Barriers and Strategies in Guideline Implementation—A Scoping Review

Abstract

Research indicates that clinical guidelines are often not applied. The success of their implementation depends on the consideration of a variety of barriers and the use of adequate strategies to overcome them. Therefore, this scoping review aims to describe and categorize the most important barriers to guideline implementation. Furthermore, it provides an overview of different kinds of suitable strategies that are tailored to overcome these barriers. The search algorithm led to the identification of 1659 articles in PubMed. Overall, 69 articles were included in the data synthesis. The content of these articles was analysed by using a qualitative synthesis approach, to extract the most important information on barriers and strategies. The barriers to guideline implementation can be differentiated into personal factors, guideline-related factors, and external factors. The scoping review revealed the following aspects as central elements of successful strategies for guideline implementation: dissemination, education and training, social interaction, decision support systems and standing orders. Available evidence indicates that a structured implementation can improve adherence to guidelines. Therefore, the barriers to guideline implementation and adherence need to be analysed in advance so that strategies that are tailored to the specific setting and target groups can be developed.

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

“…The limited availability of guidelines and low adherence in the context of this study reveal, once again, the significant gap between research and practice (Cochrane et al, ). Studies exploring the implementation of and adherence to clinical guidelines in the healthcare field (Cabana et al, ; Davis & Taylor‐Vaisey, ; Fischer, Lange, Klose, Greiner, & Kraemer, ) focus on identifying limiting factors or barriers to their availability. In this context, three main types of factors have been identified: personal factors (knowledge and attitude among professionals), factors relating to the characteristics of guidelines and external factors relating mainly to organizational models (Fischer et al, ).…”

Glycaemic optimization for patients with cardiac disease-A before-and-after study

“…External factors especially lack of resources, time constraints, heavy work load, facilitation and organisational constraints may have also played a significant role. These can be improved by standardisation of procedures and processes, linking to quality improvement, provision of adequate time to utilise guidelines, establishing clear roles in terms of standing orders, providing financial incentives, multiprofessional collaboration and local consensus groups …”

Navigating Uncertainty: Health Professionals’ Knowledge, Skill, and Confidence in Assessing and Managing Pain in Children with Profound Cognitive Impairment

“…Their usual array of “navigation aids” such as experience of similar situations and asking more senior colleagues were reported as being less reliable, making them uncertain about assessment. They did not appear to consider turning to other potential navigation aids such as guidelines or assessment tools that could have provided scaffolding for their thinking [27, 28]. Although we did not explore why they did not turn to these scaffolds, there is considerable evidence that shows that personal factors (e.g., lack of familiarity with and awareness of guidelines, potential erosion of self-efficacy), external factors (e.g., organizational constraints, time restrictions), and guideline-related factors (e.g., complexity and unavailability) act as barriers to implementing guidelines into practice [27].…”

“…They did not appear to consider turning to other potential navigation aids such as guidelines or assessment tools that could have provided scaffolding for their thinking [27, 28]. Although we did not explore why they did not turn to these scaffolds, there is considerable evidence that shows that personal factors (e.g., lack of familiarity with and awareness of guidelines, potential erosion of self-efficacy), external factors (e.g., organizational constraints, time restrictions), and guideline-related factors (e.g., complexity and unavailability) act as barriers to implementing guidelines into practice [27]. Brashers [25] proposes that uncertainty is difficult to deal with because it is multilayered and interconnected, meaning that the professionals' responses were often very contextually dependent; for example, the presence of parents could be both settling and unsettling.…”