Reinforcing good practice: Implementation of guidelines at hospital G. Pini

Nobile, M.; Bronzin, S.; Navone, Paola; Colombo, M.; Calori, G.M.; Auxilia, F.

doi:10.1016/j.injury.2014.10.015

Cited by 6 publications

(8 citation statements)

References 52 publications

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“…The data extracted in the review cannot provide a quantification of the importance of each single implementation method, but some of the included studies reported what the authors stressed as important factors for success. Multidisciplinary team approach and interdisciplinary consensus were mentioned in 6 out of 11 successful studies [21,23,24,[27][28][29]. Other aspects mentioned as impactful were personal training [19,29], continuous training and feedback [24,29], monthly analysis [21], active involvement of every member and physician leadership [21,24] and patience [24].…”

Section: Discussionmentioning

confidence: 99%

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Marche

Neuwirth

Kugler

et al. 2020

Eur J Trauma Emerg Surg

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Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology.

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Section: Discussionmentioning

confidence: 99%

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Marche

Neuwirth

Kugler

et al. 2020

Eur J Trauma Emerg Surg

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“…A total of nine papers discussed barriers to SAP guideline adherence (Tables 1 and 3) [35][36][37][38][39][40][77][78][79]. Barriers were often grouped as personal or organisational barriers and were mapped to the following nine TDF domains: knowledge [35][36][37][38][77][78][79], environmental context and resources [35][36][37][38][39][40][77][78][79], social/professional role and identity [36,40,77], memory, attention and decision processes [36,37], beliefs about consequences [37,39], beliefs about capabilities [37,38,77,78], emotion [37,40], skills [37,39,77] and social influences [37,40,77].…”

Section: Barriers To Guideline Adherencementioning

confidence: 99%

“…Multiple interventions were developed and incorporated into practice to enhance guideline use. Eight relevant TDF domains were identified: behavioural regulation [41, 44, 45, 47, 50-60, 62-67, 69, 71, 73-76, 79], environmental context and resources [41-54, 56-60, 62-68, 70-72, 74-79], skills [41,57,77], social/professional role and identity [41,49,60,62,65,67,70,72,76], knowledge [42, 43, 45-47, 49, 50, 52, 54, 56, 61-64, 68, 70, 76, 78, 79], social influences [45,48,49,69,78,79], reinforcement [49, 53, 58, 59, 62-65, 67, 71, 74] and beliefs about consequences [78]. A breakdown of the successful interventions that enabled SAP guideline use can be found in Tables 2 and 3.…”

Section: Enablers To Guideline Adherencementioning

confidence: 99%

“…Guidelines that were inaccessible, in print or electronic form, presented a concern to hospital staff. In some instances, guidelines were completely inaccessible in theatre or on the wards, preventing its use by clinical staff such as surgeons, ward nurses and anaesthesia personnel (anaesthetists and nurse anaesthetists), while in other instances it was hard to locate [36,79]. Whilst guideline dissemination has been reported as an enabler to SAP guideline adherence, it is important to note that the method of guideline dissemination and presentation also plays a role in determining the likely uptake of content [28].…”

Section: Knowledge and Environmental Context And Resourcesmentioning

confidence: 99%

“…Furthermore, a lack of agreement of guideline content by health care professionals can result in limited use of guidelines [78], exemplifying the value of including stakeholders in guideline development [78]. Involving key stakeholders in guideline development can increase the likelihood of guidelines being adhered to [79,85], thus resulting in less variation in how practice is carried out.…”

Section: Knowledge and Environmental Context And Resourcesmentioning

confidence: 99%

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Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

2021

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Background Despite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations. It has been noted that the global uptake of local and international surgical antimicrobial prophylaxis (SAP) guidelines is poor with limited research investigating factors that affect guideline adherence. The purpose of this systematic review was to determine the reported barriers and enablers to the adherence of SAP guidelines. Methods A search of the literature was performed using four electronic databases (CINAHL, EMBASE, PubMed and SCOPUS) for articles published in the English language from January 1998 to December 2018. Articles were included if they were solely related to SAP and discussed the barriers or enablers to SAP guideline adherence. Articles that assessed the adherence to a range of infection control measures or discussed adherence to antibiotic treatment guidelines rather than SAP guidelines were excluded from this review. Barriers and enablers were mapped to the Theoretical Domains Framework (TDF). The Mixed Methods Appraisal Tool was used to assess the quality of included studies. Results A total of 1489 papers were originally retrieved, with 48 papers meeting the eligibility criteria. Barriers and enablers were mapped to 11 out of 14 TDF domains: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, reinforcement, memory, attention and decision processes, environmental context and resources, social influences, emotion and behavioural regulation. Barriers were further categorised into personal or organisational barriers, while enablers were arranged under commonly trialled interventions. Conclusions There are numerous factors that can determine the uptake of SAP guidelines. An identification and understanding of these factors at a local level is required to develop tailored interventions to enhance guideline adherence. Interventions, when used in combination, can be considered as a means of improving guideline use.

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Please mind the gap between guidelines & behavior change: A systematic review and a consideration on effectiveness in healthcare

Gandolfi,

Bellè,

Nuti

2025

Health Policy

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Reinforcing good practice: Implementation of guidelines at hospital G. Pini

Cited by 6 publications

References 52 publications

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

Please mind the gap between guidelines & behavior change: A systematic review and a consideration on effectiveness in healthcare

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