Prevention of unplanned interruption in critically ill continuous renal replacement therapy patients:a best practice implementation project

Prevention of unplanned interruption in critically ill continuous renal replacement therapy patients:a best practice implementation project | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevention of unplanned interruption in critically ill continuous renal replacement therapy patients:a best practice implementation project Xianfeng Liu, Shanshan Lv, Xujing Wang, Hui Fang, Guixia Li, Yingying Cheng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7559230/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Backgrund: Renal impairment is a common complication in critically ill patients after cardiac surgery, and Continuous Renal Replacement Therapy (CRRT) is the primary treatment. Aims This study used the Knowledge to Action Framework(KTA) to explore the impact of an evidence-based nursing practice protocol on single filter longevity, complications, and the chance of unplanned interruption in critically ill CRRT patients. Methods This was a non-simultaneous controlled study and included 61 medical personnel and 90 patients. 45 pre-practice and 45post-practice patients were divided into control and intervention groups. The evidence-based practice program was developed by the evidence-based nursing process, and the best evidence application strategy was constructed based on the KTA framework for clinical practice change at the development organization level, practice level, and patient level. The knowledge, trust and behavior scores of medical personnel were analyzed before and after the evidence-based practice, and the filter life span, complication rate, and unplanned interruption rate of patients between the two groups. Results Before the evidence-based intervention, there was no difference in the comparison of patients' basic information between the two groups ( p > 0.05). After the evidence-based intervention, the patients' individual filter service life was significantly prolonged ( p < 0.001), and the complication rate was significantly reduced ( p = 0.003). The intervention group had a lower chance of unplanned CRRT than the control group ( p < 0.001). The scores of medical personnel's knowledge, trust and behavior were all higher than before the intervention ( p < 0.001). Conclusions Evidence-based nursing practice prolongs the life of individual filters in critically ill CRRT patients, reduces complication rates, and can prevent unplanned interruption with good clinical validity. Evidence-based nursing practice procedures Continuous Renal Replacement Therapy unplanned interruption knowledge to action framework 1. INTRODUCTION Renal impairment is a common complication in critically ill patients after cardiac surgery, which seriously affects the postoperative life safety of patients[1]. Continuous Renal Replacement Therapy (CRRT) is a general term for continuous, slow removal of water and solute treatment modalities. It can maintain the patient's renal function in vitro, and has now become one of the most important support measures in the treatment of various critical illnesses[2]unplanned interruption are dismounting events in which treatment is discontinued without completing the treatment goal or without reaching the planned time, and are an important indicator for evaluating the quality of CRRT. Relevant studies have shown that the rate of unplanned interruption can range from 17 to 74 percent[3]. Its emergence not only affects the recovery of patients' renal function but also increases the economic burden. Previous findings have demonstrated that nursing interventions are effective in reducing the chance of unplanned interruption in CRRT patients.[4]. However, the development of current nursing interventions mostly relies on traditional nursing experience and lacks evidence-based nursing practice[5]. Moreover, most of the related studies analyze the risk factors that may lead to their occurrence, and these have limited improvement in the quality of care[3]. Evidence-based nursing practice aims to promote quality of care by improving the scientific validity and reliability of interventions[6]. From the development of these more reliable interventions to their application in the clinical setting, they need to be supported by a scientific theoretical framework. Knowledge to Action Framework(KTA) is one of the common theoretical frameworks for knowledge transformation. It consists of 2 stages: knowledge generation and knowledge application. Knowledge application consists of 6 steps: introducing knowledge into the local context, assessing barriers, developing interventions, applying knowledge, evaluating results, and sustaining knowledge application[7]. KTA provides a clear, concise, and actionable step-by-step guide for knowledge translation. Therefore, with the guidance of KTA, this study aims to explore the impact of evidence-based nursing practice on the chance of unplanned interruption in critically ill CRRT patients. 2. OBJECTIVES The aim of this project was to improve CRRT management status in critically ill patients in the ICU of a tertiary hospital. The specific objectives were to: Document compliance with CRRT treatment for critically ill patients. Identify barriers and facilitators to compliance with evidence-based criteria regarding CRRT management status, as well as to develop and implement strategies to overcome areas of non-compliance. Evaluate compliance with best practices following the implementation of improvement strategies. 3. METHODS This project used the KTA Framework. The KTA framework is grounded in an audit and feedback process, along with a structured approach to the identification and management of barriers to compliance with recommended clinical practices. It consists of 2 phases:Knowledge Creation and Action Cycle. Phase 1:Knowledge Creation Define evidence-based practice issues and establish an evidence-based practice team. The Cardiac Surgical Intensive Care Unit (CSICU) has 24 beds and admits approximately 120 patients per month on average, with an annual average of 100 patients undergoing CRRT treatment. The project team identified critical care CRRT management as an issue within the CSICU, as the high discontinuation rate of CRRT not only increases the workload for clinical staff but also elevates patient hospitalization costs. We established a core stakeholder group to support the project. This group comprised clinicians, critical care nurses, hemodialysis nurses, research nurses, and evidence-based nursing specialists. The project team included a supervising nurse, a nurse educator, and six advanced practice nurses. The head nurse was responsible for project coordination, scheduling, and overall progress oversight. The Hemodialysis Nurse Educator developed the education plan and trained nurses. The Research Nurse handled data collection, provided feedback, developed strategies, and collaborated with other members to advance the work. The study followed the Declaration of Helsinki, informed consent was obtained from all patients, and it was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University（SWYX:NO.2025-011）.Additionally, this project has been registered with the Evidence-Based Medicine Registration Center at Fudan University in China (Registration Number: ER20251372). 3.1.1 Knowledge Inquiry Evidence retrieval according to the 6S model[8]，以 “continuous renal replacement therapy/continuous blood purification/continuous veno-venous hemofiltration/continuous veno-venous hemodialysis""unplanned stop/filter life/filter failure"served as the Chinese and English keywords for retrieving relevant clinical practice guidelines, expert consensus statements, and systematic reviews from domestic and international sources. The search encompassed databases and websites including the International Guidelines Collaboration Network, the U.S. Guidelines Network, the Scottish Intercollegiate Guidelines Network, the JBI Database, PubMed, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Medical Network. The systematic search covered materials published up to September 2024. 3.1.2 Knowledge Synthesis Two researchers independently evaluated, summarized, and extracted the best evidence from the included literature. The guideline employed the AGREE II assessment[9]. Evidence summaries and clinical decision-making traced back to original literature, with quality assessments conducted using the JBI Center for Evidence-Based Healthcare's quality evaluation tools tailored to different study types based on the original literature's classification. Systematic reviews were also quality-assessed using the JBI Center for Evidence-Based Healthcare's systematic review tools. 