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Canadian Journal of Anesthesia

, 54:728 | Cite as

Clinical practice guidelines in the intensive care unit: a survey of Canadian clinicians’ attitudes

  • Tasnim SinuffEmail author
  • Kevin W. Eva
  • Maureen Meade
  • Peter Dodek
  • Daren Heyland
  • Deborah Cook
Reports of Original Investigations

Abstract

Purpose

To understand clinicians’ perceptions regarding practice guidelines in Canadian intensive care units (ICUs) to inform guideline development and implementation strategies.

Methods

We developed a self-administered survey instrument and assessed its clinical sensibility and reliability. The survey was mailed to ICU physicians and nurses in Canada to determine local ICU guideline development and use, and to compare physicians’ and nurses’ attitudes and preferences towards guidelines.

Results

The survey was completed by 51.6% (565/1095) of potential respondents. Although less than half reported a formal guideline development committee in their ICU, 81.0% reported that guidelines were developed at their institutions. Of clinicians who used guidelines in the ICU, 70.2% of nurses and 42.6% of physicians reported using them frequently or always. Professional society guidelines (with or without local modification) were reportedly used in most ICUs, but physicians were more confident than nurses of their validity (P < 0.001). Physicians considered endorsement of guidelines by a colleague more relevant for enhancing guideline use than did nurses (P < 0.001). Nurses considered low risk of the guideline and whether the guideline is consistent with their practice (P < 0.001) to be more relevant to guideline uptake than did physicians (P < 0.001). Lack of agreement with recommendations was a more important barrier to use of guidelines for physicians than for nurses (P < 0.001).

Conclusions

Many Canadian institutions locally develop guidelines, and many ICU physicians and nurses report using them. Planning implementation strategies according to clinician preferences may increase guideline use. The nature of the differences in attitudes towards guidelines between nurses and physicians, and their impact on clinician adherence to guidelines requires further exploration.

Keywords

Guideline Development Intensive Care Unit Physician Intensive Care Unit Nurse Critical Care Nurse Intensive Care Unit Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Guide de pratique clinique dans les unités de soins intensifs: un sondage sur les attitudes des cliniciens canadiens

Résumé

Objectif

Comprendre les perceptions des cliniciens quant aux guides de pratique dans les unités de soins intensifs afin d’améliorer le développement de directives et la mise en œuvre de stratégies.

Méthode

Nous avons développé un sondage auto-administré et avons évalué sa sensibilité et sa fiabilité cliniques. Le formulaire de sondage a été envoyé à des intensivistes et des infirmiers/infirmières au Canada afin de déterminer l’utilisation et le développement local de guides de pratique dans les unités de soins intensifs, et de comparer les attitudes et préférences des médecins et des infirmiers/infirmières quant aux guides de pratique.

Résultats

Le questionnaire a été rempli par 51,6 % (565/1095) des répondants potentiels. Bien que moins de la moitié aient fait état d’un comité officiel de développement d’un guide de pratique dans leur unité de soins intensifs, 81,0% rapportent que certains guides ont été développés dans leur institution. Parmi les cliniciens utilisant des guides de pratique aux soins intensifs, 70,2 % des infirmiers/infirmières et 42,6 % des médecins ont répondu les utiliser fréquemment ou toujours. Les guides de pratique de sociétés professionnelles (avec ou sans modification locale) sont, selon le sondage, utilisés dans la plupart des unités de soins intensifs, mais les médecins ont montré plus de confiance dans leur validité que les infirmiers/infirmières (P < 0,001). Les médecins ont considéré la reconnaissance du guide de pratique par un collègue comme plus influente vis-à-vis de l’observance d’un guide de pratique que les infirmiers/infirmières (P < 0,001). Les infirmiers/infirmières ont considéré qu’un guide de pratique au risque réduit et sa cohérence avec la pratique quotidienne (P < 0,001) étaient plus pertinents à l’adoption d’un guide de pratique que les médecins (P < 0,001). Le désaccord concernant les recommandations a constitué une barrière plus importante à la mise en pratique d’un guide pour les médecins que pour les infirmiers/infirmières (P < 0,001).

Conclusion

De nombreuses institutions canadiennes développent des guides de pratique localement, et de nombreux médecins et infirmiers/infirmières des soins intensifs rapportent leur utilisation. La planification de stratégies de mise en œuvre selon les préférences des cliniciens pourrait accro ître l’utilisation des directives. La nature des différences quant aux guides par les infirmiers/infirmières et les médecins, ainsi que leur impact sur l’observance en clinique des guides, nécessitent des études approfondies.

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Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  • Tasnim Sinuff
    • 1
    Email author
  • Kevin W. Eva
    • 2
  • Maureen Meade
    • 2
  • Peter Dodek
    • 3
  • Daren Heyland
    • 4
  • Deborah Cook
    • 2
  1. 1.Department of Critical Care &Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, &Interdepartmental Division of Critical CareUniversity of TorontoTorontoCanada
  2. 2.Department of Clinical Epidemiology &Biostatistics, and Medicine ‡McMaster UniversityHamilton
  3. 3.Department of Medicine &Centre for Health Evaluation and Outcome SciencesUniversity of British ColumbiaVancouver, British Columbia
  4. 4.Department of MedicineQueen’s UniversityKingstonCanada

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