The application of antimicrobial stewardship knowledge to nursing practice: A national survey of United Kingdom pre-registration nursing students.

AIM: To assess student nurses understanding and skills in the application of antimicrobial stewardship knowledge to practice. DESIGN: Quantitative. METHODS: Cross-sectional survey. RESULTS: Five hundred and twenty three student nurses responded across 23 UK universities. Although students felt prepared in competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice, they felt less prepared in competencies in which microbiological knowledge, prescribing and its effect on antimicrobial stewardship is required. Problem-based learning, activities in the clinical setting and face-to-face teaching were identified as the preferred modes of education delivery. Those who had shared antimicrobial stewardship teaching with students from other professions reported the benefits to include a broader understanding of antimicrobial stewardship, an understanding of the roles of others in antimicrobial stewardship and improved interprofessional working. CONCLUSION: There are gaps in student nurses' knowledge of the basic sciences associated with the antimicrobial stewardship activities in which nurses are involved, and a need to strengthen knowledge in pre-registration nurse education programmes pertaining to antimicrobial management, specifically microbiology and antimicrobial regimes and effects on antimicrobial stewardship. Infection prevention and control, patient-centred care and interprofessional collaborative practice are areas of antimicrobial stewardship in which student nurses feel prepared. Interprofessional education would help nurses and other members of the antimicrobial stewardship team clarify the role nurses can play in antimicrobial stewardship and therefore maximize their contribution to antimicrobial stewardship and antimicrobial management. IMPLICATIONS FOR THE PROFESSION: There is a need to strengthen knowledge from the basic sciences, specifically pertaining to antimicrobial management, in pre-registration nurse education programmes. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: What Problem Did the Study Address? Nurses must protect health through understanding and applying antimicrobial stewardship knowledge and skills (Nursing and Midwifery Council 2018); however, there is no research available that has investigated nurses understanding and skills of the basic sciences associated with the antimicrobial stewardship activities in which they are involved. What Were the Main Findings? There are gaps in student nurses' knowledge of the basic sciences (specifically microbiology and prescribing) associated with the antimicrobial stewardship activities in which nurses are involved. Problem-based learning, and activities in the clinical setting, were reported as useful teaching methods, whereas online learning, was seen as less useful. Where and on Whom Will the Research Have an Impact? Pre-registration nurse education programmes. REPORTING METHOD: The relevant reporting method has been adhered to, that is, STROBE.

Aseptic versus clean technique during wound management? Systematic review with meta-analysis.

The management of wounds by health professionals usually involves aseptic technique. An alternative is the use of clean techniques where the risk of infection is minimised but use of non-sterile materials is considered permissible. This systematic review and meta-analysis compares these two approaches. Nine studies met the inclusion criteria. Overall risk of bias was judged to be low. The random-effects relative risk of infection for clean dressings rather than aseptic dressings was 0.86 (95% CI 0.67, 1.12). There was little evidence of statistical heterogeneity, although the small number of infections in either group resulted in wide confidence intervals. The 95% prediction interval for future studies was 0.63, 1.18. There was therefore no evidence showing inferiority of clean techniques compared to aseptic methods. Before clinical studies are undertaken with higher risk procedures, laboratory simulations should explore safety by investigating the potential for pathogen transmission at each stage in the dressing procedure.

Face mask use to prevent COVID-19 in clinical practice. Using a review of reviews to improve decision-making and transparency.