3.1.3 Knowledge Products A total of 14 documents were ultimately included, comprising 5 clinical decision aids[10-14], 1 JBI recommended practice[15], 4 expert consensus statements[16-19], and 4 evidence summaries[20-23].The management of unplanned CRRT discontinuation in critically ill patients was divided into four sections, yielding a total of 29 best evidence statements. For evidence derived from guidelines, the recommended evidence level and strength were directly adopted. For evidence from evidence summaries and clinical judgments, the task force members conducted a retrospective review of the original texts and applied the JBI Evidence Pre-grading System to grade the evidence and determine the strength of recommendation, as detailed in Table 1. Phase 2:Action Cycle 3.2.1 Identify gaps between best evidence and clinical practice:Develop optimal evidence review indicators and determine review methods, see Table1. The three indicators with the lowest implementation rates prior to evidence-based practice review were indicators 13, 14, and 19.The baseline review was conducted between September 2024 to February 2025.A total of 45 CRRT patients and 61 healthcare workers were included.All data were obtained with informed patient consent. Patient inclusion criteria:①patient age≥18 years;② patients meet the appropriate indications for CRRT;③patients have informed consent to the study. Exclusion criteria:①patients with disseminated intravascular coagulation;②patients who underwent CRRT during the tandem extracorporeal membrane pulmonary oxygen contract;③patients who terminated CRRT due to death;④patients who suspended or terminated CRRT due to equipment malfunctions or the need to go out to perform therapeutic examinations. Medical and nursing staff inclusion criteria: ① working experience ≥ 1 year; ② obtain the admission qualification of the intensive care unit (ICU); ③ obtain the appropriate informed consent. Exclusion criteria: ① Excluding nurses who went out for support, further training, or vacation. 3.2.2Apply knowledge to specific scenarios, evaluate barriers and facilitators, and specify corresponding interventions. Evidence is contextualized within clinical scenarios: the FAME framework (Feasibility-F, Appropriateness-A, Meaningfulness-M, Effectiveness-E) was applied to assess evidence feasibility, appropriateness, clinical significance, and effectiveness. Concurrently, we analyze both facilitating and impeding factors. Based on baseline review findings, we systematically assess compliance rates against baseline review criteria. This involves a comprehensive analysis of barriers and enablers to evidence application at the organizational, practitioner, and patient levels(see Table 2).The team ultimately discussed incorporating all the best evidence into clinical practice. 3.2.3 Monitor Knowledge Use Conduct another baseline review between March to September 2025. The measurement scope will be identical to the previous baseline review. During the evidence-based practice phase, a total of 889 patients were enrolled, with 45 CRRT patients meeting the inclusion criteria. Following the implementation of evidence-based practices, all patient indicators showed corresponding improvements, particularly Review Indicators 13, 14, and 19. Specific details are presented in Table 4 3.4 Evaluate Outcomes 3.4.1 General information questionnaire: Includes general information questionnaires for health-care workers and patients. The general information questionnaire for medical and nursing staff included years of work experience, education, title, and so on. The general information questionnaire for patients included gender, age, weight, ventilator use time, 24 h of blood flow, total blood flow, and so on. The general information questionnaire was designed by the researchers themselves; see the supplementary materials for details. 3.4.2 CRRT unplanned interruption rate: Rate of unplanned interruption during CRRT = number of unplanned interruptions/total number of CRRT treatments performed during the period × 100%. The criteria for unplanned interruption in this study: ① blood clot blocking the extracorporeal circulation device, resulting in blood flow not being able to pass through; ② transmembrane pressure >300mmHg (1mmHg=0.133kPa); ③ blood pump stopping; ④ filter clotting grade Ⅱ or above; ⑤ various alarms can not be eliminated, resulting in downtime. If any of the above conditions are met, the machine can be shut down unplanned. Among them, the filter coagulation grade is evaluated concerning the relevant contents in the “Blood Purification Treatment Standard Manual”. 3.4.3 Medical and nursing review indicator implementation rate: Medical and nursing review indicator implementation rate = number of correct implementations/total number of implementations x 100%. 3.4.4 Score of the Questionnaire on Knowledge, Belief and Behavior for Prevention of unplanned interruption of Continuous Renal Replacement Therapy for Medical Personnel: The Questionnaire on Knowledge, Belief and Behavior for Prevention of Unplanned Downstream of Continuous Renal Replacement Therapy for Medical Personnel, developed by Yu,et al [24] 2024, was used. The questionnaire includes three dimensions of knowledge (11 entries), attitude (11 entries), and behavior (11 entries), with a total of 37 entries. In this study, Cronbach's alpha coefficient was 0.864 with good reliability. 3.4.5 Patient treatment-related time: time of individual filter use, time of line use. 3.4.6 Occurrence of patient complications: nausea, vomiting, hypotension, muscle cramps, and fever. 3.4.7 Information collection and data analysis Data collection: online questionnaire data were collected from medical personnel before and after the training using a convenience sampling method, which was set to allow each IP address to be filled out only once. Patients' general information was filled in by the duty nurse, and was collected before and after the implementation of evidence-based nursing care, and the duty nurse was trained uniformly by the research nurse before collection. Indicator review was conducted by the research nurse and the quality control nurse every morning and afternoon for on-site observation, questionnaire survey, and inquiry record. Analysis was performed using SPSS 23.0 software. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Normally distributed variables were expressed as mean±standard deviation (x±s). Between-group comparisons were performed using independent samples t-tests and one-way ANOVA (with LSD post-hoc tests for pairwise comparisons when variances were equal; Tamhane's T 2 method for pairwise comparisons when variances were unequal). Continuous variables with skewed distributions were expressed as median (interquartile range) [M (Q L , Q U )]. Intergroup comparisons were performed using the Mann-Whitney U test and Kruskal-Wallis H test. Categorical variables were expressed as rates (%). Analysis was conducted using the chi-square test. A P value < 0.05 was considered statistically significant. 4. RESULTS Study Design and Sample This study employed a non-concurrent controlled design with purposive sampling. It was conducted in the cardiac surgery intensive care unit of a large tertiary hospital in Jinan City, Shandong Province, China. 3.1 Basic information on patients and healthcare professionals A total of 61 medical personnel were included, aged 28.98 ± 7.404 years.14 males (22.95%) and 47 females (77.05%).3 (2, 14.5) years of work experience. The distribution of educational qualifications is 1 (1.64 %) doctorate, 7 (11.48 %) master's degrees, and 53 (86.89%) bachelor's degrees. 8 (8.20%) at the senior level, 17 (27.87 %) at the intermediate level, and 39 (63.93%) at the junior level. Collected 58 patient questionnaires before and after the implementation of evidence-based care in each group, including 27 before practice and 31 after practice. The difference between the general information of patients in the two groups was not statistically significant and comparable; the details are shown in Table 3. Table 3 Comparison of patients' general information between the two groups before and after practice clinical information Pre-Evidence-Based Practice After evidence-based practice statistic p gender（%） 0.055 ① 0.814 male 32 33 female 13 12 age（year,x±s） 56.29±13.830 61.22±13.897 0.367 ② 0.546 weight（kg,x±s） 71.46±15.159 68.89±15.259 0.371 ② 0.544 Ventilator duration（h,[M(Q L , Q U )]） 26.00（13.50,112） 26.00（11.50,84.50） -0.343 ③ 0.731 ICU hours（h,[M(Q L , Q U )]） 114.00（62.00,279.50） 92.00(63.00,186.50) -0.634 ③ 0.526 24h diversion of traffic（ml,[M(Q L , Q U )]） 550.00(335.00,850.00) 550.00(365.00,840.00) -0.315 ③ 0.753 APACHE Ⅱscore(score,x±s) 9.37±1.418 9.32±1.536 0.263 ② 0.610 abbreviations: ① is t-test, ② is Mann-Whitney U-test, and ③ is X² test. 3.2 Implementation rate of health-care worker review indicators The total number of inspections by healthcare professionals before and after evidence-based practice was 385, of which 192 were before practice and 193 were after practice. The overall review indicator implementation rate for healthcare professionals was 80.11% before evidence-based practice and 94.07% after practice (χ 2 =267.409, p <0.05), as detailed in Table 4. Table 4 Comparison of review rate of implementation of group standards implementation rate sports event Pre-evidence-based practice Number of inspections After evidence-based practice Number of inspections Pre-evidence-based practice（sequence/%） After evidence-based practice（sequence/%） χ 2 P 1 NA NA NA NA NA NA 2 NA NA NA NA NA NA 3 192 193 177（89.58） 178（92.28） 0.025 0.875 4 192 193 155（80.73） 179（92.75） 12.095 0.001 5 NA NA NA NA NA NA 6 192 193 154（80.21） 176（91.19） 9.482 0.002 7 192 193 132（68.75） 177（91.71） 32.025 ＜0.001 8 192 193 190（98.96） 190（98.46） NA 1.000 9 192 193 178（92.71） 188（97.41） 4.534 0.033 10 192 193 141（73.44） 188（97.41） 44.498 ＜0.001 11 192 193 167（86.98） 186（96.37） 11.145 0.001 12 192 193 147（76.56） 190（98.44） 42.234 ＜0.001 13 192 193 113（58.85） 177（91.71） 55.901 ＜0.001 14 192 193 120（62.50） 174（90.16） 40.784 ＜0.001 15 192 193 176（91.67） 186（96.37） 3.795 0.051 16 192 193 162（84.38） 189（97.93） 21.957 ＜0.001 17 192 193 158（82.29） 165（85.49） 0.730 0.393 18 192 193 163（84.89） 189（97.93） 20.857 ＜0.001 19 192 193 128（66.67） 173（89.64） 29.773 ＜0.001 abbreviations: "NA" means that the indicator under review is not applicable. 