1 / 15

Overcoming Barriers to Guideline Compliance: Evidence-based Strategies for Preventing CLABSI

Learn about the types of barriers to guideline compliance, how to identify them, and develop processes to eliminate or reduce their effects. Discover evidence-based behaviors, ask front-line staff, observe and try out the guideline, and address beliefs and ambiguities.

leslieward
Download Presentation

Overcoming Barriers to Guideline Compliance: Evidence-based Strategies for Preventing CLABSI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. On the CUSP: STOP BSI Identifying Barriers to Evidence-basedGuideline Compliance

  2. Learning Objectives • To learn about the different types of barriers to guideline compliance • To learn how to identify the barriers to guideline compliance • To understand how to develop a process to eliminate or reduce the effects of these barriers

  3. Evidence-based Behaviors to Prevent CLABSI • Remove unnecessary lines • Wash hands prior to procedure • Use maximal barrier precautions • Clean skin with chlorhexidine • Avoid femoral lines

  4. Ask Front-line Staff • What are some of the leading problemsand barriers encountered in your unit that may hinder compliance with this guideline? • Does the front-line staff know what is expected from them regarding guideline compliance? Do they agree with the guideline? • Whatare some of the strategies and tools you have implemented toimprove compliance with this guideline in your unit?

  5. Specific Items • Who are the care providersresponsible for ensuring compliance with this guideline? Canyou describe their roles with regards to complying with thisguideline? • What information do you need to be able to followthis guideline? • How do you findout the date that a central venous catheter was inserted to a patient? • What are yourpractices to reduce central venous catheter-related bloodstreaminfections? What are the common lapses in compliance?

  6. Observe • Shadow a care provider while following a guideline (multiple times, multiple providers) • Include different lenses – nurse, infection control, human factors/ QI expert shadowing physician • Focus on system characteristics rather than the individual physician

  7. Try out the Guideline • Triability of a guideline increase guideline compliance • Usability testing of a technology (guideline) • Walkthrough: Walk the process of inserting and maintaining a central line • Scenario-based testing • How easy is it to comply with the guideline?

  8. Types of Barriers (4As) • Awareness → Implement education • Agreement → Group discussion • Ambiguity → Clarify any type of ambiguity • Ability → Identify any impeding system factors and eliminate them or reduce their impact

  9. Beliefs of a Clinician • Behavioral beliefs: Does complying with a guideline lead to positive outcome(s)? • Normative beliefs: What are the expectations of my colleagues regarding complying with a particular guideline? • Control beliefs: What are the factors that may impede or facilitate guideline compliance and how much I can control these?

  10. Ambiguities • Task ambiguity • Expectation ambiguity • Responsibility ambiguity • Method ambiguity • Exception ambiguity

  11. Examples to Barriers • Unclear feedback (expectation ambiguity):Presenting bloodstream infectionrates in the format of 4.6 per 1000 line days is not perceivedby nurses as directly relevant to their practice • Forgetting to review line necessity daily due to inadequate reminder mechanism • High workload negatively affecting hand washing compliance • Central line cart is not stocked regularly

  12. Identifying Barriers • Conduct preliminary interviews to understand causes of non-compliance. Is guideline compliance intentional or non-intentional? • Non-intentional: Interview care provider • Intentional: Conduct observations and interviews • Include different types of care providers in the process of identifying barriers (physicians, nurses, respiratory therapists, infection control, human factors expert)

  13. Reporting Findings Reporting framework • Provider: job category, skills, beliefs • Tasks: Ambiguities (role, task, exception), guideline • Environment • Tools • Organization Interdisciplinary meeting • Discuss findings • Prioritize barriers and develop action plans

  14. Action Plan • Form an interdisciplinary group of people (physician, nurse, inf control, resp therapy, human factors/QI expert, other) responsible with identifying barriers • Each one conducts at least one observation and one interview. • One clinician and one non-clinician walks through the process together. • Summarize findings using the barrier reporting framework • Discuss findings in an interdisciplinary meeting (including unit administrators) and prioritize the barriers to tackle. • Identify action plans and assign responsibilities • Review the progress periodically

  15. References • Azjen (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. • Carayon et al. (2006) Works system design for patient safety: the SEIPS model. QSHC 15: i50 - i58. • Gurses et al. (2008) Systems ambiguity and guideline compliance, QSHC 17:351-359 • Pronovost et al. (2008). Translating evidence into practice: a model for large scale knowledge translation. BMJ 337:a1714 • Reason (1990) Human Error. Cambridge University Press, Cambridge. • Rogers, E. M. (1995). Lessons for guidelines from the diffusion of innovations. Jt.Comm J.Qual.Improv. 21, 324-328. • Thompson (2008) View the world through a different lens: shadowing another Jt.Comm J.Qual.Improv . 34, 614-618(5).

More Related