Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study.

J Clin Nurs. 2012 Feb;21(3-4):437-447

Authors: Janssen MA, van Achterberg T, Adriaansen MJ, Kampshoff CS, Schalk DM, Mintjes-de Groot J

Abstract
Aims and objectives.? The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline. Background.? Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline. Methods.? This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n?=?108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors. Results.? Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested. Conclusion.? Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department. Relevance to clinical practice.? Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.

PMID: 22171544 [PubMed - as supplied by publisher]

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Codeine Therapy in the Context of Cytochrome P450 2D6 (CYP2D6) Genotype.

Clin Pharmacol Ther. 2012 Feb;91(2):321-6

Authors: Crews KR, Gaedigk A, Dunnenberger HM, Klein TE, Shen DD, Callaghan JT, Kharasch ED, Skaar TC

PMID: 22205192 [PubMed - in process]

In 1995 the Global Initiative on Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical practice and research, its major objective, of forming the basis for local and country initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socio-economic settings.
PMID: 22282546 [PubMed - as supplied by publisher]

Abstract?-? Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.
PMID: 22272918 [PubMed - as supplied by publisher]

OBJECTIVE: To assess the quality of endocrine guidelines developed in North America. STUDY DESIGN AND SETTING: A systematic review of the literature was conducted to identify all endocrine clinical practice guidelines developed in North America and published between January 1, 2007 and January 13, 2010. Two independent reviewers used the Appraisal of Guidelines, Research and Evaluation instrument to evaluate the quality of the guidelines in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. RESULTS: One hundred eligible endocrine guidelines had high scores in the scope-and-purpose (mean pooled standardized score [MPSD] of 82±14) and clarity domains (MPSD=64±17) and low scores in the stakeholder-involvement (MPSD of 36±12) and editorial independence domains (MPSD=36±36). Only 29% of guidelines scored above 60% for more than three domains. Rigor-of-development domain score was significantly higher in guidelines using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach, nondiabetes guidelines, and in published in-print vs. online publications. CONCLUSIONS: The quality of endocrine guidelines published in 2007-2009 is moderate and can be improved by (1) using methodologically sound development frameworks, (2) increasing stakeholder involvement, and (3) paying more attention to resource implications of guideline implementation.
PMID: 22280992 [PubMed - as supplied by publisher]