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Implementation strategies to facilitate the uptake of practice guidelines in nursing: A systematic review
Dr. Christine Cassidy PhD RNAssistant Professor | School of Nursing, Dalhousie University
Affiliate Scientist | IWK Health
[email protected] | @cecassidyRN
Margaret B. Harrison, Christina Godfrey, Ian D. Graham, on behalf of the Implementation Strategies in Nursing Systematic Review Working Group
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The KT Gap
Practice & PolicyEvidence
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Nursing Practice Guidelines
Nurses are the largest group of practitioners in the health system
Potential to translate evidence into practice
Practice guidelines can reduce variations in nursing practice and improve patient care
(Mackey & Bassendowski, 2017; IoM, 2011)
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Guideline Implementation
Implementation of practice guidelines is complex and inconsistent in practice
Previous research has evaluated effectiveness of implementation strategies in different contexts
Unclear which strategies are effective at implementing guidelines in nursing practice
(Grol, 2001; Fischer et al., 2016; Jones et al., 2015; Watkins et al., 2015)
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Study Aim
Determine the effectiveness of implementation strategies to facilitate the uptake of guidelines focused on nursing care
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Methods
Systematic review following Cochrane systematic review and meta-analysis guidance
Due to significant differences between studies, including intervention dose, mode of delivery, and outcomes measured, we were not able to conduct a meta-analysis
We conducted a narrative synthesis of implementation strategies used and their effectiveness
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Eligibility Criteria
Nurses (Registered Nurses, Nurse Practitioners, Licensed Practical Nurses)
Intervention used to implement a guideline in nursing (i.e., implementation strategy)
Usual practice, usual care, or traditional dissemination
Professional knowledge, practice, patient health status, resource use, expenditures
P
I
C
O
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Search Strategy & Study SelectionSystematic review of 5 electronic databases + Cochrane Effective Practice and Organization of Care (EPOC) specialized registry
Nursing library scientists at Queen’s University adapted EPOC search strategy for nursing literature
Searched up to September 30th, 2020
Two reviewers independently screened titles and abstracts, full-text papers, and assessed study quality using the EPOC Risk of Bias 2.0 Checklist
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Data Abstraction & Analysis Two reviewers used standardized form
Categorized implementation strategies using EPOC taxonomy
Inductive thematic analysis approach for strategies not included in EPOC taxonomy
Narrative synthesis & descriptive statistics
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Results
38,172 records identified
924 full-text review
41 studies in 46 papers included
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Implementation Strategies Used36 studies reported multi-component strategies5 studies reported single component strategies40/41 Studies used educational strategies
Educational Meetings(n=33)Educational Materials(n=27)Educational Outreach Visits(n=12)Audit & Feedback (n=11)
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Educational Strategies UsedVariety of educational strategies usedDifferences in mode of delivery and frequency
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27
12
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Lectures Small Group Work Pamphlets Videos
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Implementation Strategies Used - Not in EPOC Taxonomy
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Facilitation
Adaptation to Local Context
Changes to Org Policy
Participatory Approach
Number of Studies
28/41 studies included a combination of educational strategies and other implementation strategies not in the EPOC taxonomy
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Implementation Strategy Effectiveness
63%
80%
54%
59%
64%
0% 20% 40% 60% 80% 100%
Expenditures
Resource Use
Patient Health Status
Professional Practice
Professional Knowledge
Percentage of Outcomes Reported as Positive
Positive Outcomes
(n=9/14)
(n=29/49)
(n=14/26)
(n=4/5)
(n=5/8)
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Effectiveness of Strategies Not in EPOC Taxonomy
60%
Percentage of Outcomes Reported as Positiven=26/43 outcomes
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Discussion Majority of studies evaluated educational strategies and showed positive and significant effects on outcomes
Nursing appears to be advancing the evidence-base on implementation strategies
Additional implementation strategies may be more useful for nursing contexts
EPOC search strategy requires enhancement to access relevant nursing literature
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Discussion Majority of studies evaluated educational strategies and showed positive and significant effects on outcomes
Nursing appears to be advancing the evidence-base on implementation strategies
Additional implementation strategies may be more useful for nursing contexts
EPOC search strategy requires enhancement to access relevant nursing literature
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Discussion Majority of studies evaluated educational strategies and showed positive and significant effects on outcomes
Nursing appears to be advancing the evidence-base on implementation strategies
Additional implementation strategies may be more useful for nursing contexts
EPOC search strategy requires enhancement to access relevant nursing literature
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Conclusion
Practice Guidelines
Educational Strategies
Practice & Policy
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Conclusion
Practice Guidelines
Educational Strategies
Practice & Policy
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Conclusion
Practice Guidelines
Educational Strategies
Participatory Strategies
Practice & Policy
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Thank you!
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Dr. Christine Cassidy PhD RNAssistant Professor | School of Nursing, Dalhousie UniversityAffiliate Scientist | IWK [email protected] | @cecassidyRN
On behalf of the Implementation Strategies in Nursing Systematic Review Working Group