Implementation of Nationwide Evidence- and Consensus-Based Guidelines to Harmonize Neonatal Care in The Netherlands
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Date
2022-05
Journal Title
Journal ISSN
Volume Title
Publisher
Indian Academy of Pediatrics
Abstract
Background: A Dutch committee for National Guidelines in Neonatology developed nineteen evidence- and consensusbased guidelines to be used in all Dutch neonatal intensive care units (NICUs). The primary goal was to make clinical practices more uniform and consistent. Objective: This study investigated to what extent the guidelines were implemented and which factors played a role in implementation. Study design: A mixed method study design was used to investigate both the level and the process of implementation. A nationwide, multicenter, cross-sectional survey was performed using a validated instrument for measuring the level of implementation (Normalization MeAsure Development questionnaire, NoMAD). The number of implemented guidelines per NICU and the frequency and content of the amendments that NICUs made to the original consensus guidelines were analyzed. Through semistructured interviews, perceived barriers and facilitators for implementation were explored. Participants: Fellows and neonatologists working at all ten Dutch level 3-4 NICUs were eligible. Results: On an average, NICUs implemented 12.6 (of 19) guidelines (range 6-17). The Normalization Process Scale was 54 (of 65). Main influencing factors impeding implementation were guideline-related (e.g., unpractical, lengthy guidelines) and personal (e.g., an active representative responsible for local implementation). Conclusion: The implementation of our guidelines appears to be successful. Ways for improvement can be distinguished in personal, guideline-related and external factors. Empowerment of local representatives was considered most essential.
Description
Keywords
Guideline development, Neonatal intensive care unit, Quality improvement.
Citation
Talsma Elise, Jonge Rogier de, Cassel Florian, Loo Moniek van de, Bijl-Marcus Karen de, Mulder Estelle, Niemarkt Hendrik, Prins Sandra, Putten Mayke van der, Stuijvenberg Margriet van, Visser Remco, Oerlemans Anke, Hogeveen Marije. Implementation of Nationwide Evidence- and Consensus-Based Guidelines to Harmonize Neonatal Care in The Netherlands. Indian Pediatrics. 2022 May; 59(5): 371-376