Implementing best practice guidelines: the influence of personal characteristics

Clinical practice guidelines (CPGs) have not been widely adopted by general practitioners despite their obvious benefits of improving health care. Personal characteristics have been identified as one factor influencing doctors' attitudes towards guidelines. This study examined the impact of personal characteristics of Australian general practitioners on their attitudes towards guidelines. Favouring a fee-for-service remuneration system is highly associated with a negative view towards guidelines. This finding needs to be taken into account when developing strategies for the implementation of guidelines in the Australian context.     

Evaluating best practice guidelines

Clinical practice guidelines are developed with the purpose of improving patient care. The Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines (BPG) Project was implemented in 1999. It has resulted in the development, implementation and evaluation of 17 BPGs with agencies in different healthcare sectors. This article describes the process, challenges and lessons learned by the team responsible for evaluating the BPGs.     

Surgical wound benchmark tool and best practice guidelines

Surgical wounds that heal by primary intention are expected to heal without complication (Watret and White, 2001). Patients are frequently subjected to a variety of treatment regimens, often based on individual practitioners' preferences. This article discusses how one acute hospital trust developed a multidisciplinary approach to devise best practice guidelines. This was achieved through consensus and expertise of a working party, and a clinical practice benchmark tool for patients with surgical wounds to standardize and ensure the implementation of evidence-based practice. Clinical practice benchmarking is "a process through which best practice is identified and continuous improvement pursued though comparison and sharing" (Department of Health (DoH), 1999). The work has led to the development of a standardized assessment and documentation tool, which the working party hopes will be used trust-wide. In addition, ward staff are encouraged to undertake the benchmark process as a method of identifying areas where the use of this tool would ensure that standards of care could be improved.     

Enhancing nurses' capacity to facilitate learning in nursing students: effective dissemination and uptake of best practice guidelines

The preparation of nursing students for the real world of practice is a significant contemporary issue for health care and education institutions globally. Positive learning experiences are enabled through positive role models and attitudes which impact on ward culture. Although these best practices have been described, they have not been assimilated into the health-care system as the uptake of evidence is fraught with difficulties. Using the problem-solving approach of fitting evidence into practice--Read, Think, Do, this paper describes practical activities throughout the process to assimilate evidence. In particular, it details effective strategies that take into account the clinical context, such as displaying posters, demonstration of problem resolution in small group sessions and role modelling, and a presence in the clinical area. All of these contribute to the uptake of the guidelines to improve student experiences within the clinical setting.     

Urinary drainage following continence surgery: development of Canadian best practice guidelines

INTRODUCTION: Researchers evaluated the impact of a new algorithm for postoperative catheter removal with women who underwent surgery for stress incontinence. OBJECTIVE: This study aimed to improve the postoperative process by developing practice guidelines for urinary drainage after surgery for urinary stress incontinence in a female population. METHOD: The quality improvement study collected 2 years of retrospective data and 1 year of prospective data on all women who had surgery for stress incontinence. This involved a variety of surgical procedures that were performed by a small number of surgeons. RESULTS: Burch colposuspension was the predominant procedure, and on the prospective piece of the study, with the new guidelines, time to first postoperative void decreased. CONCLUSIONS: Fewer interventions and decreased length of stay indicated that the guidelines are evidence of improved practice.