CPG Implementation Barriers

Selection bias is the primary study limitation, as clinicians already familiar with PIC CPGs were more likely to participate, likely inflating reported usage and positive perceptions. The proliferation of guideline repositories at local, state, national, and international levels makes it difficult to identify the most appropriate and current guidance. Known barriers to CPG implementation include limited resources, insufficient awareness, inadequate training, physician reluctance, and fragmented interprofessional communication pathways. Geographic differences in clinical practice and entrenched local clinical cultures drove some clinicians to use local guidelines instead of or alongside PIC CPGs. Some participants perceived PIC CPG update cycles as lagging behind international guidelines.