3.3 Clinical outcome indicators Prolonged use of individual filters in patients after evidence-based practice, from 18h before practice to 23h after practice. The complication rate decreased by 27%. Unplanned interruption rate decreased from 53% to 20%. Increased score on the Knowledge, Belief and Behavior Questionnaire for Prevention of Unplanned Downstaging of Continuous Renal Replacement Therapy in healthcare workers (total score improved from 109.95±29.20 to 175.02±4.56. Knowledge dimension improved from 49.09±16.84 to 82.72±2.726. belief dimension from 26.90±6.304 to 39.21±1.181. behavioral aspects from 33.97±7.613 to 53.09±2.922), and the difference between the two groups was statistically significant ( p <0.05) when comparing the two groups, see Table 5. Table 5 Comparison of clinical outcome indicators of patients and healthcare workers between the two groups before and after practice target Pre-Evidence-Based Practice After evidence-based practice statistic p Individual filter use time(h,[M(Q L , Q U )]) 18（12，24） 23（20，26） 12347 ③ ＜0.001 Patient complication occurrence(%,[M(Q L , Q U )]) 79（41.14） 52（26.94） 8.649 ② 0.003 CRRT Unplanned Interruption Rate(%,[M(Q L , Q U )]) 53（27.60） 20（10.36） 18.620 ② ＜0.001 Score on the Knowledge, Belief and Conduct Questionnaire for Healthcare Professionals to Prevent Unplanned Interruption of Continuous Renal Replacement Therapy (CRRT)(x±s) knowledge dimension 49.09±16.84 82.72±2.726 63.983 ① ＜0.001 belief dimension 26.90±6.304 39.21±1.181 56.463 ① ＜0.001 behavioral dimension 33.97±7.613 53.09±2.922 14.435 ① ＜0.001 Total Score of Knowing, Believing and Doing Questionnaire 109.95±29.20 175.02±4.56 60.973 ① ＜0.001 abbreviations: ① is t-test, ② is Mann-Whitney U-test, and ③ is X² test. Discussion With the continuous development of the nursing discipline, the scientific nature of nursing practice is increasingly emphasized. The development of evidence-based nursing practice has largely contributed to the improvement of nursing quality. The quality of nursing care may directly affect the unplanned under-chance of CRRT patients.[25] It can be seen that evidence-based nursing practice may be of great significance to CRRT patients. CRRT can reduce the burden on the kidneys of critically ill patients by replacing their renal function in vitro, and promote functional recovery. It is an important therapeutic means to save the lives of critically ill patients. In recent years, an increasing number of studies have reported unplanned interruption of CRRT patients. Unplanned interruption not only affects the outcome of critically ill patients but also leads to unnecessary financial burdens for patients. It also increases the risk of infection and death.[26]. Nursing workers are the direct caregivers of patients during CRRT. The quality of care they provide is closely related to the success of CRRT and patient safety. Evidence-based nursing practice is the integration of relevant scientific nursing evidence with nursing experience and patient-specific conditions to form protocols and apply them to clinical settings, which play an important role in improving the quality of care and clinical outcomes for patients. Past research has demonstrated that evidence-based nursing practice is effective in improving the quality of care and has a positive impact on patient health.[27] Therefore, the evidence-based nursing practice of preventing unplanned interruption in critically ill CRRT patients was constructed and conducted in this study. This is important for improving the quality of care for CRRT patients and reducing the incidence of unplanned interruptions. Previous studies have shown that filter lifetime may have a direct relationship with the probability of unplanned interruption in patients.[28] The level of erythrocytes, albumin, and other formed components in the patient's blood increases after CRRT. This leads to an increase in transmembrane pressure, an increase in the probability of filter pore clogging, a decrease in filter life, and an increase in the probability of unscheduled downtime.[29] The results of this study showed that the duration of individual filter use in patients was extended from 18h to 23h after evidence-based practice. It can be seen that evidence-based nursing practice can have a favorable impact on patients' blood component levels and effectively prolong the life of filters. Interestingly, a recent study[30] has also suggested that an individualized anticoagulation regimen may reduce patients' shortened filter life due to coagulation problems. It is undeniable that evidence-based nursing practice can facilitate the implementation of such individualized protocols to some extent. In the present study, there was a significant reduction in the complication rate in the practice group. Unplanned interruptions are a common adverse event during CRRT in critically ill patients, and relevant studies have shown that the incidence can be as high as 74%. In this study, the pre-practice unplanned interruption rate was 53%, which is still at a high level. The intervention group had a 33% lower rate of unplanned interruption after the implementation of an evidence-based care program compared to the control group. Earlier studies have confirmed that systematic and scientific training can increase nurses' knowledge base about CRRT, which can improve nurses' awareness and ability to prevent adverse events from occurring.[31] All of these results demonstrate the effectiveness of evidence-based nursing practice in reducing the chances of unplanned interruption in CRRT patients. Meanwhile, our study evaluated the knowledge-attitude-practice scores of nursing workers based on knowledge-attitude-practice theory before and after the development of evidence-based nursing practice. The results showed that the knowledge, belief, and behavior scores of the nursing workers concerned were substantially improved after the evidence-based nursing practice. This may be due to the systematic and scientific training carried out for them prior to the practice. This may have enhanced the level of awareness and knowledge acquisition of the caregivers to a great extent and helped them to develop good beliefs. It is worth mentioning that this study is based on the KTA theoretical framework to rigorously implement the review indicators throughout the process of practice program implementation. Conclusion Overall, the results of this study confirm that evidence-based nursing practice can prolong filter life and avoid complications, and is effective in reducing the chance of unplanned interruption in critically ill CRRT patients. This is important for improving the prognosis of patients. It is evident that evidence-based nursing practice can be further applied in clinical work. Evidence-based care is the development of individualized care plans based on scientific evidence, nursing experience, and patient-specific conditions. Evidence-based practice, on the other hand, facilitates the implementation of nursing programs in clinical work. This facilitates the translation of nursing theory into clinical practice, providing more guidance for clinical work and making it more scientific and reliable. Moreover, this study uses KTA theory as a guiding framework to further standardize the overall process of practice implementation for follow-up. For patients, more effective treatment was also obtained. Therefore, our study may have some guiding significance for the development of nursing work in the future. It is important to note that this study still has some limitations. The study was single-center, and the sample size was small. In addition, most of the critically ill patients were unconscious, and information on the subjective aspects of the patients was not collected. Therefore, further multicenter and large sample studies are still needed to further confirm the effectiveness of clinical nursing practice. Declarations Ethics approval and consent to participate The study followed the Declaration of Helsinki, and it was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University（SWYX:NO.2025-011）. Additionally, this project has been registered with the Evidence-Based Medicine Registration Center at Fudan University in China (Registration Number: ER20251372). Data collection was conducted after obtaining informed consent from all participants. Confidentiality measures were implemented prior to data analysis, including the removal of personal information. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding Chinese Medicine Science and Technology Project in Shandong Province(M2022214);Chinese Medicine Science and Technology Project in Shandong Province (M20243601) Authors' contributions Liu. Wang. and Zhang . were responsible for designing research protocols, collecting follow-up data, and drafting papers. Lv. and Fang. were responsible for researching the design proposal（table1）. Wang., Li., and Cheng. were responsible for follow-up data collection and analysis. Zheng. was responsible for research proposal design and thesis proofreading. Acknowledgements The authors seriously welcome the assistance and encouragement offered by Cardiac Surgery Intensive Care Unit of Shandong Provincial Hospital Affiliated to Shandong First Medical University. We also want to express our genuine appreciation to the patients, nurses and doctors who participated in this study, without whom it would not have been feasible to complete it. 