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Beyond Compliance - Understandning the Role of Clinical Practice Guidelines in Prehospital Emergency Care

Tagger, Herman LU (2024) FLMU16 20232
Division of Risk Management and Societal Safety
Abstract (Swedish)
Bakgrund
Behandlingsriktlinjer omsätter vetenskaplig evidens till praktiska regler. De är en del av sjukvårdens säkerhetsåtgärder och syftar till att göra vården säker, enhetlig, möjliggör kvalitetskontroll och minskar sjukvårdskostnader. Men det är också viktigt att inte förväxla skapande eller hantering av dokument med att hantera faktisk säkerhet. Ett strikt fokus på följsamhet till regler kan vara problematisk på grund av skriftliga reglers begränsningar och antaganden om användarna och situationerna de ställs inför, vilket kan leda till sämre anpassningsförmåga vid hantering av komplexa situationer.
Syfte
Att undersöka hur behandlingsriktlinjer används i prehospital akutsjukvård. Detta innefattar att undersöka hur de används, i... (More)
Bakgrund
Behandlingsriktlinjer omsätter vetenskaplig evidens till praktiska regler. De är en del av sjukvårdens säkerhetsåtgärder och syftar till att göra vården säker, enhetlig, möjliggör kvalitetskontroll och minskar sjukvårdskostnader. Men det är också viktigt att inte förväxla skapande eller hantering av dokument med att hantera faktisk säkerhet. Ett strikt fokus på följsamhet till regler kan vara problematisk på grund av skriftliga reglers begränsningar och antaganden om användarna och situationerna de ställs inför, vilket kan leda till sämre anpassningsförmåga vid hantering av komplexa situationer.
Syfte
Att undersöka hur behandlingsriktlinjer används i prehospital akutsjukvård. Detta innefattar att undersöka hur de används, i vilka situationer, deras roll ur ambulanspersonalens perspektiv och hur de samspelar inom ett komplext nätverk av åtgärder, flera målsättningar och andra faktorer.
Metod
En kvalitativ metod som kombinerar observationer och intervjuer användes för att förstå hur ambulanspersonal agerar och hur behandlingsriktlinjer påverkar deras handlingar. Aktivitetsteori användes kunde för att analysera behandlingsriktlinjernas roll i ett aktivitetssystem, bestående av aktörer, mål, verktyg, mål, samverkan och fördelning av arbetsuppgifter.
Resultat
I rutinmässiga situationer tenderar erfarna ambulansteam att förlita sig på internaliserade regler snarare än att läsa behandlingsriktlinjerna. Riktlinjer används främst inför en förväntad patientkontakt, i synnerhet vid ovanligare eller potentiellt kaotiska situationer. De används också till att förbereda för situationer där regler behöver individuellt anpassas, till exempel vid omhändertagande av barn, eller för att eliminera osäkerhet när snabba åtgärder är nödvändiga. Erfarna team söker oftare efter specifik information såsom läkemedelsdoser eller undantag från inlärda regler medan oerfarna team i större utsträckning läser material i sin helhet.
Slutsats
Användning av behandlingsriktlinjer i prehospital vård begränsas av kontextuella faktorer. Ofta används behandlingsriktlinjer på väg till en patient, vilket innebär att en begränsad mängd information hinner läsas och effektivt tas till sig. För största möjliga användarvänlighet bör behandlingsriktlinjer skapas med hänsyn till ambulanspersonalens behov. En balans mellan att vara en regelbok och ett praktiskt verktyg behöver strävas efter. Ett klimat som uppmuntrar till tillit och beräknat risktagande är viktigt för såväl säkerhet som förmågan att hantera oförutsedda händelser. Utvecklingen av behandlingsriktlinjer behöver fokusera på praktisk användbarhet och ta hänsyn till ambulanspersonalens behov av information. (Less)
Abstract
Background: Clinical practice guidelines (CPGs) translate scientific knowledge into practical rules. They aim to improve safety, ensure consistency, enable quality control, and mitigate rising healthcare costs. CPGs and other written instructions are often the target or result of safety interventions in healthcare, but it is important to avoid the trap of managing documents rather than actual safety. Strict adherence to rules is often impractical due to their inherent limitations, structural incompleteness, variability in persons and processes, assumptions about users, undefined application conditions, organisational variability, and references to ideal situations. Overemphasising compliance can shift priorities, making adherence to rules... (More)
Background: Clinical practice guidelines (CPGs) translate scientific knowledge into practical rules. They aim to improve safety, ensure consistency, enable quality control, and mitigate rising healthcare costs. CPGs and other written instructions are often the target or result of safety interventions in healthcare, but it is important to avoid the trap of managing documents rather than actual safety. Strict adherence to rules is often impractical due to their inherent limitations, structural incompleteness, variability in persons and processes, assumptions about users, undefined application conditions, organisational variability, and references to ideal situations. Overemphasising compliance can shift priorities, making adherence to rules an aim rather than a means to achieve goals, and leading to requests for written rules for tasks previously managed locally. It also reduces practitioners' capacity to adapt and balance competing rules, which are essential for managing safety in complex environments. By understanding practitioners’ use of CPGs and their role in prehospital care, we can address conflicts and inform development of structure, content, and design more effectively.
