med J. 2011 Oct;87(1032):670-9. doi: 10.1136/pgmj.2010.116012. Epub 2011 Jun 29.
• Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. A unit-level perspective on the long-term sustainability of a nursing best practice guidelines program: An embedded multiple case study. Int J Nurs Stud. 2016 Jan;53:204-18. doi: 10.1016/j.ijnurstu.2015.09.004. Epub 2015 Sep 8.
• Flodgren G, Deane K, Dickinson HO, Kirk S, Alberti H, Beyer FR, Brown JG, Penney TL, Summerbell CD, Eccles MP. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD000984. doi: 10.1002/14651858.CD000984.pub2.
• Esposito P, Dal Canton A. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World J Nephrol. 2014 Nov 6;3(4):249-55. doi: 10.5527/wjn.v3.i4.249.
• Wentland BA, Hinderer KA. A Nursing Research and Evidence-Based Practice Fellowship Program in a Magnet(R)-designated pediatric medical center. Appl Nurs Res. 2020 Oct;55:151287. doi: 10.1016/j.apnr.2020.151287. Epub 2020 May 15.
• Holmes BJ, Best A, Davies H, Hunter D, Kelly MP, Marshall M, Rycroft-Malone J. Mobilising knowledge in complex health systems: A call to action. Evid. Policy 2017;13:539-60.
• Sinuff T, Muscedere J, Rozmovits L, Dale CM, Scales DC. A qualitative study of the variable effects of audit and feedback in the ICU. BMJ Qual Saf. 2015 Jun;24(6):393-9. doi: 10.1136/bmjqs-2015-003978. Epub 2015 Apr 27.
• Munoz Jimenez D. From evidence-based nursing to healthcare practice: The evaluation of results as an integrating element. Enferm Clin (Engl Ed). 2018 May-Jun;28(3):149-153. doi: 10.1016/j.enfcli.2018.04.004. No abstract available. English, Spanish.
• Christina V, Baldwin K, Biron A, Emed J, Lepage K. Factors influencing the effectiveness of audit and feedback: nurses' perceptions. J Nurs Manag. 2016 Nov;24(8):1080-1087. doi: 10.1111/jonm.12409. Epub 2016 Jun 16.
• García FJ, Salinas J, Madurga B, Cózar JM, Esteban M. Guía de atención a personas con incontinencia urinaria [internet]. Madrid: Asociación Española de Urología; Enero 2020 [consultado abril de 2021]. Available in: https://www.consejogeneralenfermeria.org/documentos-de-interes/guias-clinicas/send/67-guias-clinicas/908-guia-de-atencion-a-personas-con-incontinencia-urinaria
• Dufour S, Wu M. No. 397 - Conservative Care of Urinary Incontinence in Women. J Obstet Gynaecol Can. 2020 Apr;42(4):510-522. doi: 10.1016/j.jogc.2019.04.009.
• Estudio ALADINO 2019: Estudio sobre Alimentación, Actividad Física, Desarrollo Infantil y Obesidad en España 2019. Agencia Española de Seguridad Alimentaria y Nutrición. Ministerio de Consumo. Madrid, 2020
• Departamento de Salud del Gobierno Vasco. Estrategia de prevención de la obesidad infantil en Euskadi. PLAN SANO. 2019. Editado por Servicio Central de publicaciones del Gobierno Vasco. Disponible en: https://www.euskadi.eus/estrategia/prevencion-de-la-obesidad-infantil-en-euskadi/web01-a2osabiz/es/
• World Health Organization. Infant and young child feeding. Ginebra: WHO; 2021 [acceso12/11/2021]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding.
• Agencia Española del Medicamento y Producto Sanitarios. Programa Higiene de manos del SNS. Informe de indicadores 2019. Madrid. 2020
• Estudio APEAS. Estudio sobre la seguridad de los pacientes en atención primaria de salud. Madrid: Ministerio de Sanidad y Consumo; 2008.
• Escobar-Aguilar G, Moreno-Casbas MT, Gonzalez-Maria E, Martinez-Gimeno ML, Sanchez-Pablo C, Orts-Cortes I. The SUMAMOS EXCELENCIA Project. J Adv Nurs. 2019 Jul;75(7):1575-1584. doi: 10.1111/jan.13988. Epub 2019 Apr 2.
• Martinez-Gimeno ML, Fernandez-Martinez N, Escobar-Aguilar G, Moreno-Casbas MT, Brito-Brito PR, Caperos JM. SUMAMOS EXCELENCIA(R) Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS). Healthcare (Basel). 2021 Mar 28;9(4):374. doi: 10.3390/healthcare9040374.
• GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602. doi: 10.1016/S0140-6736(16)31678-6. Erratum In: Lancet. 2017 Jan 7;389(10064):e1. doi: 10.1016/S0140-6736(16)32606-X.
• Encuesta Nacional de Salud de España 2017. Instituto nacional de estadística. [acceso 25/08/2019]. Available in: https://www.mscbs.gob.es/estadEstudios/estadisticas/encuestaNacional/encuesta2017.htm
• OMS, Ministerio de Sanidad. La higiene de las manos en la asistencia ambulatoria y domiciliaria y en los cuidados de larga duración. Guía de aplicación de la estrategia multimodal de la OMS para la mejora de la higiene de las manos y del modelo
