Jbi Evidence Implementation最新文献

{"title":"Early detection of clinical deterioration in a pediatric intermediate care unit: a best practice implementation project.","authors":"Céline Lomme, Chantal Grandjean, Vivianne Chanez, Marie-Hélène Perez","doi":"10.1097/XEB.0000000000000536","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000536","url":null,"abstract":"<p><strong>Background: </strong>The Pediatric Intermediate Care Unit (Ped-IMC) provides specialized monitoring and care for children at high risk of clinical deterioration. The Pediatric Early Warning Score (PEWS) assesses key factors, such as vital signs and concerns from parents and nursing staff. The score helps to predict clinical deterioration, trigger a rapid interprofessional response, reduce morbidity and mortality, and enhance staff safety.</p><p><strong>Objective: </strong>This project aimed to promote the prompt identification of clinical deterioration and boost interprofessional response in a Ped-IMC through the implementation of best practices.</p><p><strong>Methods: </strong>This project used the JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practices. A follow-up audit was conducted 6 months after implementation to measure change. The audits investigated cardiopulmonary events and unplanned transfers to the pediatric intensive care unit (PICU). A staff survey measured sense of safety, and the Assessment of Interprofessional Team Collaboration Scale (AITCS) was used to measure job satisfaction and interprofessional collaboration.</p><p><strong>Results: </strong>After implementation, no cardiopulmonary events occurred (compared to one before implementation), and unplanned PICU transfers decreased from 17 (5%) to 14 (4%). Half of the medical and nursing staff (n = 30) completed the survey: interprofessional collaboration scores were stable, and job satisfaction increased from 88% to 97%. Health care providers reported feeling more listened to, with scores improving from 84% to 90%, while their sense of safety remained stable. Compliance with audit criteria increased from 0% to 100% for criteria 1 to 4, and from 0% to 24% for criterion 5.</p><p><strong>Conclusion: </strong>Implementing PEWS was feasible and effective in enhancing patient safety. While results showed promising improvements in safety culture, reduced adverse events, and increased staff satisfaction, continued monitoring and long-term evaluations are necessary to ensure that PEWS remains a reliable tool in clinical practice.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A423.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing aggression in psychiatric settings: a best practice implementation project.","authors":"Louis Prod'hom, Stéphanie Mahé, Pierre Lequin, Dorota Drozdek, Béatrice Perrenoud","doi":"10.1097/XEB.0000000000000535","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000535","url":null,"abstract":"<p><strong>Introduction: </strong>Aggression is a frequent occurrence in psychiatric settings and results from complex multifactorial phenomena. Verbal or physical aggression has a significant impact on the quality of care, with negative repercussions on patients, professionals, and health care institutions.</p><p><strong>Objectives: </strong>This project aimed to prevent and manage hetero-aggression in a university hospital psychiatric department in Switzerland through the promotion of evidence-based practices.</p><p><strong>Methods: </strong>The project used JBI's Evidence Implementation Framework, which is grounded in an audit and feedback process. A baseline audit was conducted to measure current practices for preventing and managing aggression and compare these to eight best practice recommendations. Interventions to improve compliance with best practices were implemented, and a follow-up audit was conducted to measure the changes achieved.</p><p><strong>Results: </strong>Despite a high prevalence of staff exposure to aggression, the baseline audit showed that violence risk assessments were not systematically documented. The follow-up audit revealed improvements, with the use of a validated screening tool to identify violence risk and increased prevention interventions. However, these measures had a relatively low impact on the exposure to violence of health care professionals. Patient involvement in the violence risk assessment also remained low.</p><p><strong>Conclusions: </strong>The JBI approach used in this project led to significant improvements in professional practices related to violence risk assessment and reduced the gaps between recommendations and clinical practices. Clinical practice analysis sessions are a successful means of promoting understanding of prevention interventions.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A410.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-life care among terminally ill patients in the emergency department: a best practice implementation project.","authors":"Piaoyu Yang, Li Feng, Wanting Zhou, Jili Zheng, Yuxia Zhang","doi":"10.1097/XEB.0000000000000526","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000526","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing number of older adults visiting emergency departments (EDs) near the end of life highlights the need for palliative and end-of-life care in this setting, despite the ED's focus on acute care.