Aim: To explore how CPGs mediate action in prehospital emergency care. This includes examining their use, understanding their role from the perspective of practitioners, and investigating how they interplay within a complex network of actions, multiple goals, objectives, and other factors.
Methods: A qualitative approach combining observational and interview data examines the actions of ambulance teams and the mediating effect of CPGs on action. Activity theory is used as a framework, analysing how CPGs function within an activity system portrayed by subject, goals or objects, rules and norms, interactions, task division, and the mediating role of CPGs.
Results: In routine situations, experienced ambulance teams tend to rely more on internalised rules and norms than on consulting CPGs. CPGs are primarily consulted to confirm rules or norms before patient interaction, especially in rare, new, or potentially chaotic situations. Additionally, CPGs are used to prepare when established rules and norms need to be individually adapted, such as in paediatric emergencies. Finally, CPGs can assist in resolving doubt in medical emergencies where immediate responses are necessary amid uncertainty. The information that experienced teams commonly need from CPGs are medication dosages, potential risks or hazards, exceptions to usual practices and occasionally to ensure no important actions have been omitted. In contrast, novice teams use CPGs as educational or training material and rely more extensively on them in practice.
Conclusion: The use of CPGs in prehospital care is subject to contextual limitations. Reading CPGs in preparation for patient contact occurs en route to scene, which limits the volume of information that can effectively be read. The same is true when confirming medication dosages in medical emergencies. Guideline developers should prioritise informed decisions based on ambulance teams’ needs. Balancing CPGs' roles as both rules and tools is essential. An environment that encourages trust and informed risk-taking is key for safety and ambulance teams’ ability to navigate unfamiliar and unscripted scenarios. Managing safety is distinct from administrating documents. Guideline development and usage should be grounded in practicality, reflecting the actual needs of prehospital care. (Less)
Please use this url to cite or link to this publication:
author
Tagger, Herman LU
supervisor
organization
course
FLMU16 20232
year
type
H1 - Master's Degree (One Year)
subject
keywords
Clinical Practice guidelines, Prehospital Emergency Care, Human Factors, Activity Theory, FLMU06
language
English
id
9150556
date added to LUP
2024-04-05 20:21:34
date last changed
2024-04-05 20:21:34
@misc{9150556,
  abstract     = {{Background: Clinical practice guidelines (CPGs) translate scientific knowledge into practical rules. They aim to improve safety, ensure consistency, enable quality control, and mitigate rising healthcare costs. CPGs and other written instructions are often the target or result of safety interventions in healthcare, but it is important to avoid the trap of managing documents rather than actual safety. Strict adherence to rules is often impractical due to their inherent limitations, structural incompleteness, variability in persons and processes, assumptions about users, undefined application conditions, organisational variability, and references to ideal situations. Overemphasising compliance can shift priorities, making adherence to rules an aim rather than a means to achieve goals, and leading to requests for written rules for tasks previously managed locally. It also reduces practitioners' capacity to adapt and balance competing rules, which are essential for managing safety in complex environments. By understanding practitioners’ use of CPGs and their role in prehospital care, we can address conflicts and inform development of structure, content, and design more effectively.
Aim: To explore how CPGs mediate action in prehospital emergency care. This includes examining their use, understanding their role from the perspective of practitioners, and investigating how they interplay within a complex network of actions, multiple goals, objectives, and other factors.
Methods: A qualitative approach combining observational and interview data examines the actions of ambulance teams and the mediating effect of CPGs on action. Activity theory is used as a framework, analysing how CPGs function within an activity system portrayed by subject, goals or objects, rules and norms, interactions, task division, and the mediating role of CPGs.
Results: In routine situations, experienced ambulance teams tend to rely more on internalised rules and norms than on consulting CPGs. CPGs are primarily consulted to confirm rules or norms before patient interaction, especially in rare, new, or potentially chaotic situations. Additionally, CPGs are used to prepare when established rules and norms need to be individually adapted, such as in paediatric emergencies. Finally, CPGs can assist in resolving doubt in medical emergencies where immediate responses are necessary amid uncertainty. The information that experienced teams commonly need from CPGs are medication dosages, potential risks or hazards, exceptions to usual practices and occasionally to ensure no important actions have been omitted. In contrast, novice teams use CPGs as educational or training material and rely more extensively on them in practice.
Conclusion: The use of CPGs in prehospital care is subject to contextual limitations. Reading CPGs in preparation for patient contact occurs en route to scene, which limits the volume of information that can effectively be read. The same is true when confirming medication dosages in medical emergencies. Guideline developers should prioritise informed decisions based on ambulance teams’ needs. Balancing CPGs' roles as both rules and tools is essential. An environment that encourages trust and informed risk-taking is key for safety and ambulance teams’ ability to navigate unfamiliar and unscripted scenarios. Managing safety is distinct from administrating documents. Guideline development and usage should be grounded in practicality, reflecting the actual needs of prehospital care.}},
  author       = {{Tagger, Herman}},
  language     = {{eng}},
  note         = {{Student Paper}},
  title        = {{Beyond Compliance - Understandning the Role of Clinical Practice Guidelines in Prehospital Emergency Care}},
  year         = {{2024}},
}