Implementation strategies for guidelines at ICUs: a systematic review.

Area of Science:

• Critical Care Medicine
• Health Services Research
• Evidence-Based Practice

Background:

• Clinical practice guidelines (CPGs) aim to improve patient care but require effective implementation strategies.
• Intensive care units (ICUs) present unique challenges for guideline adoption.
• Previous research has not systematically reviewed optimal implementation strategies for CPGs in ICUs.

Purpose of the Study:

• To critically analyze empirical studies on the implementation strategies for CPGs in ICUs.
• To identify effective strategies for enhancing the optimal use of CPGs in critical care settings.
• To provide evidence-based recommendations for clinicians implementing CPGs.

Main Methods:

• Systematic review with narrative synthesis.
• Searches conducted across multiple databases (CINAHL, Google Scholar, etc.) and grey literature.
• Inclusion of 11 studies after initial screening, with 8 randomized controlled trials appraised using Joanna Briggs Critical Appraisal Tools.

Main Results:

• Multi-faceted implementation strategies were found to be more effective than single strategies.
• Commonly used strategies included printed educational materials, information sessions, audit, feedback, use of champion leaders, educational outreach, and computer/internet use.
• Less frequently used strategies were practical training, monitoring visits, and grand rounds.

Conclusions:

• Clinicians can utilize findings to implement a combination of multi-faceted strategies for optimal CPG implementation in ICUs.
• This review offers valuable insights into effective CPG implementation, addressing a gap in existing literature.
• The synthesis of evidence supports the enhanced adoption and adherence to CPGs in critical care environments.