BACKGROUND: The COVID-19 pandemic has highlighted the importance of transparency and scientific rigour in the development of clinical guidance. Rapid review methodologies were widely used in the development of guidance, and in the United Kingdom, COVID-19 guidance was criticized for methodological inadequacy and erroneous conclusions. AIMS: To summarize the evidence looking at the use of face masks to prevent COVID-19 infection in clinical practice areas, and to show how this can be used in decision-making. DESIGN: Overview of systematic reviews. METHOD: Systematic reviews which included meta-analyses were sought, and data on the protective effect of face masks on COVID-19 transmission were extracted. A total of 15 papers yielded 44 effect sizes suitable for quantitative presentation, which showed wide variation in effect depending on the outcome and intervention chosen. CONCLUSIONS: Guideline development groups need to take care to choose outcomes that are of most importance to those who are the target of guidance. Quantification of the protective effect of interventions such as different types of face mask will help nurses and others decide on the utility of their use, alongside consideration of the other factors that go into informing clinical recommendations. IMPLICATIONS FOR PATIENT CARE AND THE PROFESSION: COVID-19 has been an unprecedented public health issue, but much clinical guidance was lacking in transparency. Nurses and other healthcare professionals have often expressed a lack of confidence in guidance. Systematic reviews reported a wide range of effect sizes. However, there was a high degree of indirectness and heterogeneity in methods and findings. To produce transparent guidance, those for whom guidance is intended should have evidence of effect where this is available. IMPACT: Guideline authors should reflect these outcomes in their recommendations, clearly balancing both the benefits and harms of recommending face masks to prevent COVID-19.

How aseptic technique is taught to undergraduate student nurses: A qualitative study.

BACKGROUND: Aseptic technique is essential to prevent healthcare-associated infection and reduce the risk of antimicrobial resistance but little research has explored how it is taught in undergraduate nursing curricula. OBJECTIVE: Explore how undergraduate student nurses learn about aseptic technique in classroom and clinical settings and the contribution of key stakeholders in the educational process: nurse educators, mentors and infection prevention nurses. DESIGN: Qualitative interview study with observation of teaching. SETTING: Two contrasting sites, one reporting greater innovation in relation to the teaching and practice of aseptic technique than the other. Each site comprised a university nursing department and the organisations providing student placements. PARTICIPANTS: Student nurses, university-based nurse educators, clinical mentors and infection prevention nurses. METHODS: Telephone interviews, fieldwork and unstructured observation of teaching in the universities. FINDINGS: Student nurses reported feeling poorly prepared to undertake aseptic technique. There were misunderstandings and confusion about its purpose and how it should be conducted among nurse educators and mentors. Suboptimal facilities, poor curriculum design and arrangements for competency assessment in both sites contributed to students' experiences. Reports of better innovation in one of the participating sites compared to standard practice in the other were not reflected in the data. CONCLUSIONS: The findings of this study corroborate earlier research: student nurses do not feel well-prepared to undertake aseptic technique. Healthcare providers and universities need to investigate and address deficiencies in understanding among those responsible for teaching and performing this key nursing skill. University curricula should be revised to ensure that teaching takes place optimally in relation to clinical placements, improve arrangements for students' competency assessment, focus more on teaching the principles underpinning aseptic technique and promote transferability from the classroom to different types of clinical settings. Communication between university and clinical staff should be strengthened.

Teaching health care students hand hygiene theory and skills: a systematic review.

Hand hygiene is the cornerstone of infection prevention but is poorly undertaken and under-appreciated by medical, nursing, and other health care students. This systematic review aimed to identify and describe strategies used to teach the theory and practice of hand hygiene, determine impact on knowledge and practice, and identify need for future education and research. Ten studies met the criteria for review. Health care students' theoretical knowledge of hand hygiene and their ability to practise are suboptimal and should be improved before they have contact with vulnerable patients. Educational input can increase knowledge and practice but the methodological heterogeneity of the studies and lack of rigour make it impossible to determine which interventions are most likely to be successful. The literature provides little evidence upon which to base educational practice in this area. There is a need for multi-centred longitudinal studies to measure effectiveness of teaching methods over time.

Undergraduate nursing students' education and training in aseptic technique: A mixed methods systematic review.

