Abstract
Background
A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensus-based guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent.
Objective
This study investigated to what extent the guidelines were implemented and which factors played a role in implementation.
Study design
A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semi-structured interviews, perceived barriers and facilitators for implementation were explored.
Participants
Fellows and neonatologists working at all ten Dutch level 3–4 NICUs were eligible.
Results
On an average, NICUs implemented 12.6 (of 19) guidelines (range 6–17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation).
Conclusion
The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
McClellan MB, McGinnis JM, Nabel EG, Olsen LAM. Evidence-Based Medicine and the Changing Nature of Healthcare: Meeting Summary (IOM Roundtable on Evidence-Based Medicine). National Academy of Sciences;2008. p. 49–70.
Meyer S. Evidence-based medicine in neonatology: The need for multifaceted improvements. Neonatology. 2020;117:123–24.
European Standards of Care for Newborn Health EFCNI (2020) Standards Overview. Accessed July 15, 2020. Available from: https://newborn-health-standards.org/standards/overview/
European Standards of Care for Newborn Health EFCNI (2020) Project Methods. Standard development process — in detail. Accessed July 15, 2020. Available from: https://newborn-health-standards.org/project/methods/
Horbar JD. The Vermont Oxford Network: evidence-based quality improvement for neonatology. Pediatrics. 1999; 103:350–9.
Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies-a synthesis of systematic review findings. J Eval Clin Prac. 2008; 14:888–97.
Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Policy Ment Health. 2011;38:65–76.
Fischer F, Lange K, Klose K, et al. Barriers and strategies in guideline implementation-a scoping review. Healthcare. 2016;4:36.
Centraal Bureau Statistiek, CBS Bevolkingsteller. Accessed November 23, 2020. Available from: https://www.cbs.nl/nl-nl/visualisaties/bevolkingsteller
Perined, Perinatale zorg in Nederland anno 2018: landelijke perinatale cijfers en duiding. Published November 26, 2019. Accessed March 23, 2020. Available from: URL: https://www.perined.nl/Perinatale zorg in Nederland anno 2019
Palinkas LA, Aarons GA, Horwitz S, et al. Mixed method designs in implementation research. Adm Policy Ment Health. 2011;38:44–53.
Ogrinc G, Davies L, Goodman D, et al. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25:986–92.
May CR, Mair F, Finch TL, et al. Development of a theory of implementation and integration: Normalization process theory. Implementation Science. 2009;4:29.
Rabin BA, Purcell P, Naveed S, et al. Advancing the application, quality and harmonization of implementation science measures. Implement Sci. 2012;7:119.
Rapley T, Girling M, Mair FS, et al. Improving the normalization of complex interventions: part 1 — development of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol. 2018;18:133.
Finch TL, Girling M, May CR, et al. Improving the normalization of complex interventions: part 2 — validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Med Res Methodol. 2018;18:135.
Vis C, Ruwaard J, Finch TL, et al. Toward an objective assessment of implementation processes for innovations in health care: Psychometric evaluation of the normalization measure development (NoMAD) questionnaire among mental health care professionals. J Med Int Res. 2019;21:e12376.
Bishop PA, Herron RL. Use and misuse of the Likert item responses and other ordinal measures. Intern J Exercise Sci. 2015;8:297–302.
Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018;18:91–3.
Tong ASP, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.
Morgan DL, Ataie J, Carder P, Hoffman K. Introducing dyadic interviews as a method for collecting qualitative data. Qual Health Res. 2013;23:1276–84.
King N. Chapter 21: Using Templates in the Thematic Analysis of Text. In: Cassell C, Symon G. Essential Guide to Qualitative Methods in Organizational Research. SAGE Publications Ltd; 2004. p. 256–70.
Lago P, Garetti E, Boccuzzo G, et al. Procedural pain in neonates: the state of the art in the implementation of national guidelines in Italy. Paediatr Anaesthesia. 2013;23:407–14.
Donnell Z, Hoffman R, Myers G, Sarmiento K. Seeking to improve care for young patients: Development of tools to support the implementation of the CDC Pediatric mTBI Guideline. J Safety Res. 2018;67:203–9.
Davis DA, Taylor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience, and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997;157:408–16.
Funding
None
Author information
Authors and Affiliations
Contributions
EST, RCJdeJ, FC, MvdL, KAdeB-M, EEMM, HJN, SAP, MEvdP, RV: substantial contributions to the study, including: Concep-tualization, methodology, investigation, data curation and formal analysis, participating in writing (drafting the initial manuscript); MH,MvS,AJMC: substantial contributions to the study, including: Supervision, conceptualization, methodology, investigation, interpretation of data, data curation, formal analysis, resources, participating in writing (review and editing of the manuscript). All authors provided final approval to the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Institutional Ethics Committee of the Radboudumc; No. IRB 2020-6274 dated March, 2020.
Additional information
Note
Additional material related to this study is available with the online version at www.indianpediatrics.net
Competing interest
None stated.
Electronic Supplementary Material
Rights and permissions
About this article
Cite this article
Talsma, E., de Jonge, R., Cassel, F. et al. Implementation of Nationwide Evidence- and Consensus-Based Guidelines to Harmonize Neonatal Care in The Netherlands. Indian Pediatr 59, 371–376 (2022). https://doi.org/10.1007/s13312-022-2516-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-022-2516-3