Utilization of Clinical Practice Guidelines

Keiffer, Melanie

doi:10.1016/j.cnur.2015.03.007

Cited by 42 publications

(40 citation statements)

References 17 publications

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“…In addition, utilization of clinical practice guidelines and decision support tools needs to be fostered through education and integration into organizational structures. 59,60 Previous data show that guidelines are insufficiently known and underutilized. 24,60–62 This was also the case in our study.…”

Section: Discussionmentioning

confidence: 99%

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

Lotz

Jox²,

Meurer³

et al. 2016

Palliat Med

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Background:Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions.Aim:Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents.Design:We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis.Setting/participants:We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender.Results:The decisions about medical indication were based on considerations relating to the individual patient, to the family, and to other patients. Individual patient factors included clinical aspects and benefit–burden considerations. Physicians’ individual views and feelings influenced their decision-making. Different factors were applied or weighed differently in the two cases. In case of conflict with parents, physicians preferred solutions aimed at establishing consensus.Conclusion:The pediatricians defined medical indication on a case-by-case basis and were influenced by emotional reasoning. In contrast to prevailing ethico-legal principles, they included the interests of other persons in their decisions. Decision-making strategies should incorporate explicit discussions of social aspects and physicians’ feelings to improve the transparency of the decision-making process and reduce bias.

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Section: Discussionmentioning

confidence: 99%

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

Lotz

Jox²,

Meurer³

et al. 2016

Palliat Med

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“…Practice and healthcare systems in various countries may differ greatly from countries where guidelines were developed, posing challenges for implementation of recommendations given. It is not feasible to provide information on their implementation and/or clinical use . Information on implementation of the guidelines was lacking as well as information on their impact on clinical practice.…”

Section: Review Of Venous Leg Ulcer Guidelinesmentioning

confidence: 99%

“…It is not feasible to provide information on their implementation and/or clinical use. [41][42][43] Information on implementation of the guidelines was lacking as well as information on their impact on clinical practice. Even when the guidelines are well implemented there is a lack of homogeneous results and a good clinical response to compression therapy if the complete chain is not addressed.…”

Section: Review Of Venous Leg Ulcer Guidelinesmentioning

confidence: 99%

Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications – a review of present guidelines

Andriessen

Apelqvist

Mosti

et al. 2017

Acad Dermatol Venereol

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Evidence-based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression.

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“…Unfortunately, it seems that these clinical practice guidelines are not always implemented by clinicians at the bedside, during the provision of care [2, 3]. There are complex reasons behind the hesitant uptake of guidelines by physicians, but a lack of familiarity with the content of specific guidelines is among the most salient factors associated with non-compliance [1, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study

et al. 2017

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BackgroundLack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians’ task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels. The primary objective of this study was to compare the management of a simulated severe gynaecological transurethral resection of the prostate (TURP) syndrome under spinal anaesthesia with either: an electronic cognitive aid, or with management from memory alone. The secondary objective was to assess the clinical relevance and participant perception of the usefulness of the cognitive aid.MethodsAnaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. We identified eight evidence-based management tasks for severe TURP syndrome from current guidelines and subdivided them into acute heart failure (AHF)/pulmonary oedema tasks (5) and acute hyponatraemia tasks (3). Implementation of the treatment steps was measured by scoring task items in a binary fashion (yes/no). To assess whether or not the cognitive aid had prompted a treatment step, participants from the cognitive aid group were questioned during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey.ResultsTeams in the cognitive aid group considered evidence-based treatment steps significantly more often than teams of the control group (96% vs. 50% for ‘AHF/pulmonary oedema’ p < 0.001; 79% vs. 12% for ‘acute hyponatraemia’ p < 0.001). Without the cognitive aid, performance would have been comparable across both groups. Nurses, trainees, and consultants derived equal benefit from the cognitive aid.ConclusionsThe cognitive aid improved the implementation of evidence-based practices in a simulated intraoperative scenario. Cognitive aids with current medical content could help to close the translational gap between guideline publication and implementation in acute patient care. It is important that the cognitive aid should be familiar, in a format that has been used in practice and training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0365-8) contains supplementary material, which is available to authorized users.

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Utilization of Clinical Practice Guidelines

Cited by 42 publications

References 17 publications

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

Medical indication regarding life-sustaining treatment for children: Focus groups with clinicians

Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications – a review of present guidelines

Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study

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