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Understanding adherence to guidelines in the intensive care unit: development of a comprehensive framework
Naomi E Cahill1, Jeanette Suurdt, Hélène Ouellette-Kuntz
1Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
JPEN. Journal of Parenteral and Enteral Nutrition
|November 25, 2010
Summary
Adherence to clinical practice guidelines (CPGs) for nutrition in intensive care units (ICUs) is complex. A new framework identifies factors influencing CPG use, aiding future research and quality improvement.
Area of Science:
- Critical care medicine
- Nutrition science
- Healthcare quality improvement
Background:
- Clinical practice guidelines (CPGs) aim to translate evidence into practice.
- Nutrition CPGs for intensive care units (ICUs) exist, but their impact is modest.
- Understanding adherence barriers is crucial for effective implementation.
Purpose of the Study:
- To develop a comprehensive framework for understanding adherence to nutrition CPGs in critical care.
- To identify factors influencing the application of nutrition guidelines in the ICU.
Main Methods:
- Qualitative case study approach across 4 Canadian ICUs.
- Semistructured interviews with 7 key informants per site.
- Framework analysis of interview transcripts and documents.
Main Results:
- A 5-component framework was developed: CPG characteristics, implementation process, institutional factors, provider intent, and patient clinical condition.
- These components represent numerous barriers and enablers to guideline adherence.
- The framework elucidates the complex interplay of factors affecting nutrition CPG use.
Conclusions:
- Adherence to nutrition CPGs in ICUs is multifactorial, involving complex interactions of barriers and enablers.
- The developed framework serves as a template for future research on guideline adherence.
- Quality improvement initiatives should address local barriers to enhance CPG implementation.
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