Factors affecting the implementation process of clinical pathways: a mixed method study within the context of <scp>S</scp>wedish intensive care

Bjurling-Sjöberg, Petronella; Wadensten, Barbro; Pöder, Ulrika; Nordgren, Lars; Jansson, Inger

doi:10.1111/jep.12301

Cited by 12 publications

(26 citation statements)

References 40 publications

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“…How the effect of a standardised care plan is evaluated can have a profound effect on its perceived usefulness (Bjurling-Sjöberg et al, 2015). Therefore when undertaking such research it is important to ensure robust methods and data analysis are adopted.…”

Section: Discussionmentioning

confidence: 99%

“…Without structured guidelines ICU nurses over-rely on doctors for decision making when caring for dying patients (Venkatasalu et al, 2015). Bjurling-Sjöberg et al (2015) suggested that a reason for doctor's reluctance to use standardised care plans is the perception that they lose control over decision making. Further research could identify other significant factors affecting implementation and compliance.…”

Section: Implementation and Compliancementioning

confidence: 99%

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End-of-life care guidelines and care plans in the intensive care unit

Luckett

2017

Br J Nurs

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Providing high-quality end-of-life (EoL) care within UK healthcare settings is a high priority identified in national and local guideline and policy documents. The Department of Health (DH) (2016) published a document of commitment following a review of choice at EoL, recognising the need for high-quality personalised care. This echoes many of the priorities put forward by The National Palliative and End of Life Care Partnership (2015) who published ambitions for EOL provision. These ambitions emphasised the need for individualised care, equality of access, maintaining comfort, coordination across service providers and the need for staff education and training. The National Institute of Health and Care Excellence (NICE) (2011 (updated in 2013)) quality standard for End of Life care for Adults lists several quality statements. Quality statement 3 considers the need for assessment and formation of individualised care plans for dying patients:'People approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, with the opportunity to discuss, develop and review End-of-life care guidelines and care plans in the intensive care unit Alison Luckett ABSTRACTThe aim of this literature review was to examine end of life (EoL) care practice within the Intensive care unit (ICU). By exploring the literature, it is hoped to suggest how national guidance can be integrated into the ICU setting. Delivering high-quality, patient-centred EoL care is high priority on the UK health agenda. The highly technological environment within ICU can create barriers to recognising death and initiating EoL care planning. Despite recommendations in the literature for the integration of standardised guidance, implementation, compliance and evaluation are yet to be widely reported. This literature review highlights the need for ICU health professionals to embrace EoL guideline recommendations. Development of robust processes is vital to inform future practice.

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Section: Discussionmentioning

confidence: 99%

Section: Implementation and Compliancementioning

confidence: 99%

End-of-life care guidelines and care plans in the intensive care unit

Luckett

2017

Br J Nurs

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“…Key persons from those ICUs have witnessed a positive impact of the pathways, such as a better care structure, better quality control and easier documentation. They have also pointed out that the implementation process is complicated and is affect by multiple factors, such as inspiration sources, the project group constellation, available resources, pathway characteristics, implementation activities, and staff characteristics [ 23 ]. The study that revealed these findings was, however, retrospective and primarily included the people responsible for pathway implementation, which, in some cases, had occurred several years ago [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…They have also pointed out that the implementation process is complicated and is affect by multiple factors, such as inspiration sources, the project group constellation, available resources, pathway characteristics, implementation activities, and staff characteristics [ 23 ]. The study that revealed these findings was, however, retrospective and primarily included the people responsible for pathway implementation, which, in some cases, had occurred several years ago [ 23 ]. Although the key informants’ perspectives provided valuable insights to facilitate enhanced pathway use and further understand the implementation process, there was a need for more knowledge.…”

Section: Introductionmentioning

confidence: 99%

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2018

BMC Health Serv Res

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BackgroundClinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.MethodsThe setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.ResultsA conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as ‘Struggling for a feasible tool,’ was the core category that linked all categories. The phenomenon evolved from the ‘Triggers’ (‘Perceiving suboptimal practice’ and ‘Receiving external inspiration and support’), pervaded the ‘Implementation process’ (‘Contextual circumstances,’ ‘Processual circumstances’ and ‘Negotiating to achieve progress’), and led to the process ‘Output’ (‘Varying utilization’ and ‘Improvements in understanding and practice’). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.ConclusionsThe findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3629-1) contains supplementary material, which is available to authorized users.

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“…In altre parole, la gran parte delle LG non fornisce elementi per l'appropriatezza organizzativa inerente la loro implementazione. Si sono, comunque, valutati i Fattori Critici di Successo nell'implementazione dei PDTA [17,18], seppure con esiti contraddittori. Tuttavia, si possono indicare, nell'ordine: consapevolezza del top management, consapevolezza e iniziativa bottom-up dei professionisti, sistemi di accreditamento, feedback (miglioramento continuo), capacità manageriali, sistema informativo, comunicazione, aderenza al PDTA (mantenimento), consapevolezza dei pazienti.…”

Section: Percorsi Diagnostico-terapeutici Assistenziali (Pdta)unclassified

PDTA e Medicina di Laboratorio

Cappelletti

2017

Riv Ital Med Lab

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Riassunto I Percorsi Diagnostico-Terapeutici Assistenziali (PDTA) sono definiti come interventi complessi che descrivono i processi delle decisioni cliniche e dell'organizzazione di cura di un ben definito gruppo di pazienti, in un definito periodo di tempo. Costituiscono i pilastri per la realizzazione della "centralità del paziente" sulla base delle evidenze scientifiche. I PDTA possono essere definiti come la contestualizzazione di una o più linee guida, relative a una patologia o problematica clinica, nella specifica realtà organizzativa di un'Azienda sanitaria. I PDTA sono ampiamente utilizzati ed esistono evidenze, seppur narrative, della loro efficacia. I principali problemi sono la personalizzazione e l'innovazione. La Medicina di Laboratorio deve fare la sua parte nella costruzione dei PDTA, partecipando ai gruppi multidisciplinari e multiprofessionali, con attenzione ai test pivot, al loro uso e alla loro interpretazione; alla qualità delle linee guida scelte; al dettaglio dei protocolli operativi che sostanziano il percorso; agli aspetti "interni" che determinano (performance analitica) o aumentano (total testing process) la qualità della risposta; alla verifica continua dell'appropriatezza e adeguatezza dei marcatori utilizzati e all'audit dell'effectiveness del PDTA. Si tratta di uno degli aspetti più alti di "lavoro all'interfaccia", nelle aree di pre-pre e post-post testing process, ove l'affidabilità analitica e il suo rapporto con la realtà clinica e i suoi esiti sono immediatamente percepibili. Centralità del paziente e PDTA La "centralità del paziente" [1] è divenuta un tema cruciale della Medicina occidentale, anche per la presa d'atto delle iniquità, frammentazioni, sovrapposizioni e discontinuità che caratterizzano molto spesso l'erogazione dei servizi sanitari (effetto silo) e delle loro conseguenze sugli esiti Parole chiave Medicina di Laboratorio

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Factors affecting the implementation process of clinical pathways: a mixed method study within the context of Swedish intensive care

Cited by 12 publications

References 40 publications

End-of-life care guidelines and care plans in the intensive care unit

End-of-life care guidelines and care plans in the intensive care unit

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

PDTA e Medicina di Laboratorio

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