Analysis of Barriers to Evidence Transformation and Countermeasures for MARSI Prevention in Tracheal Intubated Patients Based on the i-PARIHS Framework.

Abstract

Objective: To systematically analyze the current status of evidence application for the prevention of medical adhesive-related skin injury (MARSI) in patients undergoing tracheal intubation, identify the multidimensional barriers and facilitators in the process of evidence translation on the basis of the i-PARIHS framework, and construct targeted intervention strategies.

Methods: Review indicators were developed on the basis of the 30 pieces of best evidence for the prevention of medical adhesive-associated skin injury in patients with tracheal intubation obtained from a previous study, and the review results were analyzed for barriers and facilitators by applying the Evidence Application Barrier Identification Assessment Checklist under the i-PARIHS framework.

Results: A total of 30 pieces of evidence were screened for conversion, and 24 review indicators were formulated, of which only 13 items (54.2%) had a compliance rate>60%, and 11 items (45.8%) had compliance rates<60%, with 3 key indicators (12.5%) having extremely low compliance rates (<10%). Key obstacles: Poor feasibility of change implementation: Evidence has not been transformed into easily accessible and actionable practical tools such as flowcharts and checklists; there is a lack of standardized operating procedures to guide clinical execution. Insufficient ability and cognition of change recipients, especially anesthesiologists: lack of relevant knowledge reserves; not receiving sufficient relevant training; lack of understanding and trust in the effectiveness of intervention measures. Organizational support and environmental deficiencies include a lack of effective incentive or constraint mechanisms such as performance linkages and quality feedback. The physical work environment, such as the operating space and equipment layout, has not been optimized to support new practices.

Conclusion: The best evidence for preventing MARSI in endotracheal intubation patients shows significant differences in clinical translation, with nearly half of the reviewed indicators having insufficient compliance and serious missing items (<10%). It is urgent to develop and implement strengthened intervention strategies to address the multidimensional barriers mentioned above, particularly in terms of change enforceability, anesthesiologist capabilities, organizational mechanisms, and the environment; actively promoting healthcare personnel change; and facilitating the effective clinical translation of the best evidence.