</p><p><strong>Aim: </strong>This study implemented evidence-based end-of-life care for terminally ill adult patients in the ED in a medical center in Shanghai, China.</p><p><strong>Methods: </strong>This project followed JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practice recommendations. Barriers to evidence-based practices were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine changes in compliance.</p><p><strong>Results: </strong>The results showed significant improvement in adherence to best practice recommendations. For Criterion 1 (staff training), compliance rose from 77.5% to 100% and knowledge scores increased from 9.68 ± 1.945 to 12.30 ± 2.239 (p < 0.001). For Criterion 2 (patients screened and/or assessed for palliative care needs), compliance increased from 50% to 100%. For Criterion 3 (ED protocol for end-of-life care), compliance rose from 0% to 100%. For Criterion 4 (palliative or end-of-life patients transitioned to the appropriate service), compliance increased from 0% to 30%. For Criterion 5 (strategies promoting a suitable environment), compliance increased from 70% to 90%.</p><p><strong>Conclusions: </strong>This project resulted in positive changes, including the establishment of a formal end-of-life care protocol. Nursing team support and the range of end-of-life care interventions also improved. However, collaboration and referrals between hospitals and hospices remain challenging. Further audits are needed to assess improvements in care for end-of-life patients.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A395.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment and management of post-surgical pain in adult patients undergoing thoracic surgery: a best practice implementation project.","authors":"Delia González de la Cuesta, Esther González María, Nieves López Ibort, Ana Carmen Lahuerta Martínez, Isabel de la Torre Arrieta, Ana Sofía Martínez Mompel, M Pilar Martín Ramo, Eva Belsue Cortés, Mariana Monge Nieto, Cristina Cayón Geli, Mercedes Nuria Ferrando Margeli","doi":"10.1097/XEB.0000000000000449","DOIUrl":"10.1097/XEB.0000000000000449","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Effective management of post-operative pain improves the condition of patients and reduces their hospital stay. This, in turn, has an impact on caregivers, professionals, and institutions and, as such, is considered a primary indicator of quality. The aim of this project was to improve the assessment and management of post-surgical pain in thoracic surgery patients.</p><p><strong>Methods: </strong>This implementation project was conducted in a thoracic surgery unit of a tertiary hospital in Spain. The project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted with 44 patients, and barriers to best practice were identified. Strategies were then implemented to improve the assessment and management of post-operative pain. Three follow-up audits were performed using nine audit criteria with 34, 40, and 46 patients, respectively.</p><p><strong>Results: </strong>The baseline audit revealed poor compliance with best practices. After implementing strategies to address areas of non-compliance, health education for patients and caregivers improved up to 80%, while the measurement of pain upon admission and post-surgery rose to 91%. However, patients undergoing pre-operative assessment to guide their post-operative pain management at hospital discharge remained below 50%.</p><p><strong>Conclusions: </strong>Using a methodology to implement best practices, together with clinical audits, improved compliance with the use of validated scales to assess and manage pain. A multidisciplinary approach improves the quality of care received by patients and contributes to their recovery.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A240.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"414-423"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of individuals' attitudes and capabilities on implementation in aged care: a literature analysis.","authors":"Alice Windle, Gillian Harvey, Carol Davy","doi":"10.1097/XEB.0000000000000517","DOIUrl":"10.1097/XEB.0000000000000517","url":null,"abstract":"<p><strong>Introduction: </strong>The aged care sector is undergoing significant reform and innovation. The successful implementation of innovations requires effective strategies, tailored to address the particular barriers and enablers experienced by individuals in their own context.</p><p><strong>Aim: </strong>This study aimed to identify key factors relating to individuals' attitudes and capabilities that influence implementation in aged care.</p><p><strong>Methods: </strong>This study provides an in-depth, inductive qualitative content analysis of the literature included in a recent comprehensive scoping review on the implementation of innovations in aged care.</p><p><strong>Results: </strong>Attitude and capability factors were frequently identified as influencing implementation in aged care, as either barriers or enablers. Attitudes held by staff were predominant, and were primarily related to the innovation as well as the change process. Attitudes included resistance, concern, and defensiveness as well as enthusiasm, motivation, and a growth mindset. The beliefs that underpinned attitudes primarily related to the benefits associated with the innovation as well as perceived fears and threats, need/relevance, difficulty, enjoyment, and conflict. Capability factors largely related to staff knowledge of the innovation, background knowledge, and relevant skills as well as clarity of role-related responsibilities. The generally low skill level of the aged care workforce was also a factor, as were the capabilities of older people/clients.