Intensive insulin therapy implementation by means of planned versus emergent change approach

Prednosti in slabosti različnih protokolov vodenja vrednosti glukoze v krvi pri kritično bolnih pacientih

Uvod: Medicinske sestre v enotah intenzivne terapije uravnavajo ciljno vrednost glukoze v krvi pri kritično bolnih po sprejetih in veljavnih protokolih. Namen raziskave je bil raziskati prednosti in slabosti različnih protokolov vodenja  vrednosti glukoze v krvi pri kritično bolnih.Metode: Uporabljen je bil sistematični pregled znanstvene in strokovne literature. Iskanje literature je potekalo od 1. 2. 2017 do 8. 8. 2017. V pregled so bile vključene naslednje baze: COBIB.SI, Digitalna knjižnica Slovenije – Dlib.si, CINAHL, ProQuest, PubMed in Google Učenjak. Iskanje je potekalo z različnimi kombinacijami ključnih besed v slovenskem in angleškem jeziku: prednosti, slabosti, medicinske sestre, kritično bolni, glukoza v krvi in protokoli za vodenje vrednosti glukoze v krvi. Uporabljen je bil Boolov operater AND. Iz iskalnega nabora 1064 zadetkov je bilo v končno analizo  vključenih 15 člankov. Za obdelavo podatkov je bil uporabljen model analize konceptov.Rezultati: Identificirana so bila tri tematska področja: (1) primernost različnih protokolov za vodenje vrednosti glukoze v krvi, (2) delovne obremenitve medicinskih sester pri teh protokolih in (3) varnost protokolov. Prednosti računalniško podprtega protokola za vodenje vrednosti glukoze v krvi so v boljšem doseganju ciljne vrednosti koncentracije glukoze v krvi, slabosti pa v pojavu odstopanj v zvezi z načrtovanim časom za merjenje glukoze v krvi.Diskusija in zaključek: Nekatere raziskave ugotavljajo prednosti računalniško podprtih protokolov za vodenje vrednosti glukoze v krvi v smislu tehnoloških izboljšav, zmanjšanja delovnih obremenitev medicinskih sester in izboljšanja varnosti pacientov. Raziskava prispeva k izboljševanju klinične prakse pri delu s kritično bolnimi pacienti.

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.