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Development and Reliability/Validity Testing of a Knowledge-Attitude-Practice Scale for ICU Nurses in Preventing Unplanned Discontinuation of Continuous Renal Replacement Therapy [J]. Contemporary Nurse, 2024, 31(31): 80-85.. Lu, Z., et al., The Effectiveness of a Specialized Nursing Team Intervention in the Unplanned Interruption of Continuous Renal Replacement Therapy. Iran J Public Health, 2022. 51(3): p. 544-551. Xiaomei, X., et al., What influences interruption of continuous renal replacement therapy in intensive care unit patients: A review with meta-analysis on outcome variables. Nurs Crit Care, 2025. 30(3): p. e13179. Wang, X., et al., Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer. Medicine (Baltimore), 2020. 99(11): p. e19183. Zhang, Y., et al., Comparison of unplanned treatment interruption during CRRT in ICU patients under CVVH (pre + post dilution) or CVVHDF (post-dilution) mode: A retrospective cohort study. Nurs Crit Care, 2025. 30(2): p. e70025. Karkar, A. and C. Ronco, Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020. 10(1): p. 32. Yanting, Z., et al., Intervention measures to improve the filter life of continuous renal replacement therapy in critically ill patients-A systematic review. Nurs Crit Care, 2025. 30(4): p. e13225. Lemarie, P., et al., High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial. Anesth Analg, 2019. 129(1): p. 121-128. Table 1 and 2 Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1and2.docx Generalinformationquestionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Editor invited by journal 01 Apr, 2026 Reviewers agreed at journal 02 Jan, 2026 Reviewers agreed at journal 10 Oct, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers invited by journal 24 Sep, 2025 Editor assigned by journal 22 Sep, 2025 Submission checks completed at journal 22 Sep, 2025 First submitted to journal 22 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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INTRODUCTION","content":"\u003cp\u003eRenal impairment is a common complication in critically ill patients after cardiac surgery, which seriously affects the postoperative life safety of patients[1]. Continuous Renal Replacement Therapy (CRRT) is a general term for continuous, slow removal of water and solute treatment modalities. It can maintain the patient's renal function in vitro, and has now become one of the most important support measures in the treatment of various critical illnesses[2]unplanned interruption are dismounting events in which treatment is discontinued without completing the treatment goal or without reaching the planned time, and are an important indicator for evaluating the quality of CRRT. Relevant studies have shown that the rate of unplanned interruption can range from 17 to 74 percent[3]. Its emergence not only affects the recovery of patients' renal function but also increases the economic burden. Previous findings have demonstrated that nursing interventions are effective in reducing the chance of unplanned interruption in CRRT patients.[4].\u003c/p\u003e\u003cp\u003eHowever, the development of current nursing interventions mostly relies on traditional nursing experience and lacks evidence-based nursing practice[5]. Moreover, most of the related studies analyze the risk factors that may lead to their occurrence, and these have limited improvement in the quality of care[3]. Evidence-based nursing practice aims to promote quality of care by improving the scientific validity and reliability of interventions[6]. From the development of these more reliable interventions to their application in the clinical setting, they need to be supported by a scientific theoretical framework.\u003c/p\u003e\u003cp\u003eKnowledge to Action Framework(KTA) is one of the common theoretical frameworks for knowledge transformation. It consists of 2 stages: knowledge generation and knowledge application. Knowledge application consists of 6 steps: introducing knowledge into the local context, assessing barriers, developing interventions, applying knowledge, evaluating results, and sustaining knowledge application[7]. KTA provides a clear, concise, and actionable step-by-step guide for knowledge translation.\u003c/p\u003e\u003cp\u003eTherefore, with the guidance of KTA, this study aims to explore the impact of evidence-based nursing practice on the chance of unplanned interruption in critically ill CRRT patients.\u003c/p\u003e"},{"header":"2. OBJECTIVES","content":"\u003cp\u003eThe aim of this project was to improve CRRT management status in critically ill patients in the ICU of a tertiary hospital. The specific objectives were to:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDocument compliance with CRRT treatment for critically ill patients.\u003c/li\u003e\n \u003cli\u003eIdentify barriers and facilitators to compliance with evidence-based criteria regarding CRRT management status, as well as to develop and implement strategies to overcome areas of non-compliance.\u003c/li\u003e\n \u003cli\u003eEvaluate compliance with best practices following the implementation of improvement strategies.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"3. METHODS","content":"\u003cp\u003eThis project used the KTA Framework. The KTA framework is grounded in an audit and feedback process, along with a structured approach to the identification and management of barriers to compliance with recommended clinical practices. It consists of 2 phases:Knowledge Creation and Action Cycle.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 1:Knowledge Creation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefine evidence-based practice issues and establish an evidence-based practice team.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cardiac Surgical Intensive Care Unit (CSICU) has 24 beds and admits approximately 120 patients per month on average, with an annual average of 100 patients undergoing CRRT treatment. The project team identified critical care CRRT management as an issue within the CSICU, as the high discontinuation rate of CRRT not only increases the workload for clinical staff but also elevates patient hospitalization costs.\u003c/p\u003e\n\u003cp\u003eWe established a core stakeholder group to support the project. This group comprised clinicians, critical care nurses, hemodialysis nurses, research nurses, and evidence-based nursing specialists. The project team included a supervising nurse, a nurse educator, and six advanced practice nurses. The head nurse was responsible for project coordination, scheduling, and overall progress oversight. The Hemodialysis Nurse Educator developed the education plan and trained nurses. The Research Nurse handled data collection, provided feedback, developed strategies, and collaborated with other members to advance the work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study followed the Declaration of Helsinki, informed consent was obtained from all patients, and it was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University（SWYX:NO.2025-011）.Additionally, this project has been registered with the Evidence-Based Medicine Registration Center at Fudan University in China (Registration Number: ER20251372).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.1 Knowledge Inquiry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvidence retrieval according to the 6S model[8]，以\u0026nbsp;\u0026ldquo;continuous renal replacement therapy/continuous blood purification/continuous veno-venous hemofiltration/continuous veno-venous hemodialysis\u0026quot;\u0026quot;unplanned stop/filter life/filter failure\u0026quot;served as the Chinese and English keywords for retrieving relevant clinical practice guidelines, expert consensus statements, and systematic reviews from domestic and international sources. The search encompassed databases and websites including the International Guidelines Collaboration Network, the U.S. Guidelines Network, the Scottish Intercollegiate Guidelines Network, the JBI Database, PubMed, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Medical Network. The systematic search covered materials published up to September 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.2 Knowledge Synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo researchers independently evaluated, summarized, and extracted the best evidence from the included literature. The guideline employed the AGREE II assessment[9]. Evidence summaries and clinical decision-making traced back to original literature, with quality assessments conducted using the JBI Center for Evidence-Based Healthcare\u0026apos;s quality evaluation tools tailored to different study types based on the original literature\u0026apos;s classification. Systematic reviews were also quality-assessed using the JBI Center for Evidence-Based Healthcare\u0026apos;s systematic review tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.3 Knowledge Products\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 14 documents were ultimately included, comprising 5 clinical decision aids[10-14], 1 JBI recommended practice[15], 4 expert consensus statements[16-19], and 4 evidence summaries[20-23].The management of unplanned CRRT discontinuation in critically ill patients was divided into four sections, yielding a total of 29 best evidence statements. For evidence derived from guidelines, the recommended evidence level and strength were directly adopted. For evidence from evidence summaries and clinical judgments, the task force members conducted a retrospective review of the original texts and applied the JBI Evidence Pre-grading System to grade the evidence and determine the strength of recommendation, as detailed in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 2:Action Cycle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.1 Identify gaps between best evidence and clinical practice:Develop optimal evidence review indicators and determine review methods, see Table1.