title: Long-term adherence to a local guideline on postoperative body temperature measurement: mixed methods analysis.
abstract: OBJECTIVE
  To find out whether a successful multifaceted implementation approach of a local evidence-based guideline on postoperative body temperature measurements (BTM) was persistent over time, and which factors influenced long-term adherence.
  
  
  METHODS
  Mixed methods analysis. Patient records were retrospectively examined to measure guideline adherence. Data on influencing factors were collected in focus group meetings for nurses and a plenary meeting with an interactive questionnaire for doctors.
  
  
  RESULTS
  Records from 102 surgical patients were studied, totalling 1226 BTM. According to the guideline, an indication for BTM was present in 55% (679/1226). Actually, BTM were taken in 60% (736/1226), of which 55% (403/736) was in accordance with the guideline. The overall adherence rate to the guideline was 50% (617/1226). Belief in the advantages of the guideline and strong staff support appeared to facilitate long-term adherence. Barriers were, the controversial nature of the guideline, the lack of self-efficacy among nurses and doctors as to clinical judgement to identify an infection when refraining from BTM, and a lack of management and staff doctor support. Furthermore, newly appointed nurses and doctors were trained to measure BTM during their initial medical or nursing education, which was in contradiction with the guideline.
  
  
  CONCLUSIONS
  A multifaceted implementation strategy is not sufficient to maintain long-term adherence. To ensure long-term adherence, especially of controversial guidelines, adherence should be monitored and reported regularly over time. Strong staff support and leadership on all wards is crucial to maintain awareness. Medical and nursing curricula should include the pros and cons of taking BTM, combined with enhancing self-efficacy.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, the Netherlands. m.n.storm@amc.uva.nl
authors.forename: Marja N
authors.initials: MN
authors.lastname: Storm-Versloot
authors.forename: Anouk M
authors.initials: AM
authors.lastname: Knops
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Astrid
authors.initials: A
authors.lastname: Goossens
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
authors.forename: Hester
authors.initials: H
authors.lastname: Vermeulen
mesh_terms: D001831:Body Temperature / Q000502:physiology*; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D008485:Medical Audit; D008991:Monitoring, Physiologic / Q000592:standards*; D009426:Netherlands; D009740:Nursing Staff / Q000523:psychology; D011182:Postoperative Care; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies