Use of Evidence in Clinical Guidelines and Everyday Practice for Mechanical Ventilation in Swedish Intensive Care Units

Authors

  • Ann Catrine Eldh RN, MSSc, PhD,

    Corresponding author
    1. Research Fellow, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
    • Address correspondence to Ann Catrine Eldh, Unit for Nursing, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 23, Karolinska Institutet, SE17177 Stockholm, Sweden; anncatrine.eldh@ki.se

    Search for more papers by this author
  • Gisela Vogel RN, BSSc,

    1. Research Assistant, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
    Search for more papers by this author
  • Anna Söderberg RN, PhD,

    1. Senior Lecturer, Division of Nursing, Umeå University, Umeå, Sweden
    Search for more papers by this author
  • Hans Blomqvist MD,

    1. Associate Professor, Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden
    Search for more papers by this author
  • Yvonne Wengström RN, PhD

    1. Associate Professor, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
    Search for more papers by this author

  • The authors declare that they have no competing interests. ACE designed and supervised the study, participated in data collection and analysis, and drafted and revised the manuscript with contribution of all coauthors. GV carried out the data collection and analysis, and contributed to the revision of the paper. HB, AS and YW provided intellectual input to the planning and analysis of the study, and to the manuscript. This study was carried out with the support of a research grant in 2011 from the Strategic Research Programme in Care Sciences, Karolinska Institute, Stockholm Sweden.

ABSTRACT

Background and Aim

One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice.

Methods

Inviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open-ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside.

Findings

Fifty-five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients’ experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients’ needs.

Conclusions

Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.

Ancillary