Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process
Zoran Trogrlic1, Mathieu van der Jagt2, Theo van Achterberg3
1Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands z.trogrlic@erasmusmc.nl.
BMJ Open Quality
|September 19, 2020
Summary
Implementing delirium guidelines in intensive care units (ICUs) improved adherence and knowledge among healthcare workers. While feasible and sustainable, variability in adherence highlights the need for tailored strategies at the center level.
Area of Science:
- Critical Care Medicine
- Implementation Science
- Healthcare Quality Improvement
Background:
- Delirium is a common complication in intensive care units (ICUs).
- Effective implementation of delirium guidelines is crucial for improving patient outcomes.
- Barriers to guideline adherence in ICUs require systematic evaluation and mitigation.
Purpose of the Study:
- To evaluate the exposure of healthcare workers to a delirium guidelines implementation program.
- To assess the effects of the program on guideline adherence at the ICU level.
- To examine the impact on knowledge, perceived barriers, and experiences with implementation.
Main Methods:
- A mixed-methods process evaluation of a prospective, multicenter implementation study.
- Involved six ICUs, 4449 adult ICU patients, and approximately 500 ICU professionals.
- Utilized a tailored implementation program with various strategies including e-learning and classroom lessons.
Main Results:
- Five of six ICUs successfully implemented most guideline recommendations (>90%).
- Adherence to delirium screening performance indicators exceeded targets (>85%), but variability existed for other indicators (34-72%).
- Knowledge improved (61% to 65%), barriers were resolved, and the program was sustained 6 months post-implementation.
Conclusions:
- Multifaceted implementation of delirium guidelines is feasible, improves adherence, and is sustainable in ICUs.
- Significant variability in guideline adherence across ICUs necessitates further center-level tailoring.
- The implementation program was perceived as successful in addressing barriers and improving care.
Keywords:
clinical practice guidelinescritical careevaluation methodologyevidence-based practiceimplementation scienceMore Related Videos
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