Barriers and facilitators in the implementation of Continuous Quality Improvement and improvement interventions in the surgery service of a University Hospital in Bogota, Colombia. Cross-sectional study

Introduction: Clinical risk management systems (CRMS) are used to prevent or mitigate healthcare-related patient harm. Organizational factors can limit the effect and application of these systems. Objective: To describe the level of implementation of actions derived from the continuous quality improvement (CQI) method and aimed at improving medication (antibiotics, anticoagulants and opioids) prescription and administration processes in surgery services, as well as barriers and facilitators to their implementation. Methods: Descriptive, cross-sectional study conducted in the surgical services of a university hospital. Staff members who participated in the design, implementation or evaluation of improvement opportunities and agreed to respond to an online survey were included. Measured variables included the characteristics of the participants, extent of implementation of the interventions, and barriers and facilitators. A descriptive analysis was performed. Results: Of the 23 healthcare professionals invited to participate, 15 agreed to do so. Achievement of the implementation indicators varied between 67% and 83%. Barriers were associated with organizational structure, resources and communications, while facilitators were mainly related to methodology and team work. Conclusions: Medication prescription and administration in surgical units are highly complex processes. Continuous quality improvement implementation must anticipate barriers and facilitators when it comes to adapting interventions which have been shown to be effective. It is critical to integrate improvement projects with the organizational strategy, plan for sustainability from the early stages, and prioritize microsystem empowerment.