• Estudio nacional de vigilancia de infección nosocomial en servicios de medicina intensiva. Vall d'hebron. Barcelona; 2019. Available in: https://hws.vhebron.net/envin-helics/
• Ministerio de Sanidad - Gobierno de España. Encuesta sobre alcohol y otras drogas en ESpaña (EDADES) 1995-2022. 2022.
• Ministerio de Sanidad - Gobierno de España. Muertes atribuibles al consumo de tabaco en España, 2000-2014. 2017.
• VH R, LF S. Intervenciones de enfermería para el abandono del hábito de fumar (Cochrane). La Bibl Cochrane Plus. 2008;2.
• Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database Syst Rev. 2021 Sep 6;9(9):CD011556. doi: 10.1002/14651858.CD011556.pub2.
• Pancorbo-Hidalgo PL, García-Fernández FP, Pérez-López C y Soldevilla Agreda JJ. Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en población adulta en hospitales españoles: resultados del 5º Estudio Nacional de 2017. Available in: https://gneaupp.info/wp-content/uploads/2021/11/30-2-2019-076.pdf
• García-Fernández F.P, Torra i Bou J.E, Soldevilla-Agreda JJ, Verdú Soriano J, Torra i Bou J.E. Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en centros de atención primaria de salud de España en 2017. Available in: http://gerokomos.com/wp-content/uploads/2019/10/30-3-2019-134.pdf
• Soldevilla-Agreda JJ, García-Fernández F.P, Rodríguez-Palma M, Pancorbo Hidalgo PL. Prevalencia de lesiones por presión y otras lesiones cutáneas relacionadas con la dependencia en residencias de mayores y centros sociosanitarios de España en 2017. Gerokomos. 2019;30(4):192-199. Available in: http://gerokomos.com/wp-content/uploads/2019/12/30-4-2019-192.pdf
• Estrategia de Seguridad del Paciente del Sistema Nacional de Salud Período 2015-2020. Comité Institucional de la Estrategia de Seguridad del Paciente. Consejo Interterritorial del Sistema Nacional de Salud del día 29 de julio de 2015. Ministerio de Sanidad, Servicios Sociales e Igualdad. Available in: https://seguridaddelpaciente.sanidad.gob.es/docs/Estrategia_Seguridad_del_Paciente_2015-2020.pdf
• Sinn CL, Tran J, Pauley T, Hirdes J. Predicting Adverse Outcomes After Discharge From Complex Continuing Care Hospital Settings to the Community. Prof Case Manag. 2016 May-Jun;21(3):127-36; quiz E3-4. doi: 10.1097/NCM.0000000000000148.
• Pancorbo-Hidalgo, P. L., García-Fernández, F. P., Torra i Bou, J.-E., Verdú Soriano, J., & Soldevilla-Agreda, J. J. (2014). Epidemiología de las úlceras por presión en España en 2013: 4.o Estudio Nacional de Prevalencia. Gerokomos, 25(4), 162-170.
• Jiang Q, Li X, Qu X, Liu Y, Zhang L, Su C, Guo X, Chen Y, Zhu Y, Jia J, Bo S, Liu L, Zhang R, Xu L, Wu L, Wang H, Wang J. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China. Int J Clin Exp Pathol. 2014 Apr 15;7(5):2587-94. eCollection 2014.
• Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002 May;18(2):141-58. doi: 10.1016/s0749-0690(02)00002-2.
• World Health Organization. WHO global report on falls prevention in older age. 2007. Available in: https://www.who.int/publications/i/item/9789241563536
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• LeLaurin JH, Shorr RI. Preventing Falls in Hospitalized Patients: State of the Science. Clin Geriatr Med. 2019 May;35(2):273-283. doi: 10.1016/j.cger.2019.01.007. Epub 2019 Mar 1.

Helpful Links

• Project website

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2024
• Primary Completion (Estimated): December 15, 2025
• Study Completion (Estimated): January 30, 2026

Study Registration Dates

• First Submitted: July 19, 2024
• First Submitted That Met QC Criteria: July 24, 2024
• First Posted (Actual): July 26, 2024

Study Record Updates

• Last Update Posted (Actual): July 26, 2024
• Last Update Submitted That Met QC Criteria: July 24, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Implementation; Quality of Health Care; Nursing; Evidence-based practice; Implementation science
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Skin Diseases; Urologic Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Wounds and Injuries; Skin Ulcer; Overnutrition; Nutrition Disorders; Overweight; Body Weight; Urination Disorders; Obesity; Elimination Disorders; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Urinary Incontinence; Pediatric Obesity; Enuresis; Crush Injuries; Pressure Ulcer
• Other Study ID Numbers: SE_CECBE_2024

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No