\u003c/strong\u003e The three indicators with the lowest implementation rates prior to evidence-based practice review were indicators 13, 14, and 19.The baseline review was conducted between September 2024 to February 2025.A total of 45 CRRT patients and 61 healthcare workers were included.All data were obtained with informed patient consent.\u003c/p\u003e\n\u003cp\u003ePatient inclusion criteria:①patient age\u0026ge;18 years;②\u0026nbsp;patients meet the appropriate indications for CRRT;③patients have informed consent to the study. Exclusion criteria:①patients with disseminated intravascular coagulation;②patients who underwent CRRT during the tandem extracorporeal membrane pulmonary oxygen contract;③patients who terminated CRRT due to death;④patients who suspended or terminated CRRT due to equipment malfunctions or the need to go out to perform therapeutic examinations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical and nursing staff inclusion criteria: ① working experience \u0026ge; 1 year; ② obtain the admission qualification of the intensive care unit (ICU); ③ obtain the appropriate informed consent. Exclusion criteria: ① Excluding nurses who went out for support, further training, or vacation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.2Apply knowledge to specific scenarios, evaluate barriers and facilitators, and specify corresponding interventions.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEvidence is contextualized within clinical scenarios: the FAME framework (Feasibility-F, Appropriateness-A, Meaningfulness-M, Effectiveness-E) was applied to assess evidence feasibility, appropriateness, clinical significance, and effectiveness. Concurrently, we analyze both facilitating and impeding factors. Based on baseline review findings, we systematically assess compliance rates against baseline review criteria. This involves a comprehensive analysis of barriers and enablers to evidence application at the organizational, practitioner, and patient levels(see Table 2).The team ultimately discussed incorporating all the best evidence into clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.3 Monitor Knowledge Use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eConduct another baseline review between March to September 2025. The measurement scope will be identical to the previous baseline review. During the evidence-based practice phase, a total of 889 patients were enrolled, with 45 CRRT patients meeting the inclusion criteria. Following the implementation of evidence-based practices, all patient indicators showed corresponding improvements, particularly Review Indicators 13, 14, and 19. Specific details are presented in Table 4\u003c/p\u003e\n\u003cp\u003e3.4 \u003cstrong\u003eEvaluate Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.4.1 General information questionnaire: Includes general information questionnaires for health-care workers and patients. The general information questionnaire for medical and nursing staff included years of work experience, education, title, and so on. The general information questionnaire for patients included gender, age, weight, ventilator use time, 24 h of blood flow, total blood flow, and so on. The general information questionnaire was designed by the researchers themselves; see the supplementary materials for details.\u003c/p\u003e\n\u003cp\u003e3.4.2 CRRT unplanned interruption rate: Rate of unplanned interruption during CRRT = number of unplanned interruptions/total number of CRRT treatments performed during the period \u0026times; 100%. The criteria for unplanned interruption in this study: ① blood clot blocking the extracorporeal circulation device, resulting in blood flow not being able to pass through; ② transmembrane pressure \u0026gt;300mmHg (1mmHg=0.133kPa); ③ blood pump stopping; ④ filter clotting grade Ⅱ or above; ⑤ various alarms can not be eliminated, resulting in downtime. If any of the above conditions are met, the machine can be shut down unplanned. Among them, the filter coagulation grade is evaluated concerning the relevant contents in the \u0026ldquo;Blood Purification Treatment Standard Manual\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e3.4.3 Medical and nursing review indicator implementation rate: Medical and nursing review indicator implementation rate = number of correct implementations/total number of implementations x 100%.\u003c/p\u003e\n\u003cp\u003e3.4.4 Score of the Questionnaire on Knowledge, Belief and Behavior for Prevention of unplanned interruption of Continuous Renal Replacement Therapy for Medical Personnel: The Questionnaire on Knowledge, Belief and Behavior for Prevention of Unplanned Downstream of Continuous Renal Replacement Therapy for Medical Personnel, developed by Yu,et al [24] 2024, was used. The questionnaire includes three dimensions of knowledge (11 entries), attitude (11 entries), and behavior (11 entries), with a total of 37 entries. In this study, Cronbach\u0026apos;s alpha coefficient was 0.864 with good reliability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.4.5 Patient treatment-related time: time of individual filter use, time of line use.\u003c/p\u003e\n\u003cp\u003e3.4.6 Occurrence of patient complications: nausea, vomiting, hypotension, muscle cramps, and fever.\u003c/p\u003e\n\u003cp\u003e3.4.7 Information collection and data analysis\u003c/p\u003e\n\u003cp\u003eData collection: online questionnaire data were collected from medical personnel before and after the training using a convenience sampling method, which was set to allow each IP address to be filled out only once. Patients\u0026apos; general information was filled in by the duty nurse, and was collected before and after the implementation of evidence-based nursing care, and the duty nurse was trained uniformly by the research nurse before collection. Indicator review was conducted by the research nurse and the quality control nurse every morning and afternoon for on-site observation, questionnaire survey, and inquiry record.\u003c/p\u003e\n\u003cp\u003eAnalysis was performed using SPSS 23.0 software. Continuous variables were tested for normality using the Kolmogorov-Smirnov test. Normally distributed variables were expressed as mean\u0026plusmn;standard deviation (x\u0026plusmn;s). Between-group comparisons were performed using independent samples t-tests and one-way ANOVA (with LSD post-hoc tests for pairwise comparisons when variances were equal; Tamhane\u0026apos;s T\u003csup\u003e2\u003c/sup\u003e method for pairwise comparisons when variances were unequal). Continuous variables with skewed distributions were expressed as median (interquartile range) [M (Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)]. Intergroup comparisons were performed using the Mann-Whitney U test and Kruskal-Wallis H test. Categorical variables were expressed as rates (%). Analysis was conducted using the chi-square test. A \u003cem\u003eP\u003c/em\u003e value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"4. RESULTS","content":"\u003cp\u003eStudy Design and Sample This study employed a non-concurrent controlled design with purposive sampling. It was conducted in the cardiac surgery intensive care unit of a large tertiary hospital in Jinan City, Shandong Province, China.\u003c/p\u003e\n\u003cp\u003e3.1 Basic information on patients and healthcare professionals\u003c/p\u003e\n\u003cp\u003eA total of 61 medical personnel were included, aged 28.98 \u0026plusmn; 7.404 years.14 males (22.95%) and 47 females (77.05%).3 (2, 14.5) years of work experience. The distribution of educational qualifications is 1 (1.64 %) doctorate, 7 (11.48 %) master\u0026apos;s degrees, and 53 (86.89%) bachelor\u0026apos;s degrees. 8 (8.20%) at the senior level, 17 (27.87 %) at the intermediate level, and 39 (63.93%) at the junior level. Collected 58 patient questionnaires before and after the implementation of evidence-based care in each group, including 27 before practice and 31 after practice. The difference between the general information of patients in the two groups was not statistically significant and comparable; the details are shown in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3 Comparison of patients\u0026apos; general information between the two groups before and after practice\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eclinical information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePre-Evidence-Based Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAfter evidence-based practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003estatistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003egender（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.055\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eage（year,x\u0026plusmn;s）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e56.29\u0026plusmn;13.