Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study.
BMJ Open
; 9(3): e024159, 2019 03 15.
Article
en En
| MEDLINE
| ID: mdl-30878979
ABSTRACT
OBJECTIVE:
To compare and contrast illustrative examples of the adoption of high value practices and the de-adoption of low value practices.DESIGN:
(1) Retrospective, population-based audit of low molecular weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis (high value practice) and albumin for fluid resuscitation (low value practice) and (2) cross-sectional survey of healthcare providers.SETTING:
Data were collected from nine adult medical-surgical intensive care units (ICUs) in two large Canadian cities. Patients are managed in these ICUs by a group of multiprofessional and multidisciplinary healthcare providers.PARTICIPANTS:
Participants included 6946 ICU admissions and 309 healthcare providers from the same ICUs. MAIN OUTCOMEMEASURES:
(1) The use of LMWH for VTE prophylaxis (per cent ICU days) and albumin for fluid resuscitation (per cent of patients); and (2) provider knowledge of evidence underpinning these practices, and barriers and facilitators to adopt and de-adopt these practices.RESULTS:
LMWH was administered on 38.7% of ICU days, and 20.0% of patients received albumin.Most participants had knowledge of evidence underpinning VTE prophylaxis and fluid resuscitation (59.1% and 84.2%, respectively). Providers perceived these practices to be followed. The most commonly reported barrier to adoption was insufficient knowledge/understanding (32.8%), and to de-adoption was clinical leader preferences (33.2%). On-site education was the most commonly identified facilitator for adoption and de-adoption (67.8% and 68.6%, respectively).CONCLUSIONS:
Despite knowledge of and self-reported adherence to best practices, the audit demonstrated opportunity to improve. Provider-reported barriers and facilitators to adoption and de-adoption are broadly similar.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Heparina de Bajo-Peso-Molecular
/
Tromboembolia Venosa
/
Fluidoterapia
/
Albúmina Sérica Humana
/
Unidades de Cuidados Intensivos
/
Anticoagulantes
Tipo de estudio:
Guideline
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Límite:
Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
BMJ Open
Año:
2019
Tipo del documento:
Article
País de afiliación:
Canadá