Factors influencing long-term adherence to two previously implemented hospital guidelines.

OBJECTIVE AND SETTING After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence. DESIGN AND PARTICIPANTS A fluid balance guideline (FBG) and body temperature guideline (BTG) were developed and implemented in our hospital in 2000. Long-term adherence was determined retrospectively based on data from patient files. Focus groups were launched to explore nurses' perceptions of barriers and facilitators regarding long-term adherence. The predominant themes from the nurses' focus groups were posed to clinicians in questionnaires. RESULTS Nurses involved in the FBG (overall adherence 100%) stated that adherence has immediate advantages in terms of safety and a gain in time. Nurses and oncologists acted unanimously which was thought to enhance adherence. On the other hand, opinions differed on the BTG within the nursing teams and medical staff (overall adherence 50%). Although the guideline discourages routine postoperative body temperature measurements, temperature should be measured according to the guideline in a considerable number of cases due to changes in patient characteristics since the year 2000. Therefore, adherence was judged to be rather complex. CONCLUSIONS To secure adherence to hospital guidelines after their successful implementation, guidelines should preferably be comprehensive in terms of being applicable to the majority of the patients in that particular setting and to the most common clinical situations. All healthcare professionals involved should be aware of its immediate benefits for themselves or to their patients.

[1]  Jane M. Young,et al.  Audit and feedback: effects on professional practice and healthcare outcomes. , 2012, The Cochrane database of systematic reviews.

[2]  Elena Parmelli,et al.  Local opinion leaders: effects on professional practice and health care outcomes. , 2011, The Cochrane database of systematic reviews.

[3]  B. Allegranzi,et al.  Role of hand hygiene in healthcare-associated infection prevention. , 2009, The Journal of hospital infection.

[4]  K. Grimmer-Somers,et al.  The effectiveness of clinical guideline implementation strategies--a synthesis of systematic review findings. , 2008, Journal of evaluation in clinical practice.

[5]  A. Gurses,et al.  Systems ambiguity and guideline compliance: a qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections , 2008, Quality & Safety in Health Care.

[6]  Anke J. E. de Veer,et al.  Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review , 2008, BMC Medical Informatics Decis. Mak..

[7]  R. Grol,et al.  Systematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases , 2008, Vascular health and risk management.

[8]  P. Bossuyt,et al.  Physicians and Nurses Focus on Different Aspects of Guidelines When Deciding Whether to Adopt Them: An Application of Conjoint Analysis , 2008, Medical decision making : an international journal of the Society for Medical Decision Making.

[9]  J. Ploeg,et al.  Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. , 2007, Worldviews on evidence-based nursing.

[10]  S. Simoens,et al.  Implementing a hospital guideline on pneumonia: a semi-quantitative review. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[11]  A D Oxman,et al.  Educational outreach visits: effects on professional practice and health care outcomes. , 2007, The Cochrane database of systematic reviews.

[12]  P. Bampton,et al.  Achieving long‐term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in Australia , 2007, International journal of clinical practice.

[13]  E. Peterson,et al.  Patterns of guideline adherence and care delivery for patients with unstable angina and non-ST-segment elevation myocardial infarction (from the CRUSADE Quality Improvement Initiative). , 2006, The American journal of cardiology.

[14]  M. Whitby,et al.  Why Healthcare Workers Don't Wash Their Hands: A Behavioral Explanation , 2006, Infection Control & Hospital Epidemiology.

[15]  Luke Vale,et al.  Toward evidence-based quality improvement , 2006 .

[16]  Luke Vale,et al.  Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. , 2006, Journal of general internal medicine.

[17]  A D Oxman,et al.  Audit and feedback: effects on professional practice and health care outcomes. , 2006, The Cochrane database of systematic reviews.

[18]  S Michie,et al.  Words matter: increasing the implementation of clinical guidelines , 2005, Quality and Safety in Health Care.

[19]  I. Ray-Coquard,et al.  Persistence of medical change at implementation of clinical guidelines on medical practice: a controlled study in a cancer network. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  P. Speelman,et al.  Diagnostic accuracy of routine postoperative body temperature measurements. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  Trevor A Sheldon,et al.  What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews , 2004, BMJ : British Medical Journal.

[22]  A. Nelson,et al.  Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence. , 2004, Journal of evaluation in clinical practice.

[23]  Michel Wensing,et al.  What drives change? Barriers to and incentives for achieving evidence‐based practice , 2004, The Medical journal of Australia.

[24]  J. Borkan.  Mixed Methods Studies: A Foundation for Primary Care Research , 2004, The Annals of Family Medicine.

[25]  J. Grimshaw,et al.  From best evidence to best practice: effective implementation of change in patients' care , 2003, The Lancet.

[26]  A. Semin-Goossens,et al.  Monitoring Hyperhydration during High-Dose Chemotherapy: Body Weight or Fluid Balance? , 2003, Acta Haematologica.

[27]  Kimberly D. McCoy,et al.  Organizational Predictors of Adherence to Ambulatory Care Screening Guidelines , 2002, Medical care.

[28]  Graeme MacLennan,et al.  Attributes of clinical recommendations that influence change in practice following audit and feedback. , 2002, Journal of clinical epidemiology.

[29]  I D Graham,et al.  The management of hypertension in Canada: a review of current guidelines, their shortcomings and implications for the future. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[30]  P. Sandercock,et al.  Framework for design and evaluation of complex interventions to improve health , 2000, BMJ : British Medical Journal.

[31]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.

[32]  N. Cullum,et al.  Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations. , 1998, Quality in health care : QHC.

[33]  Siep Thomas,et al.  Attributes of clinical guidelines that influence use of guidelines in general practice: observational study , 1998, BMJ.

[34]  R. Grol,et al.  Personal paper: Beliefs and evidence in changing clinical practice , 1997 .

[35]  A D Oxman,et al.  No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[36]  J. Kitzinger,et al.  Qualitative Research: Introducing focus groups , 1995 .

[37]  Janet Mancini Billson,et al.  Focus Groups: A Practical Guide for Applied Research , 1989 .

[38]  David L. Morgan,et al.  Focus groups: A new tool for qualitative research , 1984 .