</p><p><strong>Conclusions: </strong>Attitudes and capabilities are key factors that can influence implementation, particularly those held by staff as well as other stakeholders. Identifying and monitoring stakeholders' attitudes, underlying beliefs, and capabilities enables the selection of appropriate implementation strategies to optimize the successful introduction and sustainment of innovations to improve care for older people.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A373.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"554-575"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relational factors influencing implementation in aged care: a literature review.","authors":"Alice Windle, Gillian Harvey, Carol Davy","doi":"10.1097/XEB.0000000000000523","DOIUrl":"10.1097/XEB.0000000000000523","url":null,"abstract":"<p><strong>Introduction: </strong>There are widespread efforts to implement change and innovation to improve care for older people in aged care. Relational factors are among the key determinants of implementation in care settings, and are an emerging area of implementation research attention.</p><p><strong>Aim: </strong>This study aimed to identify relational factors that influence implementation in aged care.</p><p><strong>Methods: </strong>We conducted inductive descriptive qualitative content analysis of studies included in a recent comprehensive scoping review of implementation in aged care.</p><p><strong>Results: </strong>We identified a variety of relational factors that influence implementation. Collaboration among stakeholders was a key factor, in particular between disciplines, and among the aged care staff as well as with external service providers. We found that managers' support was vital, as was clear and frequent communication between stakeholders. Implementation was aided by established, cohesive, trusting, non-hierarchical relationships, as well as shared values and visions.</p><p><strong>Conclusions: </strong>A range of factors in the socio-relational context can influence implementation in aged care. Assessing these factors and tailoring implementation strategies accordingly can promote successful implementation to improve care for older people.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A384.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"595-611"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain assessment and management in patients with dementia in Taiwan: a best practice implementation project.","authors":"Shwu-Feng Tsay, Cheng-Yu Chang, Jui-Yuan Su, Sing Shueh Hung, Pei-Fan Mu","doi":"10.1097/XEB.0000000000000481","DOIUrl":"10.1097/XEB.0000000000000481","url":null,"abstract":"<p><strong>Introduction: </strong>The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia.</p><p><strong>Objectives: </strong>The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community.</p><p><strong>Methods: </strong>The project followed the JBI Model of Evidence-based Healthcare and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance.</p><p><strong>Results: </strong>This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome.</p><p><strong>Conclusions: </strong>Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A294.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"424-435"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-at-home care in Singapore: distilling policy and implementation strategies essential to support scale-up using Policy Labs.","authors":"Shaoying Dylan Goh, Tze Yang Tan, Crystal Min Siu Chua, Yuka Asada, Karen E Peters, Yi Feng Lai","doi":"10.1097/XEB.0000000000000504","DOIUrl":"10.1097/XEB.0000000000000504","url":null,"abstract":"<p><strong>Background: </strong>The Mobile Inpatient Care at Home (MIC@Home) initiative was implemented as a promising solution to address challenges brought about by rising demand for hospital services due to an aging population. This initiative leveraged technology and remote care delivery.</p><p><strong>Aim: </strong>To explore key strategies for the effective expansion of MIC@Home in Singapore.</p><p><strong>Methods: </strong>This study examined local qualitative insights reported in the literature and explored the implementation and policy implications through the Policy Labs method. Thirty-two clinicians, administrators, and policymakers participated in the study. Data were collected through facilitated discussions in three Policy Lab sessions. The findings were analyzed and key strategies were identified to prioritize plans for implementation improvements and policy redesign.</p><p><strong>Results: </strong>The priorities that would aid in upscaling MIC@Home in Singapore included (1) policy redesign: optimize manpower, shift stakeholder mindsets, enhance third-party providers, and integrate mainstream financing options to support effective implementation; (2) guidelines and clinical operations: emphasize innovative IT solutions for triage, quality-focused training programs, operational efficiency through standardized protocols, nationalized logistics, and collaboration across MIC@Home clusters; and (3) leadership and governance: advocate a clear mandate to establish professional societies for accreditation and create a balanced governance structure that addresses MIC@Home's unique complexities.