{"title":"评估妊娠期高血压疾病指南的实施情况和单位影响:基于模型的方法。","authors":"Nora Drummond, Alissa Carver, Joanne Bailey","doi":"10.1891/JDNP-D-20-00028","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.</p><p><strong>Objective: </strong>Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.</p><p><strong>Methods: </strong>Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.</p><p><strong>Results: </strong>The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.</p><p><strong>Conclusions: </strong>Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.</p><p><strong>Implications for nursing practice: </strong>Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2021-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of Implementation and Unit Impact of a Hypertensive Disorder of Pregnancy Guideline: A Model-Based Approach.\",\"authors\":\"Nora Drummond, Alissa Carver, Joanne Bailey\",\"doi\":\"10.1891/JDNP-D-20-00028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.</p><p><strong>Objective: </strong>Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.</p><p><strong>Methods: </strong>Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.</p><p><strong>Results: </strong>The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.</p><p><strong>Conclusions: </strong>Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.</p><p><strong>Implications for nursing practice: </strong>Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.</p>\",\"PeriodicalId\":40310,\"journal\":{\"name\":\"Journal of Doctoral Nursing Practice\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2021-01-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Doctoral Nursing Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1891/JDNP-D-20-00028\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Doctoral Nursing Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1891/JDNP-D-20-00028","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"NURSING","Score":null,"Total":0}
Evaluation of Implementation and Unit Impact of a Hypertensive Disorder of Pregnancy Guideline: A Model-Based Approach.
Background: Hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. To address this, a large Midwestern hospital initiated a practice guideline. Practice guidelines should improve outcomes, but implementation of these remains challenging. At the time of initiation of the guideline, no implementation or evaluation plan was conceived.
Objective: Evaluate the implementation and unit impact of a guideline for the management of hypertensive disorders of pregnancy in a large academic health system in the Midwest.
Methods: Six objectives, guided by the constructs of the Ottawa Model of Research Utilization, were operationalized to evaluate the implementation and unit impact of the guideline.
Results: The guideline implemented was consistent with national recommendations. Intervention education was inconsistent across provider types. A survey of staff revealed insight into a unit in the midst of practice change. A chart review revealed below-target management of patients with severe range blood pressures. Not following the guideline was associated with hospital readmission.
Conclusions: Guideline implementation can be efficiently and holistically evaluated with a model-based framework, even in projects that were not initiated with such an approach.
Implications for nursing practice: Nurses provide expertise in model-based approaches that result in comprehensive evaluations of quality improvement processes.