Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2014 Nov 25:9:120.
doi: 10.1186/s13012-014-0120-1.

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children

Bonnie J Stevens  1 , Janet Yamada  2 , Sara Promislow  3 , Jennifer Stinson  4 , Denise Harrison  5 , J Charles Victor  6 ; Members of the CIHR Team in Children’s Pain
Collaborators, Affiliations
Multicenter Study

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children

Bonnie J Stevens et al. Implement Sci. .

Abstract

Background: Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation.

Methods: Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period.

Results: Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies.

Conclusions: Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Allocation diagram. SC, Standard Care; EPIQ, Evidence-based Practice for Improving Quality.
Figure 2
Figure 2
Examples of knowledge translation strategies by type.
Figure 3
Figure 3
Proportion of children receiving targeted pain practice per intervention cycle.
Figure 4
Figure 4
Median cumulative number of knowledge translation strategies implemented by type†. Note † comparing units (N = 16) that met aims by C4 vs those that did not. ◊ Units that met, exceeded, or came within 80% of their stated practice aim. ● Units that achieved less than 80% of their stated practice aims.
See this image and copyright information in PMC

References

    1. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):1–349. doi: 10.3310/hta8060. - DOI - PubMed
    1. Scott-Findlay SD, Estabrooks C. Knowledge translation and pain management. In: Finley GA, McGrath PJ, Chambers CT, editors. Bringing Pain Relief to Children. New Jersey: Humana Press; 2006. pp. 199–226.
    1. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci. 2012;7:50. doi: 10.1186/1748-5908-7-50. - DOI - PMC - PubMed
    1. Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies-a synthesis of systematic review findings. J Eval Clin Pract. 2008;14(5):888–897. doi: 10.1111/j.1365-2753.2008.01014.x. - DOI - PubMed
    1. Hakkennes S, Dodd K. Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care. 2008;17(4):296–300. doi: 10.1136/qshc.2007.023804. - DOI - PubMed

Publication types