Utilization of Clinical Practice Guidelines: Barriers and Facilitators

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Key points

  • Clinical practice guidelines are tools used to assist health care professionals in clinical decision making with the ultimate goal of improving patient care.

  • Promoting the implementation of clinical practice guidelines at the point of care delivery is a hurdle to translating scientific findings into practice.

  • As access to electronic evidence sources increase, the amount of evidence available to clinicians for clinical decision support is overwhelming.

  • Increased adoption of electronic health

Utilization of clinical practice guidelines: barriers and facilitators

Clinical practice guidelines are designed to improve quality of care, reduce variation in practice and ensure evidence-based care is delivered when appropriate. Despite the creation of guidelines at national and international levels, guidelines are underutilized by clinicians at the bedside to improve patient care. Clinical practice guidelines are “systematically developed statements to assist practitioners and patients to make decisions about appropriate health care for specific circumstances.”

Statement of the problem

Decisions about when, why, and how to pursue certain diagnoses and treatments are complicated. Patient care interventions are based on scientific principles, theoretical knowledge, and a clinician’s expertise. Clinical practice guidelines exist as tools to augment clinician decision making, yet several barriers to implementation have been identified in the literature. Researchers cite a lack of knowledge of guideline existence, complexity of guidelines, staff attitude, lack of training, time,

Purpose

The purpose of this project was to seek an understanding of what factors promote or prevent the implementation of evidence-based clinical practice guidelines at the point of care delivery using a population of neuroscience advanced practice providers.

Background

Even with the exponential growth of publicly available clinical practice guidelines, ease of access to high-quality evidence is out of reach for many clinicians. As access to electronic evidence sources increases, the amount of evidence available to clinicians for clinical decision support is overwhelming. It is often difficult for providers to stay current with the evidence necessary to provide the standard of care. In practice, clinicians use experience, education, literature, a patient’s

Health care

The Institute of Medicine’s Promoting Adoption of Clinical Practice Guidelines report challenges the health care community to create systems from within that promote the uptake and use of clinical practice guidelines at the point of care.16 The Institute of Medicine recognizes this as one of the main steps in translating research findings into the mainstream of practice. A growing body of evidence shows that the rate of clinical practice guideline adoption is affected by the interaction of the

Impact of project on population

Adherence to well-designed clinical practice guidelines is recognized as a strategy to reduce error and improve outcomes for neuroscience patients. Neurosurgical and cerebrovascular adverse events such as thromboembolic events, infection, wrong level surgery, management of vasospasm, and salt wasting syndromes are complications likely be reduced by use of evidence-based guidelines and protocols.22 In recent years, professional medical and nursing organizations attempted to monitor effects on

Application of theoretic framework

Although clinical practice guidelines encourage the consistent, efficient application of evidence when used by clinicians at the bedside, a knowledge translation gap exists.25 Social, cognitive, and motivational factors enable efficient knowledge translation in an organization.25 The interrelationship between several concepts impacts the utilization of clinical practice guidelines in clinical practice (Fig. 2).

The literature reveals many barriers and facilitators that impede the successful

Project Design

The purpose of this project was to assess factors that negatively or positively influenced advanced practice provider utilization of clinical practice guidelines in a community hospital. The method in this project was described in both a broad and narrow context relevant to neuroscience advanced practice provider clinical practice. A nonexperimental, cross-sectional, descriptive design was used to gather qualitative and quantitative data via survey. The project was approved by the institutional

Results

In assessing advanced practice provider use of clinical practice guidelines, statements and open-ended questions related to knowledge, attitude, and behaviors were evaluated via survey. Frequency distribution tables of results were constructed for both clinical practice guidelines in general and the hospital specific anticoagulation reversal guidelines (Tables 2 and 4). An overall response rate to determine the score and mean related to all the statements was calculated. Before computing the

Relationship of Results to Framework

Individual professional decisions were central to the execution of clinical practice guidelines, understanding perceptions to similar clinical scenarios of patients encountered on a daily basis were integral to recommending approaches to improve adherence. Responses to open-ended questions regarding these high-acuity scenarios were evaluated to attain insight into factors that promote or prevent adherence to the use of clinical practice guidelines. Striking similarities in correct responses of

Acknowledgments

The author gratefully acknowledges the support and guidance of S.D. Krau, PhD, CNE Associate Professor, School of Nursing, Vanderbilt University and C. Thomson-Smith, MSN, RN, JD, FAANP, Assistant Dean Faculty Practice & Assistant Professor, School of Nursing, Vanderbilt University.

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