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Abstract
Introduction Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.
Objective The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.
Methods We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.
Results From the 159 included studies, eight categories of implementation activities were identified: education; planning and preparation; method-based approach; audit and feedback; motivate and remind; resource allocation; simulation and training; and patient involvement. Most studies reported activities from multiple categories. Implementation factors included: clinical competence and collaboration; resources; readiness and engagement; external influence; organisational involvement; QI competence; and feasibility of innovation. Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: fidelity or compliance; proxy indicator for fidelity; sustainability; acceptability; and spread. Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.
Conclusions The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.
- Antibiotic management
- Medical emergency team
- Medication reconciliation
- Implementation science
- Patient safety
Data availability statement
Data are available upon reasonable request. This applies to data used for descriptive statistics/cluster analysis.
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- Antibiotic management
- Medical emergency team
- Medication reconciliation
- Implementation science
- Patient safety
Data availability statement
Data are available upon reasonable request. This applies to data used for descriptive statistics/cluster analysis.
Supplementary materials
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Footnotes
Contributors JTO, ES, PEA, JA, SH, RKL, NS, HVW, JØ and MH contributed to the planning of the review, and have contributed to and accepted submission of the manuscript. JTO, SH, HVW, PEA, ES and MH conducted screening, data extraction and coding. RKL performed the literature searches. JA planned and conducted statistical analyses. JTO and MH are guarantors. An open-source, active-learning-aided software tool (ASReview) was used in the title/abstract screening phase, to increase efficiency of the review. Details are stated in the Methods section of the paper and the PRISMA flow diagram.
Funding This study was funded by Norges Forskningsråd (The Research Council of Norway) (316274), Helse Vest (Western Norway Regional Health Authority) (No grant number), Fonna Hospital Trust (No grant number), Bergen Hospital Trust (No grant number)
Competing interests All authors have completed the ICMJE form for disclosure of competing interests. JTO, ES, SH, HVW have been supported in their work on this paper by grants from the Research Council of Norway, the Western Norway Regional Health Authority, and the Bergen Hospital Trust. MH has been supported in her work on this paper by grants from the Research Council of Norway, and by employment as a researcher by the Fonna Hospital Trust. SH has headed the reference group for the Norwegian Patient Safety Campaign (2011–2014, honorary without payment), and is a paid member of the Regional Committee for Medical Ethics since 2021. PEA has coauthored this paper as part of his work at the Norwegian Centre for Antiobiotic Use in Hospitals, Haukeland University Hospital. He is also an editor of the national guidelines for antibiotic use in hospitals, member of the editorial board of the national guidelines for antibiotic use in primary care, and member of the national breakpoint committee, all without extra funding, as part of his ordinary work. NS has recieved consulting fees as director of London Safety and Training Solutions. RKL has coauthored this paper salaried as an academic librarian at the University of Bergen.
Provenance and peer review Not commissioned; externally peer reviewed.
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