AIM: To appraise and synthesize empirical studies exploring undergraduate nursing students' education and training in aseptic technique. DESIGN: Mixed methods, systematic literature review adopting Joanna Briggs Institute methodology. DATA SOURCES: Thirteen electronic databases were searched 1996-2020, followed by searches with a general browser, hand-searching key journals and reviewing reference lists of retrieved papers. REVIEW METHODS: Potentially eligible papers were scrutinised by two reviewers. Those eligible were critically appraised and quality assessed using the Critical Appraisal Skills Programme and Specialist Unit for Review Evidence checklists. RESULTS: Of 538 potentially eligible studies, 27 met the inclusion criteria. There was limited evidence of the effectiveness of different teaching methods. Students' knowledge, understanding and competency varied and were often poor, although they reported confidence in their ability to perform aseptic technique. Students and qualified nurses perceived that education and training in aseptic techniques might be improved. CONCLUSION: Education and training in aseptic technique might be improved but the review findings should be viewed cautiously because the studies lacked methodological rigour. IMPACT: This appears to be the first systematic review to explore undergraduate nursing students' education and training in relation to aseptic technique. There was limited evidence to support the effectiveness of different teaching methods and scope for improving nursing students' knowledge, understanding and competency in aseptic technique. Students and qualified nurses suggested that education and training might be enhanced. More robust studies are required to support education, practice and policy.

Survey with content analysis to explore nurses' satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique.

BACKGROUND: Aseptic technique is a key skill undertaken every day by large numbers of nurses. However, there is relatively little empirical evidence to underpin practice. Furthermore, it is not clear to what extent it should be considered a single task or a set of principles to be applied differentially depending upon the situation and how individual nurses make this decision. OBJECTIVE: This study explored nurses' experiences of continuing professional education (CPE) in relation to aseptic technique. DESIGN: A national survey was undertaken throughout the United Kingdom. Responses were subjected to inductive quantitative content analysis. PARTICIPANTS: Participants were recruited via an electronic link placed on the website of a major nursing organisation. RESULTS: 941 nurses responded. 253 (26.9%) were satisfied with arrangements for continuing professional education. Satisfaction was associated with a perception of good support from employers, sound preparation before qualifying and practising aseptic technique regularly. 311 (33%) were dissatisfied. Reasons included witnessing unwarranted variations in practice (n = 55, 5.8%), witnessing suboptimal practice requiring correction (65, 6.9%), a perception that standards had fallen through a decline in pre-registration preparation (n = 109, 11.6%) and opportunities for updating (n = 124, 13.2%). Some employers had introduced training in conjunction with organisation-wide change in practice. In other cases participants reported receiving updates when required to perform a new procedure, when moving between clinical specialities or changing employer. Train-the-trainer (cascade) teaching was used in formal and informal arrangements for updating. CONCLUSION: This study provides a springboard for exploring arrangements for updating and assessing nurses' competence to undertake aseptic technique. Health providers need to evaluate what is currently provided and address gaps in provision. There is clear evidence that the current system does not meet the needs of many nurses.

Undertaking qualitative reviews in nursing and education - A method of thematic analysis for students and clinicians.

Objectives: To develop a simplified but rigorous method for qualitative reviews using thematic analysis, suitable for students and clinicians. Design: Methodological review. Data sources: Cochrane and Joanna Briggs Institute (JBI) methods, key references from these, and important original methodologies. Review methods: Examining similarities and differences between methods, and how key features can be combined. Results: Features of the JBI method, meta-ethnography, meta-study, and thematic-analysis were combined. This results in a method that uses codes from the original paper that are combined into themes. Themes reflect patterns in the data, most notably similarity and differences between codes; but also a line of argument. Where codes and themes are nested, the relationship between them should be shown in a hierarchical tree. There is also explicit consideration of the methods, theory, and assumptions behind each of the included papers. The quality of the underlying studies, body of evidence, and confidence in findings should be assessed using the tools described; and these used to develop transparent findings. Conclusions: This is one method by which systematic reviews can be undertaken by students and clinicians.

Electronic hand hygiene monitoring: accuracy, impact on the Hawthorne effect and efficiency.