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e61.22\u0026plusmn;13.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.367\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eweight（kg,x\u0026plusmn;s）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e71.46\u0026plusmn;15.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e68.89\u0026plusmn;15.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.371\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eVentilator duration（h,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)]）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e26.00（13.50,112）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e26.00（11.50,84.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-0.343\u003csup\u003e③\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eICU hours（h,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)]）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e114.00（62.00,279.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e92.00(63.00,186.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-0.634\u003csup\u003e③\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e24h diversion of traffic（ml,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)]）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e550.00(335.00,850.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e550.00(365.00,840.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-0.315\u003csup\u003e③\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eAPACHE Ⅱscore(score,x\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e9.37\u0026plusmn;1.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e9.32\u0026plusmn;1.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.263\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eabbreviations: ① is t-test, ② is Mann-Whitney U-test, and ③ is X\u0026sup2; test.\u003c/p\u003e\n\u003cp\u003e3.2 Implementation rate of health-care worker review indicators\u003c/p\u003e\n\u003cp\u003eThe total number of inspections by healthcare professionals before and after evidence-based practice was 385, of which 192 were before practice and 193 were after practice. The overall review indicator implementation rate for healthcare professionals was 80.11% before evidence-based practice and 94.07% after practice (\u0026chi;\u003csup\u003e2\u003c/sup\u003e =267.409, \u003cem\u003ep\u003c/em\u003e \u0026lt;0.05), as detailed in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of review rate of implementation of group standards implementation rate\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003esports event\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePre-evidence-based practice\u003c/p\u003e\n \u003cp\u003eNumber of inspections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eAfter evidence-based practice\u003c/p\u003e\n \u003cp\u003eNumber of inspections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003ePre-evidence-based practice（sequence/%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eAfter evidence-based practice（sequence/%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e177（89.58）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e178（92.28）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e155（80.73）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e179（92.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e12.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e154（80.21）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e176（91.19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e132（68.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e177（91.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e32.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e190（98.96）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e190（98.46）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e178（92.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e188（97.41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e141（73.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e188（97.41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e44.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e167（86.98）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e186（96.37）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e147（76.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e190（98.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e42.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e113（58.85）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e177（91.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e55.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e120（62.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e174（90.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e40.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e176（91.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e186（96.37）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e162（84.38）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e189（97.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e21.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e158（82.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e165（85.49）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e163（84.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e189（97.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e20.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e128（66.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e173（89.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e29.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eabbreviations: \u0026quot;NA\u0026quot; means that the indicator under review is not applicable.\u003c/p\u003e\n\u003cp\u003e3.3 Clinical outcome indicators\u003c/p\u003e\n\u003cp\u003eProlonged use of individual filters in patients after evidence-based practice, from 18h before practice to 23h after practice. The complication rate decreased by 27%. Unplanned interruption rate decreased from 53% to 20%. Increased score on the Knowledge, Belief and Behavior Questionnaire for Prevention of Unplanned Downstaging of Continuous Renal Replacement Therapy in healthcare workers (total score improved from 109.95\u0026plusmn;29.20 to 175.02\u0026plusmn;4.56. Knowledge dimension improved from 49.09\u0026plusmn;16.84 to 82.72\u0026plusmn;2.726. belief dimension from 26.90\u0026plusmn;6.304 to 39.21\u0026plusmn;1.181. behavioral aspects from 33.97\u0026plusmn;7.613 to 53.09\u0026plusmn;2.922), and the difference between the two groups was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) when comparing the two groups, see Table 5.\u003c/p\u003e\n\u003cp\u003eTable 5 Comparison of clinical outcome indicators of patients and healthcare workers between the two groups before and after practice\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003etarget\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003ePre-Evidence-Based Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eAfter evidence-based practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003estatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eIndividual filter use time(h,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e18（12，24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e23（20，26）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e12347\u003csup\u003e③\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003ePatient complication occurrence(%,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e79（41.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e52（26.94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e8.649\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eCRRT Unplanned Interruption Rate(%,[M(Q\u003csub\u003eL\u003c/sub\u003e, Q\u003csub\u003eU\u003c/sub\u003e)])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e53（27.60）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e20（10.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e18.620\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eScore on the Knowledge, Belief and Conduct Questionnaire for Healthcare Professionals to Prevent Unplanned Interruption of Continuous Renal Replacement Therapy (CRRT)(x\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eknowledge dimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e49.09\u0026plusmn;16.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e82.72\u0026plusmn;2.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e63.983\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003ebelief dimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e26.90\u0026plusmn;6.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e39.21\u0026plusmn;1.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e56.463\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003ebehavioral dimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e33.97\u0026plusmn;7.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e53.09\u0026plusmn;2.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e14.435\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eTotal Score of Knowing, Believing and Doing Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e109.95\u0026plusmn;29.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e175.02\u0026plusmn;4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e60.973\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eabbreviations: ① is t-test, ② is Mann-Whitney U-test, and ③ is X\u0026sup2; test.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWith the continuous development of the nursing discipline, the scientific nature of nursing practice is increasingly emphasized. The development of evidence-based nursing practice has largely contributed to the improvement of nursing quality. The quality of nursing care may directly affect the unplanned under-chance of CRRT patients.[25]\u0026nbsp;It can be seen that evidence-based nursing practice may be of great significance to CRRT patients.\u003c/p\u003e\n\u003cp\u003eCRRT can reduce the burden on the kidneys of critically ill patients by replacing their renal function in vitro, and promote functional recovery. It is an important therapeutic means to save the lives of critically ill patients. In recent years, an increasing number of studies have reported unplanned interruption of CRRT patients. Unplanned interruption not only affects the outcome of critically ill patients but also leads to unnecessary financial burdens for patients. It also increases the risk of infection and death.[26]. Nursing workers are the direct caregivers of patients during CRRT. The quality of care they provide is closely related to the success of CRRT and patient safety. Evidence-based nursing practice is the integration of relevant scientific nursing evidence with nursing experience and patient-specific conditions to form protocols and apply them to clinical settings, which play an important role in improving the quality of care and clinical outcomes for patients. Past research has demonstrated that evidence-based nursing practice is effective in improving the quality of care and has a positive impact on patient health.[27] Therefore, the evidence-based nursing practice of preventing unplanned interruption in critically ill CRRT patients was constructed and conducted in this study. This is important for improving the quality of care for CRRT patients and reducing the incidence of unplanned interruptions.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that filter lifetime may have a direct relationship with the probability of unplanned interruption in patients.[28]\u0026nbsp;The level of erythrocytes, albumin, and other formed components in the patient\u0026apos;s blood increases after CRRT. This leads to an increase in transmembrane pressure, an increase in the probability of filter pore clogging, a decrease in filter life, and an increase in the probability of unscheduled downtime.[29]\u0026nbsp;The results of this study showed that the duration of individual filter use in patients was extended from 18h to 23h after evidence-based practice. It can be seen that evidence-based nursing practice can have a favorable impact on patients\u0026apos; blood component levels and effectively prolong the life of filters. Interestingly, a recent study[30]\u0026nbsp;has also suggested that an individualized anticoagulation regimen may reduce patients\u0026apos; shortened filter life due to coagulation problems. It is undeniable that evidence-based nursing practice can facilitate the implementation of such individualized protocols to some extent. In the present study, there was a significant reduction in the complication rate in the practice group. Unplanned interruptions are a common adverse event during CRRT in critically ill patients, and relevant studies have shown that the incidence can be as high as 74%. In this study, the pre-practice unplanned interruption rate was 53%, which is still at a high level. The intervention group had a 33% lower rate of unplanned interruption after the implementation of an evidence-based care program compared to the control group. Earlier studies have confirmed that systematic and scientific training can increase nurses\u0026apos; knowledge base about CRRT, which can improve nurses\u0026apos; awareness and ability to prevent adverse events from occurring.[31]\u0026nbsp;All of these results demonstrate the effectiveness of evidence-based nursing practice in reducing the chances of unplanned interruption in CRRT patients.\u003c/p\u003e\n\u003cp\u003eMeanwhile, our study evaluated the knowledge-attitude-practice scores of nursing workers based on knowledge-attitude-practice theory before and after the development of evidence-based nursing practice. The results showed that the knowledge, belief, and behavior scores of the nursing workers concerned were substantially improved after the evidence-based nursing practice. This may be due to the systematic and scientific training carried out for them prior to the practice. This may have enhanced the level of awareness and knowledge acquisition of the caregivers to a great extent and helped them to develop good beliefs. It is worth mentioning that this study is based on the KTA theoretical framework to rigorously implement the review indicators throughout the process of practice program implementation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, the results of this study confirm that evidence-based nursing practice can prolong filter life and avoid complications, and is effective in reducing the chance of unplanned interruption in critically ill CRRT patients. This is important for improving the prognosis of patients. It is evident that evidence-based nursing practice can be further applied in clinical work. Evidence-based care is the development of individualized care plans based on scientific evidence, nursing experience, and patient-specific conditions. Evidence-based practice, on the other hand, facilitates the implementation of nursing programs in clinical work. This facilitates the translation of nursing theory into clinical practice, providing more guidance for clinical work and making it more scientific and reliable. Moreover, this study uses KTA theory as a guiding framework to further standardize the overall process of practice implementation for follow-up. For patients, more effective treatment was also obtained. Therefore, our study may have some guiding significance for the development of nursing work in the future.\u003c/p\u003e\n\u003cp\u003eIt is important to note that this study still has some limitations. The study was single-center, and the sample size was small. In addition, most of the critically ill patients were unconscious, and information on the subjective aspects of the patients was not collected. Therefore, further multicenter and large sample studies are still needed to further confirm the effectiveness of clinical nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study followed the Declaration of Helsinki, and it was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University（SWYX:NO.2025-011）. Additionally, this project has been registered with the Evidence-Based Medicine Registration Center at Fudan University in China (Registration Number: ER20251372). Data collection was conducted after obtaining informed consent from all participants. Confidentiality measures were implemented prior to data analysis, including the removal of personal information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChinese Medicine Science and Technology Project in Shandong Province(M2022214);Chinese Medicine Science and Technology Project in Shandong Province (M20243601)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiu. Wang. and Zhang . were responsible for designing research protocols, collecting follow-up data, and drafting papers. Lv. and Fang. were responsible for researching the design proposal（table1）. Wang., Li., and Cheng. were responsible for follow-up data collection and analysis. Zheng. was responsible for research proposal design and thesis proofreading.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors seriously welcome the assistance and encouragement offered by Cardiac Surgery Intensive Care Unit of Shandong Provincial Hospital Affiliated to Shandong First Medical University. We also want to express our genuine appreciation to the patients, nurses and doctors who participated in this study, without whom it would not have been feasible to complete it.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMohrag, M., et al., Risk Factors and Outcomes of Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Single-Center Study. J Clin Med Res, 2024. 16(7-8): p. 375-380.\u003c/li\u003e\n\u003cli\u003eRonco, C. and T. Reis, Continuous renal replacement therapy and extended indications. Semin Dial, 2021. 34(6): p. 550-560.\u003c/li\u003e\n\u003cli\u003eXiaomei, X., et al., What influences interruption of continuous renal replacement therapy in intensive care unit patients: A review with meta-analysis on outcome variables. Nurs Crit Care, 2025. 30(3): p. e13179.\u003c/li\u003e\n\u003cli\u003eYu, H., et al., Effects of nursing intervention based on feedforward control on preventing unplanned interruption during continuous renal replacement therapy. Minerva Surg, 2023. 78(4): p. 462.\u003c/li\u003e\n\u003cli\u003eNeyra, J.A. and K. Kashani, Improving the quality of care for patients requiring continuous renal replacement therapy. Semin Dial, 2021. 34(6): p. 501-509.\u003c/li\u003e\n\u003cli\u003eFriesen-Storms, J.H., et al., Systematic implementation of evidence-based practice in a clinical nursing setting: a participatory action research project. J Clin Nurs, 2015. 24(1-2): p. 57-68.\u003c/li\u003e\n\u003cli\u003eTorres, C.P., F.J. Mendes and M. Barbieri-Figueiredo, Use of \u0026quot;The Knowledge-to-Action Framework\u0026quot; for the implementation of evidence-based nursing in child and family care: Study protocol. PLoS One, 2023. 