THE CAUSES OF HEALTHCARE PROVIDERS' FAILURE TO FOLLOW PAEDIATRIC ASTHMA TREATMENT PROTOCOLS IN A SAUDI ARABIAN EMERGENCY DEPARTMENT
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Abstract
Concise background Within a decade, the incidence of bronchial asthma among children in Saudi Arabia increased from 8% to 23%. Improvements in patient outcomes necessitated the development of evidence-based clinical practice standards and protocols for asthma therapy, which in turn led to advances in asthma management. The goal of this study is to find out why some people don't follow the Paediatric Asthma Management Protocol (PAMP) and how well the doctors and nurses at King Khalid University Hospital's paediatric emergency room follow the rules. Techniques This study consists of two parts: a survey of potential participants and an analysis of the patients' medical data. Reviewing the medical records of all children diagnosed with asthma who visited the Paediatric Emergency Department (PED) between January 1, 2009, and March 31, 2009 allowed us to examine how well healthcare providers (doctors and nurses) followed the eight guidelines set out by the PAMP. Following are some suggestions for filling in the gaps between evidence and practice that are often encountered: 1) keeping track of how serious the asthma is according to the nursing staff's and treating physician's evaluation 2) limiting the dosage of ipratropium that doctors can give to kids with severe asthma The third way to take salbutamol is with an inhaler and a spacer. 4) Documentation regarding the parents' educational background 5) Administering systemic corticosteroids to every patient with an acute asthma attack 6) limiting the amount of chest x-rays that minors with a possible chest illness can undergo 7) All asthma cases should be treated as outpatients, unless the severity of the condition necessitates hospitalisation. 8. limiting the recommended dosage of antibiotics for children with chest infections. The second part of this study is an interview with a focus group. The goal of this interview is to find out why the recommendations that were found in the chart review were not followed. Ten registered nurses and ten active medical doctors participated in two separate focus group interviews. The focus group interviews were all videotaped and subsequently transcribed verbatim. The interviews were analysed using theory-based content analysis in order to discover themes and sub-themes. Results and discussion that follows A grand number of 657 charts were reviewed. The percentage of healthcare professionals who followed the eight suggestions stated before was determined. It turned out that just five of the eight suggestions made before were actually implemented. Three major themes emerged from the focus group interview data as reasons for the aforementioned lack of compliance with the five recommendations. Here are the following themes: 1) organization-related elements, 2) asthma management protocol-related problems, and 3) healthcare provider-related difficulties. Last Remarks Organisational barriers and a lack of a protocol implementation strategy are the main causes of non-compliance with the PAMP recommendations. Also playing a role are the healthcare providers' own personal views and attitudes.
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1. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S: Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009, 64: 476-483. 10.1136/thx.2008.106609. Article CAS PubMed Google Scholar 2. Cardarelli WJ: Asthma: are we monitoring the correct measures?. Popul Health Manag. 2009, 12: 87-94. 10.1089/pop.2008.0021. Article PubMed Google Scholar 3. Al-Moamary MS, Al-Hajjaj MS, Idrees MM, Zeitouni MO, Alanezi MO, Al-Jahdal HH, et al: The Saudi Initiative for asthma. Ann Thorac Med. 2009, 4: 216-233. 10.4103/1817-1737.56001. Article PubMed PubMed Central Google Scholar 4. Al Frayh AR: Asthma patterns in Saudi Arabian children. J R Soc Health. 1990, 110: 98-100. 10.1177/146642409011000309. Article CAS PubMed Google Scholar 5. Hijazi N, Abalkhail B, Seaton A: Asthma and respiratory symptoms in urban and rural Saudi Arabia. Eur Respir J. 1998, 12: 41-44. 10.1183/09031936.98.12010041. Article CAS PubMed Google Scholar 6. Self TH, Usery JB, Howard-Thompson AM, Sands C: Asthma treatment protocols in the emergency department: are they effective?. J Asthma. 