Factors influencing long-term adherence to two previously implemented hospital guidelines.
OBJECTIVE
After successful implementation, adherence to hospital guidelines should be sustained. Long-term adherence to two hospital guidelines was audited. The overall aim was to explore factors accounting for their long-term adherence or non-adherence.


METHODS
A fluid balance guideline (FBG) and body temperature guideline (BTG) were developed and implemented in our hospital in 2000. Long-term adherence was determined retrospectively based on data from patient files. Focus groups were launched to explore nurses' perceptions of barriers and facilitators regarding long-term adherence. The predominant themes from the nurses' focus groups were posed to clinicians in questionnaires.


RESULTS
Nurses involved in the FBG (overall adherence 100%) stated that adherence has immediate advantages in terms of safety and a gain in time. Nurses and oncologists acted unanimously which was thought to enhance adherence. On the other hand, opinions differed on the BTG within the nursing teams and medical staff (overall adherence 50%). Although the guideline discourages routine postoperative body temperature measurements, temperature should be measured according to the guideline in a considerable number of cases due to changes in patient characteristics since the year 2000. Therefore, adherence was judged to be rather complex.


CONCLUSIONS
To secure adherence to hospital guidelines after their successful implementation, guidelines should preferably be comprehensive in terms of being applicable to the majority of the patients in that particular setting and to the most common clinical situations. All healthcare professionals involved should be aware of its immediate benefits for themselves or to their patients.
Knops
A M
AM
Department of Quality Assurance and Process Innovation, Academic Medical Center, Room A3-503, PO Box 22660, 1100 DD Amsterdam, The Netherlands. a.m.knops@amc.nl
Storm-Versloot
M N
MN
Mank
A P M
AP
Ubbink
D T
DT
Vermeulen
H
H
Bossuyt
P M M
PM
Goossens
A
A
D001831:Body Temperature; D019983:Guideline Adherence / Q000458:organization & administration*; D006784:Hospitals, Teaching; D006801:Humans; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014882:Water-Electrolyte Balance