Barriers and facilitators to the implementation of clinical practice guidelines in sonography

Abstract

Knowledge of the size of the adult liver is an essential factor in diagnosing liver disease and in the monitoring of treatment response over time. Although there are multiple methods to determine liver size using ultrasound, currently, no clinical practice guideline exists. Recently, a reference range and equation to determine liver volume using ultrasound was developed. In order to guide the development of a clinical guideline, a scoping review was conducted in order to identify the potential barriers and facilitators to the implementation of this new measurement technique in clinical practice. A total of 40 articles were included in the review. The most commonly cited barriers to guideline adherence can be divided into categories that are related to individual barriers (knowledge and attitude) and external factors (guideline and environmental). The facilitators to overcome such barriers were also identified. It was reported that implementation is most beneficial when a range of strategies that aim to address the identified barriers are used. In conclusion, this scoping review has identified barriers and facilitators to aid in the development of interventions to improve sonographers' adherence to clinical practice guidelines in the clinical environment.

Australian cardiac sonographers' use of industry guidelines when performing a transthoracic echocardiogram

“…Perceived behavioural controls to following TTE guidelines included internal (knowledge and attitude) and external (guideline and environmental) facilitators and barriers 26 . Internal perceived behavioural controls (Figure 6) included having insufficient guideline specific education available 42/116 (36%), feeling uncertain about what TTE guidelines to follow 24/117 (21%) and finding TTE guidelines difficult to follow 10/117 (9%).…”

“…Perceived behavioural controls to following TTE guidelines included internal (knowledge and attitude) and external (guideline and environmental) facilitators and barriers. 26 Internal perceived behavioural controls (Figure 6…”

Australasian sonographers' knowledge, awareness, and attitudes towards the international evidence‐based guidelines for the diagnosis of polycystic ovarian syndrome

“…For example, many sonographers reported using the Rotterdam criteria, which were published in 2003 10 . Studies suggest this is a widespread issue, with a variety of factors influencing the implementation of new guidelines, including awareness, familiarity, and attitudes towards the guideline, as well as ease of use and credibility of evidence used to inform the guideline 22–26 . Different guidelines may require individual implementation strategies; however, most sources agree that purely disseminating a guideline is not enough to ensure its implementation 25,26 .…”

“…Workplaces should also provide updated protocols, reflecting the new guidelines, with extra time allowed for the ultrasound if required, 22,24,25 as well as incorporation into university curricula. Feedback from sonographers should be encouraged and acted on throughout the implementation period and beyond 23,25,26 . Ensuring sonographers are provided with adequate education is also imperative to provide consistency in the diagnosis of PCOM.…”

“…10 Studies suggest this is a widespread issue, with a variety of factors influencing the implementation of new guidelines, including awareness, familiarity, and attitudes towards the guideline, as well as ease of use and credibility of evidence used to inform the guideline. 22 , 23 , 24 , 25 , 26 Different guidelines may require individual implementation strategies; however, most sources agree that purely disseminating a guideline is not enough to ensure its implementation. 25 , 26 Active learning in the form of education sessions should be provided to sonographers to familiarise them with the guidelines and the evidence base on which they are formed and help translate knowledge into practice.…”