Implementation of evidence-based practice guidelines to prevent urinary retention in hospitals: A process evaluation in orthopaedic care.

BACKGROUND AND

objectivesNational clinical practice guidelines promote evidence-based practice, though are hardly implemented without local facilitation. While further research is needed as for what facilitation strategies work, in what context, and with what outcomes, the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trialled a tailored implementation intervention for evidence-based clinical practice guidelines in orthopaedic care. Informed by the principles of realism, this paper describes the evaluation of the context, mechanisms, and outcomes triad of locally assembled teams of nursing and rehabilitation staff and their managers offered monthly guideline implementation support for one year.

methodsA process evaluation incorporating group interviews with designated teams across seven intervention sites, at the end of their programme and 12 months later. Individual facilitator logs, photos and educational material from the intervention, and external facilitators' notes were added. The data was thematically analysed, describing and contrasting the initial hypotheses with a refined understanding of the theoretical and practical features of the process and outcomes.

resultsWith increased knowledge of the content and purpose of the guidelines and further recognition of their local context and implementation essentials, the intervention facilitated the local, designated teams to practise concurrent quality improvement procedures and skills. Having both staff and managers on the teams authorised modifications of their local context in favour of guideline implementation. The one-year support programme enabled primary implementation steps, though a comprehension of what could work and why required that the teams saw the intervention through.

conclusionLearning about the implementation of a clinical practice guideline is a local effort. This requires dedicated teams with sustained roles, resources, and mandate, with external implementation and clinical support. Nevertheless, this is a slow process that requires repeated or prolonged follow-up to identify long-term implementation intervention outcomes.

trial registrationUS National Institutes of Health Clinical Trials Registry: NCT04700969. Registered 8 January 2021. https://clinicaltrials.gov/study/NCT04700969.