46 Chapter 2 We recommend guideline developers to think about audit criteria while developing a nursing guideline. Most studies described developing an audit criteria checklist as one of their preparations. A predefined audit criteria checklist could help healthcare professionals and organizations in the execution, goal-setting and evaluation of the implementation of nursing guidelines. We noted a lack of goal-setting in most studies. The study of Jolliffe et al. [76] was one of the exceptions: the goal was for staff to adhere to minimally 75% of applicable guideline indicators per patient prior to commencing the study. When pre-defined audit criteria are available it might be possible to set goals and evaluate the implementation of guidelines without extensive preparations. Less than half of the studies included in this review performed a barrier assessment, and most were poorly described. Further, we could not relate performing a barrier assessment to a positive effect on the primary outcomes. Four studies that performed a barrier assessment did not state that the identified barriers were used to select the implementation strategies. In line with other reviews, we think that tailoring strategies based on a barrier assessment is important [14, 89]. A barrier assessments can provide crucial information about the context where the implementation will take place. Finding and describing barriers and facilitators in detail can help in choosing adequate implementation strategies, this may increase the effectiveness of the implementation of nursing guidelines. Conclusion This systematic review provides an extensive, up-to-date review of the implementation of nursing guidelines and the used implementation strategies. More than half of the studies showed a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. A wide variety of implementation strategies were identified in implementing nursing guidelines. Education is the most frequently used strategy to implement nursing guidelines in practice. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Consistency in reporting of the used implementation strategies and the duration of measurement of the impact of the strategy should be improved in future studies.
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