Overview

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)

Eligibility

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:

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