Implementation of an evidence-based guideline on fluid resuscitation: lessons learnt for future guidelines.

European Journal of Pediatrics
Merit M TabbersM Offringa

Abstract

There is little experience with the nationwide implementation of an evidence-based pediatric guideline on first-choice fluid for resuscitation in hypovolemia. We investigated fluid prescribing behavior at (1) guideline development, (2) after guideline development, and (3) after active implementation and identified potential barriers and facilitators for guideline implementation. In order to minimize costs and to optimize implementation effect, we continuously developed and adjusted implementation strategies according to identified barriers. Implementation success was evaluated using questionnaires, pharmaceutical data, and data from medical records. The most remarkable change occurred after guideline development and dissemination: Normal saline use by neonatologists increased from 22-89% to 100% and by pediatric intensivists from 43-71% to 88-100%, and synthetic colloid use by pediatric intensivists declined from 29-43% to 0-13% with a reduction in albumin use by neonatologists from 11-44% to 0%. After active guideline implementation, most of specialist's management behavior was according to the guideline. Stakeholders involved in the developmental process are of great importance in disseminating recommendations before active i...Continue Reading

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Citations

Jan 8, 2013·Indian Journal of Anaesthesia·Virendra K Arya
Nov 6, 2012·The Journal of Urology·Rosa BurgersMarc A Benninga
Jul 28, 2016·Revista paulista de pediatria : orgão oficial da Sociedade de Pediatria de São Paulo·Mario C VieiraSolena Ziemer Kusma
Jun 15, 2018·Journal of Pediatric Gastroenterology and Nutrition·Nina F SteutelMerit M Tabbers
Aug 16, 2018·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Gregory MooreSandra Dunn

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