2007, 44: 243-248. 10.1080/02770900701246691. Article PubMed Google Scholar 7. Gustafsson PM, Watson L, Davis KJ, Rabe KF: Poor asthma control in children: evidence from epidemiological surveys and implications for clinical practice. Int J Clin Pract. 2006, 60: 321-334. 10.1111/j.1368-5031.2006.00798.x. Article CAS PubMed Google Scholar 8. Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, et al: Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004, 114: 40-47. 10.1016/j.jaci.2004.04.042. Article PubMed Google Scholar 9. Field MJ, Lohr KN: Guidelines for clinical practice: from development to use. Institute of Medicine. 1992, National Academy Press, Washington, D.C Google Scholar 10. Grol R: Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001, 39: II46-II54. Article CAS PubMed Google Scholar 11. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004, 8: 72. Article Google Scholar 12. Rogers EM: Diffusion of innovations, 5th ed edn. 2003, Free Press, New York Google Scholar 13. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629. 10.1111/j.0887-378X.2004.00325.x. Article PubMed PubMed Central Google Scholar 14. Gildenhuys J, Lee M, Isbister GK: Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?. Int J Emerg Med. 2009, 2: 33-39. 10.1007/s12245-008-0063-x. Article PubMed Google Scholar 15. Bousquet J, Clark TJ, Hurd S, Khaltaev N, Lenfant C, O'byrne P, et al: GINA guidelines on asthma and beyond. Allergy. 2007, 62: 102-112. CAS PubMed Google Scholar 16. Kitzinger J: Qualitative research:introducing focus groups. Br Med J. 1995, 311: 299-302. 10.1136/bmj.311.7000.299. Article CAS Google Scholar 17. Freeman T: 'Best practice' in focus group research: making sense of different views. J Adv Nurs. 2006, 56: 491-497. 10.1111/j.1365-2648.2006.04043.x. Article PubMed Google Scholar 18. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res. 2005, 15: 1277-1288. 10.1177/1049732305276687. Article PubMed Google Scholar 19. Kitson AL, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A: Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008, 3: 1-10.1186/1748-5908-3-1. Article PubMed PubMed Central Google Scholar 20. Logan J, Graham ID: Toward a comprehensive interdisciplinary model of health care research use. Science communication. 1998, 20: 227-246. 10.1177/1075547098020002004. Article Google Scholar 21. Kontos PC, Poland BD: Mapping new theoretical and methodological terrain for knowledge translation: contributions from critical realism and the arts. Implement Sci. 2009, 4: 1-10.1186/1748-5908-4-1. Article PubMed PubMed Central Google Scholar 22. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al: Lost in knowledge translation: time for a map?. J Contin Educ Health Prof. 2006, 26: 13-24. 10.1002/chp.47. Article PubMed Google Scholar 23. Francke AL, Smit MC, de Veer AJ, Mistiaen P: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak. 2008, 8: 38-10.1186/1472-6947-8-38. Article PubMed PubMed Central Google Scholar 24. Tooher R, Middleton P, Babidge W: Implementation of pressure ulcer guidelines: what constitutes a successful strategy?. J Wound Care. 2003, 12: 373-2. Article CAS PubMed Google Scholar 25. Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al: Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol. 2006, 108: 1234-1245. 10.1097/01.AOG.0000236434.74160.8b. Article PubMed Google Scholar 26. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al: Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999, 282: 1458-1465. 10.1001/jama.282.15.1458. Article CAS PubMed Google Scholar 27. Tinetti ME, Bogardus ST, Agostini JV: Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004, 351: 2870-2874. 10.1056/NEJMsb042458. Article CAS PubMed Google Scholar 28. Levy ML, Thomas M, Small I, Pearce L, Pinnock H, Stephenson P: Summary of the 2008 BTS/SIGN British Guideline on the management of asthma. Prim Care Respir J. 2009, 18 (Suppl 1): S1-16. Article PubMed Google Scholar 29. Cabana MD, Ebel BE, Cooper-Patrick L, Powe NR, Rubin HR, Rand CS: Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med. 2000, 154: 685-693. Article CAS PubMed Google Scholar 30. Davis DA, Taylor-Vaisey A: Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997, 157: 408-416. CAS PubMed PubMed Central Google Scholar Pre-publication history • The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/226/prepub
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