Delegation of work to nurses improves guideline implementation

Practices that delegate disease management to appropriately trained nurses are more likely to stick to treatment guidelines, UK research suggests.

The study, published in BMC Family Practice, looked at 15 practices in Scotland to assess levels of compliance with the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidelines for asthma, and barriers to implementation.

The researchers then carried out in-depth interviews with GPs and practice nurses from five of the practices with varying levels of compliance.

The research found that delegation of work to nurses ‘might be a lynchpin of effective guideline implementation'.

But effective delegation depended on a series of factors, the researchers said. GPs in practices employing nurses with advanced training, such as prescribing skills, were more likely to be confident in delegating work to them.

In addition to this, practices with ‘flat' hierarchies, in which practice nurses and GPs shared responsibility for asthma, and with strong communication between members of the practice team, had higher rates of compliance.

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