Jordan Portia, Mpasa Ferestas, Ten Ham-Baloyi Wilma, Bowers Candice
Department of Nursing Science, Nelson Mandela Metropolitan University , Port Elizabeth, South Africa.
Faculty of Health Sciences, Nelson Mandela Metropolitan University , Port Elizabeth, South Africa.
Int J Health Care Qual Assur. 2017 May 8;30(4):358-372. doi: 10.1108/IJHCQA-08-2016-0119.
Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.'s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 ( n=11) research studies met the inclusion criteria. Findings After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.'s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used. Practical implications Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs. Originality/value No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.
目的 本文旨在批判性地分析与重症监护病房（ICU）临床实践指南（CPG）实施策略相关的实证研究。
设计/方法/途径 采用了一种系统评价方法，并结合了改编自波佩等人叙事综合法的叙事综合。2014年通过CINAHL、谷歌学术、学术搜索完整版、Cochrane随机对照试验注册库、通过PUBMED检索的MEDLINE以及灰色文献进行了检索，并于2016年8月更新。在阅读摘要、标题和全文文章后，有11项研究符合纳入标准。
研究结果 经过批判性评价，使用乔安娜·布里格斯批判性评价工具，保留了8项在成人和新生儿ICU中采用实施策略的随机对照试验。采用并改编了波佩等人的叙事综合法来分析和综合数据，并形成结论性陈述。纳入研究发现，多方面策略似乎比单一策略更有效。最常用的策略包括印刷教育材料、信息/会议、审核、反馈、使用拥护者领导者、教育外展访问以及计算机或互联网使用。实践培训、监督访问和大查房使用较少。
实际意义 临床医生可以利用这些研究结果，在ICU中实施多方面实施策略的最佳组合，以促进CPG的最佳使用。
原创性/价值 在ICU中，此前尚未对最佳实施CPG的实施策略进行过系统评价。
