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Evaluating the implementation of national recommendations on multidrug-resistant bacterial microorganisms in
Maria Heckel1, Annabell Illig1, Sarah Brunner1
1Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Introduction:
In 2017, a national recommendation on multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care was published. In order to monitor the implementation in a hospital-based palliative care unit, a dedicated multidisciplinary working group on MDRO was established. It developed a standard operating procedure and a documentation template (checklist). The aim of the present study is to evaluate the implementation status after one year.
Methods:
A mixed-methods approach was selected. The status of implementation was identified through a survey among staff members. A retrospective routine data analysis was performed. A focus group discussion with members of the working group focused on previous steps, factors conducive to implementation and on remaining problems.
Results:
Almost all (18 out of 20) participants (20 out of 29 eligible staff members) knew the national recommendations. Twelve out of 27 recommendations had a high degree of implementation after one year, another 13 recommendations were seen as at least partly integrated into daily routine. For two recommendations the degree of implementation was rated low: (i) "Taking into account any additional time constraint imposed by protection and isolation measures when planning for personnel and bed occupancy", and (ii) "Facilitating the patient's ability to distinguish and recognize team members and family caregivers". Working group members reported improvements since the implementation, whilst reporting some uncertainty prevailing among both staff members and visitors. Inhibitory factors were said to include the complexity of the standard operating procedure, inadequate usage and poor usability of the checklist. Behavioural and cognitive barriers such as anxieties related to transmission and the sense of security caused by the routine use of protective clothing were considered to be strong. Improving the checklist and the standard operating procedure as well as anchoring procedures in daily routine were considered to be the next important steps.
Discussion:
The implementation of recommendations is an iterative process and requires the ongoing development of appropriate measures for implementation in the respective institution. A multidisciplinary working group with monitoring tasks is an advantage.
Insights
Implementing national guidelines for multidrug-resistant bacterial microorganisms (MDRO) in palliative care requires ongoing adaptation. While many recommendations were adopted, challenges remain in staff training and patient-centered communication.
Area of Science:
- Healthcare Management
- Infectious Disease Control
- Palliative Care
Background:
- A national recommendation on multidrug-resistant bacterial microorganisms (MDRO) in end-of-life care was published in 2017.
- A multidisciplinary working group developed a standard operating procedure and checklist to monitor MDRO implementation in a hospital palliative care unit.
Purpose of the Study:
- To evaluate the implementation status of national MDRO recommendations after one year in a hospital-based palliative care unit.
- To identify factors influencing the successful integration of MDRO guidelines into clinical practice.
Main Methods:
- A mixed-methods approach was employed, including staff surveys and retrospective routine data analysis.
- A focus group discussion with the working group explored implementation facilitators and barriers.
Main Results:
- High awareness of national MDRO recommendations among staff.
- Twelve out of 27 recommendations achieved high implementation; 13 were partly integrated.
- Low implementation for recommendations concerning time constraints for isolation measures and patient recognition of caregivers.
- Identified barriers included SOP complexity, poor checklist usability, and behavioral factors like transmission anxiety.
Conclusions:
- MDRO recommendation implementation is an iterative process requiring continuous institutional adaptation.
- A multidisciplinary working group is beneficial for monitoring and guiding implementation efforts.
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