Perceived facilitators and barriers to clinical clearance of the cervical spine by emergency department nurses: A major step towards changing practice in the emergency department

Clement, Catherine M.; Stiell, Ian G.; Davies, Barbara; O’Connor, Annette M.; Brehaut, Jamie; Sheehan, Pamela; Clavet, Tami; Leclair, Christine; MacKenzie, Taryn; C, Béland

doi:10.1016/j.ienj.2009.12.002

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…For example, when interventions required shared platforms, participants noted that confidentiality relating to user privacy needed to be considered and that patient awareness of the shared platform could influence information disclosed [ 51 ]. Concerns regarding legality and fear of litigation were also commonly cited barriers when interventions called for changes in roles and responsibilities [ 44 , 54 ]. Concerns about safety meant that staff were less likely to endorse or fully participate in the implementation [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

et al. 2018

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BackgroundTranslation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved. Existing literature describes a range of barriers and facilitators to the implementation process. This systematic review identifies and explores relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions.MethodsWe searched MEDLINE, PsychInfo, Embase, Web of Science, and CINAHL using search terms focused specifically on barriers and facilitators to the implementation of patient-focused interventions in hospital settings. To be eligible, papers needed to have collected formal data (qualitative or quantitative) that specifically assessed the implementation process, as experienced by the staff involved.ResultsOf 4239 papers initially retrieved, 43 papers met inclusion criteria. Staff-identified barriers and facilitators to implementation were grouped into three main domains: system, staff, and intervention. Bi-directional associations were evident between these domains, with the strongest links evident between staff and intervention.ConclusionsResearchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success. The interrelationships between domains are also crucial, as resources in one area can be leveraged to address barriers in others. These findings emphasize the importance of careful intervention design and pre-implementation planning in response to the specific system and staff context in order to increase likelihood of effective and sustainable implementation.Trial registrationThis review was registered on the PROSPERO database: CRD42017057554 in February 2017. Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0726-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

et al. 2018

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“…However, there are unique facilitators to successful practice change in the ED, including interest in novel tools and acceptance of new responsibilities [26]. Interventions to address barriers to change in the ED include educational outreach, formal feedback to the clinical care team, and process change [25]. Best practices solutions utilize a multifaceted approach [27, 28].…”

Section: Discussionmentioning

confidence: 99%

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

et al. 2016

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BackgroundThe Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG).MethodsA single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for non-adherence. Binomial confidence intervals and student’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis. Regression models were used to analyze the significance of various predictors to non-adherent treatment.Results103 cases met the inclusion and exclusion criteria, with 63.1 % receiving non-adherent treatment, most commonly use of a fluoroquinolone (FQ) in cases with cystitis (97.6 %). In cases with pyelonephritis, inappropriate antibiotic choice (39.1 %) and no initial IV antibiotic for pyelonephritis (39.1 %) where recommended were the most common characterizations of non-adherence. Overall, cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis (OR 0.9, 95 % confidence interval 0.4–2.2, P = 0.90). In multivariable analysis, patients more likely to receive non-adherent treatment included those without a recent history of a UTI (OR 3.8, 95 % CI 1.3–11.4, P = 0.02) and cystitis cases with back or abdominal pain only (OR 11.4, 95 % CI 2.1–63.0, P = 0.01).ConclusionsPatients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment, potentially suggesting diagnostic inaccuracy. Physician education on evidence-based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens.

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“…En effet, l'équipe de Stiell et al, à l'origine de la règle d'Ottawa, a publié une étude dont l'objectif était de déterminer les élé-ments facilitateurs ou bloquants pour appliquer un protocole anticipé aidant à retirer par les IDE les colliers cervicaux aux patients victimes d'un traumatisme [4]. Cette enquête montre que les IDE sont grandement satisfaits (96 %) de ces protocoles.…”

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The nurse-initiated X-ray orders in emergency department

Claret

Bobbia

Coussaye³

2017

Ann. Fr. Med. Urgence

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Perceived facilitators and barriers to clinical clearance of the cervical spine by emergency department nurses: A major step towards changing practice in the emergency department

Cited by 12 publications

References 22 publications

Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections

The nurse-initiated X-ray orders in emergency department

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