title: What Registered Nurses Do and Do Not in the Management of Pediatric Peripheral Venous Catheters and Guidelines: Unpacking the Outcomes of Computer Reminders.
abstract: BACKGROUND
  Clinical practical guidelines (CPGs) may enhance evidence-based practice, but require implementation. Computer reminders have previously shown various effects in supporting implementation; in a concomitant study, we found no effect on complications in peripheral venous catheters (PVCs) or registered nurses' (RNs) adherence to a CPG in pediatric care. Yet, there is a need to determine how reminders operate in particular contexts.
  
  
  OBJECTIVE
  To depict if, in what context, and how computer reminders regarding evidence-based management of PVC in pediatric care are applied according to RNs' actions and experience.
  
  
  METHODS
  Qualitative data from nonparticipant observations and interviews with 18 RNs in four intervention units at a pediatric hospital were analyzed with content analysis.
  
  
  RESULTS
  Attention given to the computer reminders varied; the RNs noticed them in units where there was an agreement about the management and recording of PVCs, but not elsewhere. Rather, computer reminders did not facilitate adherence to the PVC-CPG where the CPG was not acknowledged from the start. RNs who knew how to manage PVCs had peer support and received additional reminders, which suggested that the computer reminders added to the significance of PVCs in pediatric care.
  
  
  CONCLUSIONS
  While the computer reminders alone did not support CPG implementation, they further increased the attention to PVCs in contexts where there was a readiness to change along with a supportive culture. We suggest further studies tailoring implementation strategies to include electronic means if there is a beneficial context.
authors.affiliation: Associate Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Affiliated Researcher, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: Clinical teacher, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: AnnaMaria
authors.initials: A
authors.lastname: Tollne
authors.affiliation: Lecturer, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Förberg
authors.affiliation: Professor, School of Education, Health and Social Studies, Dalarna University, Falun, Sweden, and Associate Professor, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallin
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000379:methods*; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D036301:Qualitative Research; D017010:Reminder Systems / Q000592:standards* / Q000706:statistics & numerical data; D012984:Software / Q000592:standards; D011795:Surveys and Questionnaires
keywords: clinical practice guidelines; computer reminders; context; evidence-based practice; implementation; pediatric; peripheral venous catheters