OBJECTIVES: To evaluate a type five electronic monitoring system (EMS) for hand hygiene (HH) adherence with respect to accuracy and ability to avoid the Hawthorne effect. DESIGN: HH events were observed manually and electronically. The agreement between the two observation methods was evaluated. Continuous electronic measurement was made throughout the study. SETTING: An acute 31-bed medical ward in a National Health Service trust in London, United Kingdom. PARTICIPANTS: Staff working or attached to the ward. INTERVENTION: A newly developed type five EMS that can measure disinfectant dispenser usage as well as continuous movements of health workers throughout the ward with arm-length precision and analyse HH adherence was installed at the ward. RESULTS: A total of 294 HH events were observed in five sessions by an observer previously unknown to the ward. There was concordance between HH adherence assessed by manual observer and the EMS on 84% (79.1%-89.9%) of the occasions. During the five observation sessions, the observed HH adherence increased from 24% to 76% while the EMS measurements immediately before the arrival of the observer remained constant for all sessions. CONCLUSION: The 84% agreement between the EMS and the manual observation suggest a high level of precision for the evaluated system. The Hawthorne effect (higher rate of HH performance) was clearly seen in the increase by a factor of three in the manually observed adherence from session to session as the health workers became more aware of them being observed. The EMS was able to avoid the Hawthorne effect when the observer was not present.

National cross-sectional survey to explore preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom.

BACKGROUND: Aseptic technique is a core nursing skill. Sound preparation is required during pre-registration nursing education to enable student nurses to acquire the knowledge and skills necessary to prevent and control healthcare-associated infection and promote patient safety. Few studies have explored nursing students' education and training in aseptic technique. OBJECTIVES: To investigate what, when and how pre-registration nursing students are taught aseptic technique and how they are assessed in undergraduate, pre-registration nursing programmes in the United Kingdom. DESIGN: National cross-sectional survey exploring preparation to undertake aseptic technique in pre-registration nursing curricula in the United Kingdom. SETTING: Universities providing undergraduate, pre-registration adult nursing programmes in the United Kingdom. PARTICIPANTS: Nurse educators. METHODS: Structured telephone interviews were conducted with nurse educators. Descriptive and inferential statistical data analyses were undertaken. RESULTS: Response rate was 70% (n = 49/70). A variety of different learning and teaching methods were reported to be in use. Teaching in relation to aseptic technique took place in conjunction with teaching in relation to different clinical procedures rather than placing emphasis on the principles of asepsis per se and how to transfer them to different procedures and situations. Wide variation in teaching time; use of multiple guidelines; inaccuracy in the principles identified by educators as taught to students; and limited opportunity for regular, criteria based competency assessment were apparent across programmes. CONCLUSIONS: Pre-registration preparation in relation to aseptic technique requires improvement. There is a need to develop a working definition of aseptic technique. The generalisability of these findings in other healthcare students needs to be explored.

Qualitative interview study exploring frontline managers' contributions to hand hygiene standards and audit: Local knowledge can inform practice.

BACKGROUND: Frontline managers promote hand hygiene standards and adherence to hand hygiene protocols. Little is known about this aspect of their role. METHODS: Qualitative interview study with frontline managers on 2 acute admission wards in a large National Health Service Trust in the United Kingdom. RESULTS: Managers reported that hand hygiene standards and audit were modeled on World Health Organization guidelines. Hand hygiene outside the immediate patient zone was not documented but managers could identify when additional indications for hand hygiene presented. They considered that audit was worthwhile to remind staff that hand hygiene is important but did not regard audit findings as a valid indicator of practice. Managers identified differences in the working patterns of nurses and doctors that affect the number and types of hand hygiene opportunities and barriers to hand hygiene. Ward managers were accepted as the custodians of hand-hygiene standards. CONCLUSIONS: Frontline managers identified many of the issues currently emerging as important in contemporary infection prevention practice and research and could apply them locally. Their views should be represented when hand hygiene guidelines are reviewed and updated.

Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis.

OBJECTIVE: To systematically review the literature exploring the impact of isolation on hospitalised patients who are infectious: psychological and non-psychological outcomes. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Embase, Medline and PsycINFO were searched from inception until December 2018. Reference lists and Google Scholar were also handsearched. RESULTS: Twenty-six papers published from database inception to December 2018 were reviewed. A wide range of psychological and non-psychological outcomes were reported. There was a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardised mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34), although both had high levels of heterogeneity, and worse outcomes for a range of care-related factors but with significant variation. CONCLUSION: The review indicates that isolation to contain the risk of infection has negative consequences for segregated patients. Although strength of the evidence is weak, comprising primarily single-centre convenience samples, consistency of the effects may strengthen this conclusion. More research needs to be undertaken to examine this relationship and develop and test interventions to reduce the negative effects of isolation.

Applying thematic synthesis to interpretation and commentary in epidemiological studies: identifying what contributes to successful interventions to promote hand hygiene in patient care.

OBJECTIVES: Hand hygiene is considered the most important preventive measure for healthcare-associated infections, but adherence is suboptimal. We previously undertook a Cochrane Review that demonstrated that interventions to improve adherence are moderately effective. Impact varied between organisations and sites with the same intervention and implementation approaches. This study seeks to explore these differences. METHODS: A thematic synthesis was applied to the original authors' interpretation and commentary that offered explanations of how hand hygiene interventions exerted their effects and suggested reasons why success varied. The synthesis used a published Cochrane Review followed by three-stage synthesis. RESULTS: Twenty-one papers were reviewed: 11 randomised, 1 non-randomised and 9 interrupted time series studies. Thirteen descriptive themes were identified. They reflected a range of factors perceived to influence effectiveness. Descriptive themes were synthesised into three analytical themes: methodological explanations for failure or success (eg, Hawthorne effect) and two related themes that address issues with implementing hand hygiene interventions: successful implementation needs leadership and cooperation throughout the organisation (eg, visible managerial support) and understanding the context and aligning the intervention with it drives implementation (eg, embedding the intervention into wider patient safety initiatives). CONCLUSIONS: The analytical themes help to explain the original authors' perceptions of the degree to which interventions were effective and suggested new directions for research: exploring ways to avoid the Hawthorne effect; exploring the impact of components of multimodal interventions; the use of theoretical frameworks for behaviour change; potential to embed interventions into wider patient safety initiatives; adaptations to demonstrate sustainability; and the development of systematic approaches to implementation. Our findings corroborate studies exploring the success or failure of other clinical interventions: context and leadership are important.

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England.

OBJECTIVES: To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. DESIGN: A modelling study based on a combination of published data and clinical practice. SETTING: NHS hospitals in England. PRIMARY AND SECONDARY OUTCOME MEASURES: Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. RESULTS: In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs. CONCLUSION: This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.

Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool.

BACKGROUND: Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. METHODS: The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. RESULTS: Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. CONCLUSIONS: Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.

Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England.

OBJECTIVE: To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs). METHODS: Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs). RESULTS: The model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention. CONCLUSION: If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.

Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland.

OBJECTIVE: The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families. DESIGN: Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. SETTING: Four hospitals in Ireland. PARTICIPANTS: Healthcare professionals, patient and families. RESULTS: Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a 'dissonance between IPC guidelines and the reality of clinical practice' (theme 1) and 'Challenges to legitimatize guidelines' recommendations in practice' (theme 3). These elements contributed to 'Symbolic implementation of IPC guidelines' (theme 2), which was also determined by a 'Lack of shared reflection upon IPC practices' (theme 4) and a clinical context of 'Workforce fragmentation, time pressure and lack of prioritization of IPC' (theme 5). CONCLUSIONS: Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.

Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review.

OBJECTIVE: To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions. DESIGN: Scoping review. METHODS: A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013-2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted. RESULTS: From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing on the professional-patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional's power). CONCLUSIONS: There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.