PRO: confronting resistance to rule-based medicine is essential to improving outcomes

Blakey, John; Brown, Michael; Pinchin, James; Barley, Mark; Sharples, Sarah

doi:10.1136/thoraxjnl-2014-205986

Cited by 4 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other than the professionals' role and level of experience, a number of factors have been found to affect professionals' views, including lack of knowledge or unawareness about the latest evidence, resistance to change established ways of practice, and a tendency to overemphasise successful personal clinical decisions over successful decisions based on rules, among others (Blakey, Brown, Pinchin, Barley, & Sharples, 2015). Since exploring these factors was not the aim of the [Blinded] survey, they were not included in the questionnaire.…”

Section: Accepted Articlementioning

confidence: 99%

The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals

Fernández-Méndez

Harvey

Windle

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design Cross-sectional, multi-centre, survey based study. Methods An online, short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia, and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than five years' experience were more likely to rate a patient spending 50-74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia.

show abstract

Section: Accepted Articlementioning

confidence: 99%

The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals

Fernández-Méndez

Harvey

Windle

et al. 2019

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…When questioned about the reasons for their low implementation of the system’s care recommendations, user feedback revealed a lack of awareness of the system’s functionality, limited belief in its relevance and value and perceived challenges in integrating the recommendations into daily practice. [9] These barriers to uptake are the cautionary counter to the potential of the EMR: in order to realise the potential of EMR-based CDSS, there is a need for clear planning and co-design with healthcare professionals to ensure they are valuable and practical tools.…”

Section: Current Use – Clinical Management and Resource Efficienciesmentioning

confidence: 99%

Use of electronic medical records and biomarkers to manage risk and resource efficiencies

Blakey

Chisholm²,

Price³

et al. 2017

European Clinical Respiratory Journal

View full text Add to dashboard Cite

The migration from paper to electronic medical records (EMRs) was motivated by the administrative need to record, retrieve and process increasing amounts of clinical data in the 1980s. In the intervening period, there has been growing recognition of the potential of such records for achieving care efficiencies, informing clinical decision making and real-life research. EMRs can be used to characterise patient groups, management approaches and differential outcomes. Characterisation can also help with identification of potential biomarkers for future risk determination and likely treatment response. The future heralds even greater opportunities through integration of clinical records and a range of technology-based solutions within a more complete electronic health record (EHR). Through application of algorithms based on identified risk predictors and disease determinants, clinical records could also be used to enable risk stratification of patients to optimise targeted interventions, conserving resources to achieve individual patient and system-wide benefit. In this review, we reflect on the evolution of the EMR and EHR and discuss current and emerging opportunities, particularly with respect to biomarkers and targeting of innovative biologic interventions. We also consider some of the critical issues associated with realising the potential of the EHR as a clinical aid and research tool in an age of emerging technologies.

show abstract

“…For example, hand hygiene remains 1 of the top 10 patient safety issues that have a seemingly simple answer but no real success with ongoing sustained compliance. 14 …”

Section: Be Brutally Honest About Available Time and Resourcesmentioning

confidence: 99%

Making It Meaningful: Finding Quality Improvement Projects Worthy of Your Time, Effort, and Expertise

Stausmire

Ulrich

2015

Critical Care Nurse

View full text Add to dashboard Cite

This article is the second of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. The article is a brainstorming session on paper, written to assist nurses and managers in identifying possible quality improvement projects that are meaningful to them and will make a real difference in their critical care units. Every unit and institution has its own unique mix of resources, culture, physical environment, patient population, technology, documentation processes, health care providers, and multiple other factors. Thus specific patient care and safety challenges must be identified and prioritized individually for quality improvement by each unit. Projects also must be manageable and within the scope of time, effort, and expertise available-no quality improvement project is "too small" if it is applicable to your critical care area and will improve outcomes. A s the nurse manager of the trauma intensive care unit, you have just received the most recent patient satisfaction scores, and they are still below the preferred institutional benchmark. The lowest scoring items are (1) staff effort to include patients/families in decisions about treatment, (2) how well nurses kept patients/family informed, and (3) the amount of attention paid to the patient's special or personal needs. At the next team meeting, you invite your staff to offer suggestions on how to improve satisfaction scores. A lively discussion erupts, with some nurses recommending a research project and others a quality improvement (QI) project. Using published guidelines, 1 the group decides to use current evidence-based knowledge and best practices applicable to their patient population that will address the identified deficiencies (QI) versus trying to generate new knowledge or This article has been designated for CE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe how to determine process improvement priorities 2. Review the use of process improvement methods that will work for your facility 3. Review patient safety strategies and initiatives endorsed by the Agency for Healthcare Research and Quality to prevent harm

show abstract

PRO: confronting resistance to rule-based medicine is essential to improving outcomes

Cited by 4 publications

References 13 publications

The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals

The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals

Use of electronic medical records and biomarkers to manage risk and resource efficiencies

Making It Meaningful: Finding Quality Improvement Projects Worthy of Your Time, Effort, and Expertise

Contact Info

Product

Resources

About