Variable compliance with clinical practice guidelines identified in a 1-day audit at 66 French adult intensive care units*

Abstract

At the bedside, clinical guidelines are fully applied in 24% of patients. Our study underlines the need to both improve the process of implementation and become cognizant of excessive proliferation of clinical guidelines.

Confirmation of brain death diagnosis: A study on French practice

“…A survey conducted on-site at each ICU by personnel not belonging to the unit could reduce this potential bias. This type of study has been carried out in France on a different topic [28]. However, given the low incidence of brain death, this type of audit seems disproportionate.…”

“…Twenty percent of other ICUs followed a protocol [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The combination of these two reasons was chosen by 35% of respondents.…”

Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature

“…A 1-day audit of intensive care practice showed that a MAP goal was pre-fixed in only 70% of patients with septic shock [31]. In most patients, physicians seem to target a MAP of greater than 65 mm Hg.…”

Sepsis guideline implementation: benefits, pitfalls and possible solutions

“…Others felt their pediatric early warning systems served the same purpose on the wards, and still others felt that introduction of the sepsis guideline implied that they were managing sepsis incorrectly beforehand. These reasons for skepticism are not unique to any single institution or any particular guideline and imply that crafting a resource-appropriate guideline is an important process but without attention to cultural issues, implementation and adoption are likely to be less than optimal (Figure 3[24]). Another area that has hindered adoption and sustainability is the failure to measure meaningful outcomes and share the information widely with team members.…”