School of Nursing & Midwifery Annual Report 2018

Catherine McAuley School of Nursing and Midwifery, UCC

The Implementation of National Clinical Effectiveness Committee Clinical Guidelines Relating to Health Care Associated Infections in Irish Healthcare Organisations: multiple perspectives

The story: When patients and their families come in contact with the Irish healthcare system, they expect treatment and care that is evidence-based, effective, safe, and of high quality. One approach to meeting these expectations is the implementation of clinical practice guidelines for use by healthcare professionals across disciplines. The National Clinical Effectiveness Committee (NCEC) published the “National Clinical Guideline No. 2 Management and Prevention of Methicillin-resistant Staphylococcus aureus (MRSA)” and “National Clinical Guideline No. 3 Surveillance, Diagnosis and Management of Clostridium difficile Infection” in December 2013 and June 2014 respectively. The objectives of introducing such national guidelines were to improve patient care, minimise mortality and morbidity, minimise and control MRSA and C. difficile spread, and to help contain healthcare costs.

Our research aimed to explore the complex reality of implementing these guidelines in a variety of contexts.

The three-phased study allowed the team to gain an in depth understanding of implementation of the guidelines and provides insights that could improve guideline implementation. Overall, symbolic implementation of guidelines is shaped by the sense making of staff and confirms the existence of a dissonance between infection prevention and control guidelines and the practical realities of working in healthcare. This perceived dissonance is reinforced by (and reinforces) a challenging context for changes, in which staff and service users may feel discouraged from embedding and sustaining infection prevention and control guidelines. The lack of regular procedures for monitoring implementation of these guidelines plays an important role in feeding back into the sense of meaningfulness of guidelines, accentuating the sense of dissonance and reinforcing the symbolic implementation of guidelines in many instances.

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