Sundhedsprofessionelles adherence ved implemnteret referenceprogram- Sekventiel metodetriangulering i case studie om patienter med hoftenær fraktur

Rønfeldt, Ingerlise

4. semester

Klinisk Videnskab og Teknologi, Kandidat (KVT)

2018

2018-06-06

61 pages

Indledning: Generelt er kvaliteten høj i det danske sundhedsvæsen, men der er stadig plads til forbedringer. Et af de værktøjer, der hjælper med at sikre høj kvalitet i pleje og behandling, er brug af evidensbaserede retningslinjer. Det ses derfor relevant, at disse implementeres og anvendes i klinisk praksis. Litteraturen belyser adskillige barrierer mod at anvende kliniske retningslinjer, som derved resulterer i manglende adherence. Barrierne som ses i litteraturen er bl.a. ressourcer, manglende viden og organisatoriske problemer ift. retningslinjerne. Formål: Formålet med dette projekt er at få viden, der giver mulighed for at svare på, hvorfor kliniske retningslinjer ikke altid følges i praksis, når sundhedspersonale ved, at anvendelse bidrager til at sikre høj kvalitet og behandling af patienten. Det vil blive afklaret, om det skyldes patientens almene tilstand, eller om det skyldes at sundhedsprofessionelle har manglende adherence til at følge kliniske retningslinjer. På baggrund af fund og resultater i specialet, vil der blive præsenteret forsøg på løsningsmodeller for at sikre, at kliniske retningslinjer følges i fremtiden. Metode: Metoden er sekventiel metode triangulering baseret på casestudie fra egen praksis i en ortopædisk afdeling. Dataindsamlingsmetoderne vil være systematisk litteratur søgning, audit og fokus gruppe interview. De indsamlede data vil blive diskuteret op imod litteraturen. Fund og resultater: De vigtigste barrierer, der opstod var; Oplæring af nyansatte, dokumentation, Anvendelighed af PRI og ressourceforbrug. Barrierne syntes at lede til manglende adherence ift. at følge en klinisk retningslinje hos de sundhedsprofessionelle. Barrierne er forsøgt belyst med forskellige løsningsmodeller. Disse er identificeret gennem litteraturen og ses derfor som anvendelige.

Introduction: Generally, quality is high in the Danish health service, but there is still room for improvement. One of the tools that help ensure high quality care and treatment is use of evidencebased guidelines in clinical practice. It seems therefor important that these are implemented and will be used in clinical practice. The literature shows several barriers as health professionals do not follow clinical guidelines, such as lack of time, lack of knowledge and organizational issues with the guideline. Aim: The purpose of this project is to gain knowledge that enables to answer why clinical guidelines not always are followed in practice when health professionals contribute to ensuring high quality care and treatment for the patient. It will be clarified whether it is due to the general condition of the patients, or because nurses have a lack of adherence following clinical guidelines. Based on results and findings in this project, attempted solutions will be presented, to help ensure that clinical guidelines are followed in the future. Methods: The methods are sequential method triangulation, based on a qualitative case study from own practice in an Orthopedic ward. There will be systematic literature search. Audit and Focus Group Interviews will be used collecting data, which will be discussed against literature. Results and findings: The main barriers that emerged are; Lack of new employee training, Inadequate documentation, Convenience of document management and resources on the ward. These barriers seems to lead to adherence to following clinical guidelines. Conclusion: Based on audit and focus group interviews, health professionals may have barriers to following clinical guidelines. The barriers are expressed in this thesis in the form of the need for further training of new employees, inadequate documentation, the ease of use of PRI and resource consumption for the health professionals. All barriers are attempted to be met through different solutions. The solutions are identified through the literature and are therefore seen as a useful method for possible solutions. In conclusion, it can be said that the range of measures described as possible solutions has not been tested in practice, so it is not known if the measures are effective and useful in practice. Based on the literature, however, this is considered as properly.

Adherence ; Barrierer ; Kliniske retningslinjer

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