Sepsis Guideline Implementation
Sepsis Guideline Implementation
In order to circumvent some of the barriers outlined above, as a first step, the guideline writing process should be rigorous and transparent. It is important that appropriate clinicians and policy makers be involved early in the discussion pertaining either to crafting a guideline de novoor to adapting an existing guideline, such as the WFPICCS society or Surviving Sepsis Campaign guidelines. This is important because failure to invite the appropriate broad representation to the table will likely lead to frustration, suspicion and ultimately failure. For example, in our institution an oversight on our part was failure to involve pharmacy representatives at the start of the process even though they are involved in stocking unit doses of antibiotics in the emergency room and ICUs.
The AGREE tool is an example of a tool that provides a roadmap to either create or evaluate a guideline (http://www.agreetrust.org). Strict adherence to the elements included in such a roadmap will enable all stages to be conducted without missing any important steps, will insure the appropriate team members are involved, and will insure transparency and literature review. It will also allow evaluation of the necessary resources and outcome measures as well as opportunities for revising the guideline. The AGREE tool consists of 6 domains (Table 1) that address all aspects of implementation. Each of these domains controls a series of items (total 23) that guide every step of guideline development and address factors that may preclude adoption. AGREE is not the only tool that serves to assist in guideline development but it is validated, easy to use, widely accepted and comes with an easily accessible training manual.
Barriers to successful guideline implementation are summarized in Figure 4. Poor adherence can be due to inherent flaws in the process used in preparing the guidelines as outlined above, but just as important are the strategies used in implementation. Moreover, if quality control indicators for evaluation and monitoring are not appropriate and agreed on, monitoring will be haphazard and inadequate and provide meaningless information. This poses a problem in that if outcome measures are not monitored diligently, it is very difficult to determine the effectiveness of the guideline and to act to revise the guideline and protocol or address deficiencies in guideline implementation. Feedback loops using rapid PDSA (Plan, Do, Study, Act) cycles are important to continuously improve the guideline itself as well as to address cultural, resource and care process issues. In addition, with the advent of new technology, the framework used should include processes to incorporate these new facets to improve the care processes (Figure 3).
(Enlarge Image)
Figure 4.
Barriers to successful guideline implementation. All must be addressed for successful adoption of guidelines.
A Framework for Crafting a Sepsis Guideline
In order to circumvent some of the barriers outlined above, as a first step, the guideline writing process should be rigorous and transparent. It is important that appropriate clinicians and policy makers be involved early in the discussion pertaining either to crafting a guideline de novoor to adapting an existing guideline, such as the WFPICCS society or Surviving Sepsis Campaign guidelines. This is important because failure to invite the appropriate broad representation to the table will likely lead to frustration, suspicion and ultimately failure. For example, in our institution an oversight on our part was failure to involve pharmacy representatives at the start of the process even though they are involved in stocking unit doses of antibiotics in the emergency room and ICUs.
The AGREE tool is an example of a tool that provides a roadmap to either create or evaluate a guideline (http://www.agreetrust.org). Strict adherence to the elements included in such a roadmap will enable all stages to be conducted without missing any important steps, will insure the appropriate team members are involved, and will insure transparency and literature review. It will also allow evaluation of the necessary resources and outcome measures as well as opportunities for revising the guideline. The AGREE tool consists of 6 domains (Table 1) that address all aspects of implementation. Each of these domains controls a series of items (total 23) that guide every step of guideline development and address factors that may preclude adoption. AGREE is not the only tool that serves to assist in guideline development but it is validated, easy to use, widely accepted and comes with an easily accessible training manual.
Barriers to successful guideline implementation are summarized in Figure 4. Poor adherence can be due to inherent flaws in the process used in preparing the guidelines as outlined above, but just as important are the strategies used in implementation. Moreover, if quality control indicators for evaluation and monitoring are not appropriate and agreed on, monitoring will be haphazard and inadequate and provide meaningless information. This poses a problem in that if outcome measures are not monitored diligently, it is very difficult to determine the effectiveness of the guideline and to act to revise the guideline and protocol or address deficiencies in guideline implementation. Feedback loops using rapid PDSA (Plan, Do, Study, Act) cycles are important to continuously improve the guideline itself as well as to address cultural, resource and care process issues. In addition, with the advent of new technology, the framework used should include processes to incorporate these new facets to improve the care processes (Figure 3).
(Enlarge Image)
Figure 4.
Barriers to successful guideline implementation. All must be addressed for successful adoption of guidelines.