</p><p><strong>Conclusion: </strong>This study offers valuable insights into the challenges and strategies affecting the MIC@Home model's scalability, highlighting critical areas for implementation and policy redesign. By addressing the identified challenges through targeted strategies, Singapore can champion the MIC@Home model as a viable and sustainable alternative to traditional inpatient care.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A340.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"504-517"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder engagement: supporting innovation in aged care.","authors":"Carol Davy, Alice Windle, Gillian Harvey","doi":"10.1097/XEB.0000000000000524","DOIUrl":"10.1097/XEB.0000000000000524","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to understand stakeholder engagement in aged care by examining four key objectives: who was engaged, how they were engaged, the factors that supported their engagement, and the outcomes realized from the process.</p><p><strong>Introduction: </strong>The aged care sector must innovate to meet increased service demand, staff shortages, insufficient funding, and rising client expectations. Effective innovation in this sector requires meaningful stakeholder engagement, yet the definitions and processes surrounding engagement are often ambiguous and criticized for being tokenistic.</p><p><strong>Eligibility criteria: </strong>We conducted a descriptive secondary analysis of data from a scoping review that examined factors affecting the implementation of innovations in community and residential aged care settings.</p><p><strong>Methods: </strong>Data were inductively coded based on the four key objectives. The findings were validated and interpreted in collaboration with a Research Advisory Group composed of aged care clients, staff, and sector representatives.</p><p><strong>Results: </strong>The majority of studies engaged aged care staff, with limited involvement of clients, families, and the community. Approaches encouraging open communication and collaboration fostered stronger participation and relationships. Clear information, resources, and leadership support improved outcomes, enhanced staff capability, and built stakeholder trust.</p><p><strong>Conclusions: </strong>Our study underscores the importance of meaningful stakeholder engagement in implementing innovations within the aged care sector. Expanding involvement to ensure clients, family members, and the wider community are involved could enhance outcomes. Adopting more interactive and inclusive approaches also fosters equitable participation, ensuring that diverse perspectives contribute to the success of these innovations.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A387.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"525-544"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of complexity in clinical practice guidelines: a Delphi study including perspectives from guideline developers and implementers.","authors":"Marleen Corremans, Zachary Munn, Sanne Peters, Pascale Jonckheer, Heidi Parisod, Gerlinde Lenaerts, Marlène Karam, Nancy Durieux, Anne-Lise Leclercq, Ashley Boers, Herman Vandevijvere","doi":"10.1097/XEB.0000000000000499","DOIUrl":"10.1097/XEB.0000000000000499","url":null,"abstract":"<p><strong>Abstract: </strong>The Medical Research Council proposed a framework to develop and implement complex interventions in practice. How to adopt these interventions is described in recommendations of evidence-based clinical practice guidelines. Many factors may influence the complexity of a guideline. The aim of this paper is to describe the determinants of complexity in the development and implementation of an evidence-based clinical practice guideline.A working group with 16 participants was established, consisting of a debate team and a Delphi panel. The debate team discussed online to define the key elements of the MRC's definition of a complex intervention to see whether these elements are applicable to guidelines. These elements were presented to the Delphi panel to assess their relevance.After the first round, consensus was reached on eight elements, with the inter-rater reliability varying from 0.83 to 1.00. After the second Delphi round, consensus was reached on two more elements. The consensus stated that these ten elements all define an aspect of the complexity in guidelines. There was no agreement regarding the exclusion of a specific element.Developers and end-users consider that the complexity of a guideline and its implementation is affected when the number of components, settings, targeted behaviors, and stakeholders increase; when a gap exists between the guideline and the reality of clinical practice; or when differences in education are evident between end-users. Moreover, the level of collaboration required of the different end-users, the scope of change, the level of evidence in the guideline, and the workload for end-users also determine complexity.</p><p><strong>Spanish abstract: </strong>http://links.lww.com/IJEBH/A333.</p>","PeriodicalId":48473,"journal":{"name":"Jbi Evidence Implementation","volume":" ","pages":"518-524"},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}