A Survey Of The Status And Influencing Factors Of Clinical Implementation Of The Guidelines Related To Flushing And Locking PICC

Objective:The study conducted a consistency analysis of the recommendations related to flushing and locking peripherally inserted central catheter(PICC),and developed a questionnaire based on the results of the consistency analysis,which was used to investigate status and influencing factors of clinical implementation of the guidelines related to flushing and locking PICC.This study aimed to provide a theoretical basis for developing interventions to promote the clinical implementation of the guidelines,as well as to provide data support and reference for institutions or governments to develop and implement policies for the clinical translation of the guidelines.Methods:1.Consistency analysis of the recommendations related to flushing and locking PICC:A systematic search of electronic databases,guideline websites,PICC-related websites and references of related literature was conducted to obtain guidelines related to flushing and locking PICC.The Appraisal of guidelines for research and evaluation II(AGREE II),the Appraisal of Guidelines Research and Evaluation Recommendations Excellence(AGREE REX),and the Reporting Items for Practice Guidelines in Healthcare(RIGHT)were used to appraise the quality of the included guidelines.Two authors independently extracted recommendations,and conducted consistency analysis of the content and strength of the recommendations.2.Cross-sectional survey of clinical implementation of the guidelines related to flushing and locking PICC:Based on the results of consistency of recommendations,the Clinical Implementation of the Guidelines related to Flushing and Locking PICC Questionnaire was generated by expert consultation.The nurses,who have participated or are currently participating in PICC care,were convenience sampled.The Clinical Implementation of the Guidelines related to Flushing and Locking PICC Questionnaire and the Barriers and Facilitators of Evidence Implementation Scale were used to surveyed the status of clinical implementation of the guidelines,and factors influencing the clinical implementation of guidelines were analyzed by univariate analysis and multifactorial analyses.Results:1.Consistency analysis of the recommendations related to flushing and locking PICC:(1)A total of 46 guidelines related to flushing and locking PICC were included,and 39 guidelines reported 26 combinations of evidence ratings and strength of recommendation ratings.(2)The overall RIGHT reporting rate for the included guidelines ranged from22.7%to 91.4%,with the lowest reporting field was the review and quality assurance(41.3%)and the lowest reporting item was the how the outcomes were selected and sorted(10.9%).The overall AGREEⅡscore of 46 guidelines was61.6%(IQR:51.5%-72.1%),with the overall score of the Chinese guidelines was53.3%(IQR:46.6%-60.7%)and the overall score of the English guidelines was64.9%(IQR:59.1%-75.0%).The median AGREEⅡscore for each field ranged from43.8%to 94.4%,with the lowest score for applicability and the highest score for clarity of presentation.The overall AGREE REX score was 62.1%(IQR:53.7%-72.2%),with the overall score of the Chinese guidelines was 53.7%(IQR:51.4%-66.7%)and the overall score of the English guidelines was 65.8%(IQR:56.1%-73.0%).The score of clinical applicability(77.8%)was highest,and the score of values and preferences(43.8%)was lowest.(3)Thirty-nine main recommendations were extracted from the 46 guidelines,and three recommendations were inconsistent on whether to recommend heparin and thrombolytic/fibrinolytic drugs as flushing or locking solutions.2.Cross-sectional survey of clinical implementation of the guidelines related to flushing and locking PICC:(1)Based on the results of the consistency analysis of the recommendations,a questionnaire on the clinical implementation of the guidelines related to flushing and locking PICC was developed after two rounds of expert consultation,with a content validity of 0.938 and a Cronbach’sαof 0.725.A total of 801 questionnaires were collected in this survey.The overall clinical implementation rate of the recommendations was 89.0%(IQR:64.5%-94.3%),and the clinical implementation rates of 6 recommendations were less than 50.0%.(2)The total score of the Barriers and Facilitators of Evidence Implementation Scale was 147.2±18.9,and the mean scores of 4 fields(implementation context,organizational form of evidence implementation,head of evidence implementation,and nurse team)more than 3.(3)The results of t test,ANOVA andX~2test showed statistically significant differences in clinical implementation of guidelines related to flushing and locking PICC between different departments,positions,professional titles,years of working,and educational qualifications;nurses who had attended training on clinical translation and implementation of the guidelines,and PICC specialist nurses had higher scores of clinical implementation of guidelines related to flushing and locking PICC.The Pearson and the Spearman correlation analysis showed that the score of organizational form of evidence implementation was negatively correlated with the score of the flushing and locking technique,and positively correlated with the flushing and locking timing,health education,assessment and documentation,quality control,the flushing and locking tools,and the volume of the flushing and locking fluid.Other five fields(implementation context,head of evidence implementation,evidence,nurse team,and patient)were all positively correlated with the score of clinical implementation of the guidelines related to flushing and locking PICC.(4)The results of the multiple linear regression and logistic regression analyses showed that the barriers of clinical implementation of the guidelines related to flushing and locking PICC were"Unavailability of evidence resources in the available literature"and"Lack of patient awareness or negative to implementation of evidence",and the facilitators included"evidence-based implementation in the form of projects","evidence-based knowledge of the team","head nurse actively promoting evidence-based implementation in the department","nurses have rich clinical expertise","higher authorities require the promotion of evidence-based nursing","the head of the implementation of evidence is able to ask structured nursing questions based on PIPOST principles",and nurses,who working in the department of oncology,department of internal,higher positions and at least 11 years,flush and lock PICC.Conclusions:1.A total of 46 guidelines related to flushing and locking PICC were included in this study.The quality of the methodology,report and recommendation was poor,and there were gaps between the English and Chinese guidelines.There were differences between the different guidelines related to flushing and locking PICC in the grading criteria of evidence and strength of recommendation.The consistency analysis of the content of the recommendations related to flushing and locking PICC showed that there were contradictions in the recommendations of different guidelines regarding the flushing and locking fluid,other recommendations were consistent in content but not in strength of recommendations,and some recommendations lacked specific implementation details.2.The clinical implementation of the 36 consistent recommendations related to flushing and locking PICC showed that the overall rate of clinical implementation is high,but there are still some weaknesses that need to be further improved.The clinical implementation of the guideline was influenced by patient,guidelines,nurse team,organizational form of evidence implementation,head of evidence implementation,and implementation context,researchers can develop interventions to promote the clinical implementation of the guidelines related to flushing and locking PICC at these 6 fields.