Barriers to the implementation of sepsis guideline in a Canadian pediatric tertiary care centre

Abstract

Introduction: Adherence to Clinical Practice Guidelines for sepsis can improve care processes and outcomes; however, sepsis guideline adherence is plagued by many barriers. The purpose of this article is to report the perceived barriers for implementing a sepsis guideline at British Columbia's Children Hospital. Methods: This is a mixed method study. Data were collected from clinicians using a questionnaire that covered 3 major domains and included two open-ended questions. Quantitative data analysis focused on the Mean Overall Barrier Score (MOBS) in each category using descriptive and inferential statistical techniques. Qualitative data were analyzed thematically through deductive and inductive approaches. Results: A total of 176 clinicians participated in the study. Nurses and physicians were the largest groups of participants (52.7% and 41.2%, respectively). Nurses perceived more barriers (MOBS: 3.3; 95% CI: 3.1-3.4) compared to attending physicians (MOBS: 3.6; 95% CI: 3.3-3.8). The most frequent type of barriers reported was contextual, including environmental and guideline related barriers (MOBS: 3.1; 95% CI: 2.9-3.3), whereas the least barrier reported was lack of motivation (MOBS: 4.0; 95% CI: 3.9-4.2). Clinicians who were highly motivated and perceived less environmental barriers were more likely to use the guideline (Odds Ratio of 2.2 [p = .036] and 2.2 [p = .092], respectively). Conclusions: Motivation was the most important predictor of guideline use while contextual barriers hindered use. Therefore, motivating the clinicians and removing external barriers offers the best chance for successful guideline implementation. Furthermore, removing barriers for the use of sepsis guideline among nursing group needs more consideration.

Physicians’ Perspectives of the Factors Influential in Implementing National Clinical Guidelines for Hypertension in Iran: A Qualitative Study

“…Our findings demonstrated that the comprehensiveness, applicability, and perceived usefulness of the clinical guideline played a crucial role in its successful implementation. Although most of the participants in the study expressed that comprehensiveness and applicability were favorable factors for implementing the guideline, other studies have noted these factors as challenges [24,30]. For example, participants in the study of Hisham et al [31] believed that strict adherence to evidencebased recommendations and ignoring the role of clinical experiences in the guideline could pose a threat to its implementation and patient care.…”

“…Attitudinal responses were also noted to have considerable impacts on guideline implementation. The results of Mosavianpour et al [30] showed that knowledge and positive attitudes were the factors that favourably affected the implementation of guidelines for managing sepsis in a pediatric hospital; on the other hand, motivational factors had the least role in this regard.…”

The Predictors of Perceived Barriers and Facilitators of Applying Sepsis Six Guidelines Among Critical Care Nurses

“…Similarly, the nurse’s compliance with the Sepsis Six guidelines leads to decreased sepsis-related complication and mortality rates and improved clinical outcomes [ 26 ]. However, low adherence and compliance with applying the Sepsis Six guidelines are still unresolved issues impeding sepsis management due to several barriers [ 27 ]. Previous researchers have identified several barriers and facilitators to implementing the Sepsis Six guidelines [ 20 , 28 ].…”

The Predictors of Perceived Barriers and Facilitators of Applying Sepsis Six Guidelines Among Critical Care Nurses

“…Similarly, the nurse's compliance with sepsis six guidelines leads to decrease in sepsis-related complication and mortality rates and improved clinical outcomes [22]. However, low adherence and compliance with applying sepsis six guidelines are still unresolved issues impeding sepsis management due to several barriers [23]. Previous researchers have identified several barriers and facilitators to the implementation of sepsis six guidelines [19,24].…”