Guideline dissemination and implementation interventions for nursing

Abstract

Background: The implementation of practice guidelines by nurses may reduce variations in practice and improve patient care. Research is needed to identify the most effective implementation interventions to increase the use of guidelines in practice and the impact of guideline implementation. Objective: To conduct a systematic review to identify and assess the effects of the interventions employed to increase the use of practice guidelines in nursing. Methods: Systematic review searching Cochrane EPOC Group specialized register, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO to 2013 for randomized controlled trials, controlled before-and-after studies and controlled interrupted time series analyses. Two reviewers independently assessed study quality and extracted data. Results: Over 21,000 titles screened to identify 26 studies (reported in 28 papers); 25 RCTs, 1 CBA; 15 studies from North American, 8 from Europe; 3 studies at high risk of bias; most common implementation interventions: educational meetings (n = 19); distribution of educational material (N = 19); outreach visits (n = 12). Educational meetings plus distribution of educational material plus other interventions had largest effect on nursing practice (medium ARD 18–40%). Interventions improved knowledge of nurses (median ARD 6–10%); improved practice of nurses (median ARD 3–40%); and improved patient outcomes (median ARD −2–7.7%). Discussion: Implementation interventions to increase guideline use by nurses generally improved their knowledge and practice, and patient outcomes. Conclusion: When implemented practice guidelines in nursing, improves process of care and patient health outcomes. Research on guideline implementation continues to evolve and suggest that nursing may be different than medicine.