18(3): p. e0283656.\u003c/li\u003e\n\u003cli\u003eAlper, BS, Haynes, RB. EBHC pyramid 5.0 for accessing preappraised evidence and guidance. Evid Based Med. 2016, 21(4):123-125. \u003c/li\u003e\n\u003cli\u003eMCLAUGHLIN K,FOUREUR M,JENSEN ME,et al.Review and appraisal of guidelines for the management of asthma during pregnancy.[J].Women and birth : journal of the Australian College of Midwives,2018,31(6):e349-e357.\u003c/li\u003e\n\u003cli\u003eWang Chunqing, Hu Yan. JBI Evidence Pre-classification and Evidence Recommendation Level System (2014 Edition) [J]. Journal of Nurse Training, 2015, (11): 964-967.\u003c/li\u003e\n\u003cli\u003eGOLPER TA.Continuous kidney replacement therapy in acute kidney injury[EB/OL]https://www.uptodate.com/contents/continuous-kidney-replacement-therapy-in-acute-kidney-injury\u003c/li\u003e\n\u003cli\u003eBANDER SJ.Central venous catheters for acute and chronic hemodialysis access and their management[EB/OL]https://www.uptodate.com/contents/central-venous-catheters-for-acute-and-chronic-hemodialysis-access-and-their-management\u003c/li\u003e\n\u003cli\u003eSABADOJJ.Basic principles of ultrasound-guided venous access[EB/OL]http://www--uptodate--cn--https.uptodatecn.slyy.qfclo.com:2222/contents/basic-principles-of-ultrasound-guided-venous-access\u003c/li\u003e\n\u003cli\u003eDAVENPORT A.Anticoagulation for continuous kidney replacement therapy[EB/OL]http://www--uptodate--cn--https.uptodatecn.slyy.qfclo.com:2222/contents/anticoagulation-for-continuous-kidney-replacement-therapy\u003c/li\u003e\n\u003cli\u003eMATHEW S.Continuous renal replacement therapy:regional citrate anticoagulation[EB/OL]\u003c/li\u003e\n\u003cli\u003eExpert Panel of the Chinese Society of Nephrology. Guidelines for Anticoagulation Management in Continuous Renal Replacement Therapy [J]. Chinese Journal of Nephrology, 2022, 38(11): 1016-1024.\u003c/li\u003e\n\u003cli\u003eChinese Critical Care Hemodialysis Collaborative Group. Chinese Expert Consensus on the Establishment and Application of Vascular Access for Critical Care Hemodialysis (2023) [J]. Chinese Medical Journal, 2023, 103(17): 1280-1295.\u003c/li\u003e\n\u003cli\u003eChinese Critical Care Hemodialysis Collaborative Group, Nursing Subcommittee of the Chinese Critical Care Hemodialysis Collaborative Group. Chinese Expert Consensus on Critical Care Hemodialysis Nursing (2021) [J]. Chinese Journal of Modern Nursing, 2021, 27(34): 4621-4632.\u003c/li\u003e\n\u003cli\u003eChinese Nursing Association Venous Infusion Therapy Professional Committee. Expert Consensus on Clinical Venous Catheter Maintenance Procedures [J]. Chinese Journal of Nursing, 2019, 54(9): 1334-1342.\u003c/li\u003e\n\u003cli\u003eYang Jianguo, He Xifei, Yan Jianjun, et al. Summary of Optimal Evidence for Prevention and Management of Extracorporeal Circulatory Coagulation in Heparin-Free Continuous Renal Replacement Therapy [J]. Journal of Nursing Science, 2022, 29(10): 54-59.\u003c/li\u003e\n\u003cli\u003eXu Weiwei, Liu Xin, Zhang Xuan, et al. Evidence-Based Recommendations for Anticoagulation Management in Patients Undergoing Maintenance Hemodialysis [J]. Journal of Nursing Education, 2021, 37(14): 1255-1261.\u003c/li\u003e\n\u003cli\u003eJiang Yanhua, Xing Weijie, Zhou Xingmei, et al. Summary of best evidence for central venous catheter maintenance in patients on continuous renal replacement therapy[J]. Journal of Nurse Advancement, 2021,36(6):533-539.\u003c/li\u003e\n\u003cli\u003eZhang Jie, Bu Jingjing, Gao Peng, et al. Summary of Optimal Evidence for Preventing Unplanned Disconnection During Continuous Renal Replacement Therapy Management [J]. Military Nursing, 2024, 41(06): 103-107.\u003c/li\u003e\n\u003cli\u003eYu Jing, Sun Zhongwen, Jiu Zhaohua, et al. Development and Reliability/Validity Testing of a Knowledge-Attitude-Practice Scale for ICU Nurses in Preventing Unplanned Discontinuation of Continuous Renal Replacement Therapy [J]. Contemporary Nurse, 2024, 31(31): 80-85..\u003c/li\u003e\n\u003cli\u003eLu, Z., et al., The Effectiveness of a Specialized Nursing Team Intervention in the Unplanned Interruption of Continuous Renal Replacement Therapy. Iran J Public Health, 2022. 51(3): p. 544-551.\u003c/li\u003e\n\u003cli\u003eXiaomei, X., et al., What influences interruption of continuous renal replacement therapy in intensive care unit patients: A review with meta-analysis on outcome variables. Nurs Crit Care, 2025. 30(3): p. e13179.\u003c/li\u003e\n\u003cli\u003eWang, X., et al., Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer. Medicine (Baltimore), 2020. 99(11): p. e19183.\u003c/li\u003e\n\u003cli\u003eZhang, Y., et al., Comparison of unplanned treatment interruption during CRRT in ICU patients under CVVH (pre\u0026thinsp;+\u0026thinsp;post dilution) or CVVHDF (post-dilution) mode: A retrospective cohort study. Nurs Crit Care, 2025. 30(2): p. e70025.\u003c/li\u003e\n\u003cli\u003eKarkar, A. and C. Ronco, Prescription of CRRT: a pathway to optimize therapy. Ann Intensive Care, 2020. 10(1): p. 32.\u003c/li\u003e\n\u003cli\u003eYanting, Z., et al., Intervention measures to improve the filter life of continuous renal replacement therapy in critically ill patients-A systematic review. Nurs Crit Care, 2025. 30(4): p. e13225.\u003c/li\u003e\n\u003cli\u003eLemarie, P., et al., High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial. Anesth Analg, 2019. 129(1): p. 121-128.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1 and 2","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Evidence-based nursing practice procedures, Continuous Renal Replacement Therapy, unplanned interruption, knowledge to action framework","lastPublishedDoi":"10.21203/rs.3.rs-7559230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7559230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackgrund:\u003c/h2\u003e\u003cp\u003eRenal impairment is a common complication in critically ill patients after cardiac surgery, and Continuous Renal Replacement Therapy (CRRT) is the primary treatment.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e\u003cp\u003eThis study used the Knowledge to Action Framework(KTA) to explore the impact of an evidence-based nursing practice protocol on single filter longevity, complications, and the chance of unplanned interruption in critically ill CRRT patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis was a non-simultaneous controlled study and included 61 medical personnel and 90 patients. 45 pre-practice and 45post-practice patients were divided into control and intervention groups. The evidence-based practice program was developed by the evidence-based nursing process, and the best evidence application strategy was constructed based on the KTA framework for clinical practice change at the development organization level, practice level, and patient level. The knowledge, trust and behavior scores of medical personnel were analyzed before and after the evidence-based practice, and the filter life span, complication rate, and unplanned interruption rate of patients between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBefore the evidence-based intervention, there was no difference in the comparison of patients' basic information between the two groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After the evidence-based intervention, the patients' individual filter service life was significantly prolonged (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the complication rate was significantly reduced (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). The intervention group had a lower chance of unplanned CRRT than the control group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The scores of medical personnel's knowledge, trust and behavior were all higher than before the intervention (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEvidence-based nursing practice prolongs the life of individual filters in critically ill CRRT patients, reduces complication rates, and can prevent unplanned interruption with good clinical validity.\u003c/p\u003e","manuscriptTitle":"Prevention of unplanned interruption in critically ill continuous renal replacement therapy patients:a best practice implementation project","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 22:11:03","doi":"10.21203/rs.3.rs-7559230/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2026-04-01T09:14:23+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"202565609659398154717229034942700050094","date":"2026-01-03T03:31:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55272054901038299053284021871943971583","date":"2025-10-11T00:14:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2693181708619571692364230769171785947","date":"2025-09-24T10:24:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-24T04:23:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-22T11:32:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-22T10:44:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-09-22T09:28:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65632686-d44b-4e1a-a704-50fdfde55eb7","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T22:11:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-06 22:11:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7559230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7559230","identity":"rs-7559230","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}