• Maaike A P Janssen, Theo van Achterberg, Marian J M Adriaansen, Caroline S Kampshoff, Donna M J Schalk, and Joke Mintjes-de Groot.
• Faculty of Health and Social Studies, Department of Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands. maaike.janssen@han.nl
• J Clin Nurs. 2012 Feb 1;21(3-4):437-47.

Aims And ObjectivesThe objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.BackgroundGuideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline.MethodsThis is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors.ResultsVarious factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested.ConclusionNurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department.Relevance To Clinical PracticeInsight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.© 2011 Blackwell Publishing Ltd.

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