Leaders’ perspective on innovation, recipients, context and facilitation characteristics for the implementation of Irish Clinical Guidelines on HCAI (interviews)
| Themes | Categories supplemented by leaders’ narratives |
| Innovation—guidelines | Category: Guidelines supported the standardisation of clinical practice “National Clinical Effectiveness Committee and that whole structure is about providing us nationally with a framework for the implementation of evidence into clinical practice… and to evaluate the impact of the guidelines in practice through audit.” (P13) Category: Guidelines as large documents and difficult to locate “I think probably the important thing for any guideline, be it local or national, that people are aware that it exists and having it (the guideline) user friendly and accessible… and know where you can access the full guideline… that it is easily accessible and it is just clicking on a link as opposed to having to go through a page to be redirected as it ( the guideline ) can be hard to find.” (P13) “The bigger version ( of the guideline ) would be too cumbersome… I wouldn’t have the time personally to read it… for day to day things I actually think there should be snappy one page, two page documents, quick referral guides.” (P12) Category: Different levels of awareness of guidelines between staff positions “I would say that outside of say myself or the official controller or CNS (Clinical Nurse Specialist) or… antimicrobial pharmacist I’m not so certain of the awareness of these guidelines by other groups in the hospital…” (P1) |
| Recipients—health service leaders and staff |
Category: Guidelines as Holy Grail and time consuming “I think sometimes guidelines are over-arching and they are the Holy Grail but I just don’t think that they are very feasible in practice… C. difficile brings about its own problems… patient needs… can be quite time consuming… time spent in a room or cordoning off a ward… that adds to extra time… with the same amount of staff” (P5) |
| Context—health service |
Category: Importance of governance systems, effective communication loops with audit and timely feedback “I actually think as the hospitals marry together or whether they go like trusts or whatever that networking between hospitals is important. A group role is important and it has been shown to be important in the job I am in because you share information between hospitals and people. Within the hospital I think that there has to be key people in place whether it be a committee like setting or whatever like-minded people trying to implement guidelines as best they can because it is one thing to bring in a guideline but you need local governance and the local implementation teams to bring that about… you have to just make sure that even what happens at committee level that it actually filters down to the wards.” (P12) Category: Suboptimum infrastructure “… it is very frustrating knowing that w e can’t do better without that ( single rooms ) and they (Health Service Executive/hospital management) don’t understand; there is no sign of any of that money coming in.” (P11) Category: Wish for more positive affirmation of things done well … I often think that if wording is put in. Acknowledging subtly that the infrastructure isn’t what it should be and that we just have to do what we can.” (P11) |
| Facilitation—engagement strategies used for the implementation of Irish Clinical Guidelines |
Category: Role of infection prevention and control nurse as vital instrumental in ensuring the implementation of the HCAI guidelines “Their ( infection prevention and control nurse ) role is expanded, now they are required to feed in to the data nationally,… other parts of their role have expanded… they have all these other issues to deal with.” (P12) “… having so many different profiles in terms of my job spectrum it is fantastic to have those guidelines because I cannot be everything and cannot be the infection control person in the small setting where you may only have a director of nursing and a CNM ( Clinical Nurse Manager ) so having the infection control nurse that is up to date and has the relevant knowledge to access is absolutely vital for us to comply with national standards.” (P8) “we just feel that bringing it back to ward level that you know have these sessions… for staff attending… pertinent information sessions, updates re the guidelines… for staff… there is no member of staff going to sit down and read… three hundred pages of the document so what you want is to get the critical information out there ( on the wards ).” (P12) “we just feel that bringing it back to ward level that you know have these sessions… for staff attending… pertinent information sessions, updates re the guidelines… for staff… there is no member of staff going to sit down and read… three hundred pages of the document so what you want is to get the critical information out there ( on the wards ).” (P12) |
HCAI, Healthcare Associated Infection; P, Participant.