Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
Pediatric Critical Care, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
BMJ Open Qual. 2024 Mar 1;13(1):e002485. doi: 10.1136/bmjoq-2023-002485.
Evidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall compliance to multiple nuanced guidelines in a paediatric intensive care setting.
Guideline compliance was observed and measured with a prospective cohort at a tertiary academic paediatric medical-surgical intensive care unit. Adherence to 19 evidence-based clinical care guidelines was evaluated in 814 patients, and reasons for non-compliance were noted along with other associated outcomes.
Overall facility compliance was unexpectedly high at 77.8% over 4512 compliance events, involving 826 admissions. Compliance varied widely between guidelines. Guidelines with the highest compliance were stress ulcer prophylaxis (97.1%) and transfusion administration such as fresh frozen plasma (97.4%) and platelets (94.8%); guidelines with the lowest compliance were ventilator-associated pneumonia prevention (28.7%) and vitamin K administration (34.8%). There was no significant change in compliance over time with observation. Guidelines with binary decision branch points or single-page decision flow diagrams had a higher average compliance of 90.6%. Poor compliance was more often observed with poor perception of guideline trustworthiness and time limitations.
Measuring guideline compliance, though onerous, allowed for evaluation of current clinical practices and identified actionable areas for institutional improvement.
循证临床护理指南通过减少错误、改善结果并可能降低医疗保健成本来改善医疗。虽然有一些关于个别指南遵守情况的数据，但在儿科重症监护环境中，没有关于多项细致指南总体遵守情况的数据。
前瞻性队列研究在一所三级学术儿科内科重症监护病房进行了指南遵守情况的观察和测量。在 814 名患者中评估了 19 项循证临床护理指南的依从性，并记录了不遵守的原因以及其他相关结果。
在涉及 826 例入院的 4512 次依从性事件中，整个设施的依从率令人意外地高达 77.8%。指南之间的依从率差异很大。依从率最高的指南是应激性溃疡预防（97.1%）和输血管理，如新鲜冷冻血浆（97.4%）和血小板（94.8%）；依从率最低的指南是呼吸机相关性肺炎预防（28.7%）和维生素 K 管理（34.8%）。观察发现，随着时间的推移，依从性没有明显变化。具有二进制决策分支点或单页决策流程图的指南平均依从率为 90.6%。较差的依从性更常发生在对指南可信度和时间限制的看法较差的情况下。
衡量指南的遵守情况虽然繁琐，但允许评估当前的临床实践并确定机构改进的可操作领域。
