Mind the gap! Guideline implementation for peripheral venous catheters in paediatric care : documetation, complications, adherence and context

Introduction: There is a knowledge translation gap between evidence, based on research findings and clinical practice. Clinical practice guidelines (CPGs) have been proposed as a strategy to condense and disseminate research findings. However their existence alone does not minimise the gap, they have to be implemented in everyday practice. Registered nurses’ (RNs) work context influences their research use, but little is known on what contextual factors that influence RNs’ adherence to CPGs. Computer reminders have shown potential to minimise the knowledge translation gap, but insights into their effect on patients’ outcomes, RNs’ adherence and in what context they are most effective is still understudied. Aim: to evaluate the effects of implementing recommendations from a CPG for peripheral venous catheters (PVCs) as reminders in electronic patient records (EPR) and to describe factors of importance for the implementation process and outcomes. Methods: the setting for all four papers was a large paediatric university hospital in Sweden. Data for paper I was collected from 14 inpatient units through observations of patients and PVCs, and audit of EPRs. This was carried out at baseline and than two times after implementing a documentation template for PVCs. Data on PVCs and patients for paper II were retrieved from the EPR at 12 inpatient units, divided into neonatal and paediatric units. Paper III was a cross-sectional survey, including 23 in- and outpatient units. Data was collected through a questionnaire concerning RNs’ adherence to CPG recommendations and their work context, measured by the Alberta Context Tool (ACT). Paper IV was a cluster randomised study, at 12 inpatient units, with computer reminders based on the CPG. A stratified randomisation of units, based on occurrence of PVCs, was performed. The primary outcome was documented signs and symptoms of PVC-related complications at removal and secondary outcome was RNs’ adherence to the CPG, and their work context measured by the ACT. Results: A statistical, not clinical, significant increase of PVCs with complete documentation was the result of the PVC template. One of the 22 complications observed at baseline was documented and none of the complications (n=17 and n=9) post-intervention (paper I). Just over one-third (35.4%) of the patients were affected by a PVC-related complication, with infiltration and occlusion occurring most frequently. Complications were more common in younger age patients