Barriers to the Implementation of Practice Guidelines in Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Qualitative Approach

Hayes, Sean M.; Murray, Suzanne; Dupuis, Martin; Dawes, Martin; Hawes, Ian A.; Barkun, Alan N.

doi:10.1155/2010/878135

Cited by 24 publications

(24 citation statements)

References 50 publications

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“…7–9 Furthermore, our findings are supported by implementation studies of other interprofessional protocols identifying policy and protocol factors such as unclear role responsibilities, timing for protocol completion, and challenges learning complex protocols as barriers to successful implementation. 17,18 …”

Section: Discussionmentioning

confidence: 99%

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Boehm¹,

Vasilevskis²,

Dietrich³

et al. 2017

Am J Crit Care

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Background The ABCDE interprofessional bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility) reduces delirium and weakness in critically ill patients, but bundle uptake is limited. Objective To understand the relationship between organizational domains and provider attitudes. Methods One-time electronic survey in ten ICUs across the country to examine associations between organizational domains of a) policy/protocol factors (protocol attributes, role clarity, training/understanding), b) unit milieu (coordination, peer advocates, teamwork), c) tasks (autonomy, time demands), d) labor quality (competence), e) labor quantity (sufficient staff), and f) physical environment (unit layout, supplies/equipment) with provider attitudes of a) perceived ease of completion, b) perceived safety, c) confidence, and d) perceived strength of evidence regarding the ABCDE bundle. Interprofessional participants must have worked ≥4 shifts/month (N=315). We used Spearman (rs) correlations to examine the associations between organizational domain and provider attitude subscales. Spearman ≥.32 was considered clinically significant. Results Protocol attributes (rs=0.37–0.58), role clarity (rs=0.38–0.59), training/understanding (rs=0.33–0.46), coordination (rs=0.32–0.46), and peer advocates (rs=0.37–0.48) were associated with less difficulty performing the bundle and better confidence, perceived safety and strength of evidence. Participants also reported less difficulty carrying out the bundle when the team works well together. Task autonomy was associated with better perceived safety (rs=0.35) and confidence (rs=0.47) related to the bundle. Conclusions There are organizational domains that positively influence provider attitudes. Policy and protocol factors, unit milieu, and task autonomy have the strongest associations with provider attitudes. Focusing interventions on these particular organizational domains may facilitate ABCDE bundle uptake.

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Section: Discussionmentioning

confidence: 99%

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Boehm¹,

Vasilevskis²,

Dietrich³

et al. 2017

Am J Crit Care

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show abstract

“…No systematic investigation of why such patients are admitted has been undertaken. Several previous studies ▶ have examined barriers to, and attempted to improve, adherence to practice guidelines recommending the use of risk scores for UGIB [24,25]. These studies were focused at practitioner rather than patient level factors.…”

Section: Discussionmentioning

confidence: 99%

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2017

Endosc Int Open

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“…Durante el ingreso solo en el 25% de centros el responsable directo de la atención al enfermo es el especialista de aparato digestivo: ello se ha comprobado que puede influir en la aplicación correcta de los recursos terapéuticos marcados por las guías clínicas 12,13 .…”

Section: Discussionunclassified

Asistencia urgente a los pacientes con hemorragia digestiva alta en los hospitales comarcales catalanes

Cerezo¹,

Tatros²,

Mombiela³

et al. 2011

Gastroenterología y Hepatología

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Barriers to the Implementation of Practice Guidelines in Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Qualitative Approach

Cited by 24 publications

References 50 publications

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Untitled

Asistencia urgente a los pacientes con hemorragia digestiva alta en los hospitales comarcales catalanes

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