AACN News—January 2007—Practice

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Vol. 24, No. 1, JANUARY 2007

Potential Barriers to Implementing Practice Alerts

By Maureen A. Seckel,
and Kathleen H. Miller, RN, EdD, APRN-BC
2005-06 Research Work Group

AACN began developing Practice Alerts in 2004 to close the gap between research and practice, to provide guidance, to standardize practice and to identify and inform nurses and other healthcare professionals about new advances and trends in practice.

The goal of the Practice Alerts was to assist the bedside nurse in taking the evidence from the research and implementing a change in practice to ensure that the patient was receiving optimal care. The Practice Alerts are planned annually by the volunteer Research Work Group in conjunction with AACN staff, based on feedback from AACN members, and sent to experts in the topic for development. Now that evidence-based guidelines are easily accessible online to members and nonmembers, what are the potential barriers for implementing these Practice Alerts?

Barriers to Implementation
Individual and institutional barriers to implementing evidence-based practice include lack of knowledge and time; value and knowledge regarding research; resistance to change; and access to computers and data bases.

An immediate barrier may be a lack of knowledge that AACN Practice Alerts exist. The Research Work Group and AACN are committed to spreading the word about these evidence-based practice guidelines, which are available at www.aacn.org > Clinical Practice > Practice Alerts.

In addition to poster and concurrent session presentations at NTI 2006, the Research Work Group wrote a series of articles for AACN News. Copies of the latest Practice Alert (at the time of NTI 2006), Noninvasive Blood Pressure Monitoring were handed out to NTI attendees. Additionally, each new Practice Alert was published in its entirety in AACN News as it became available and a link to the Practice Alert is included in Critical Care Newsline, the weekly electronic newsletter from AACN. Knowledge is the key to transforming your workplace, so ensure that your nursing and other professional colleagues know that the Practice Alerts can be accessed via the AACN Web site (www.aacn.org).
The following Practice Alerts are available:
• Oral Care in the Critically Ill
• Noninvasive Blood Pressure Monitoring
• Severe Sepsis
• Deep Vein Thrombosis Prevention
• Preventing Catheter-Related Bloodstream Infections
• Verification of Feeding Tube Placement
• Dye in Enteral Feedings
• Family Presence During CPR and Invasive Procedures
• ST Segment Monitoring
• Dysrhythmia Monitoring
• Pulmonary Artery Pressure Measurement
• Ventilator Associated Pneumonia

Time is a treasured commodity and an important factor in implementing changes in a nurses’ clinical practice. The format of the Practice Alerts provides a relatively time-efficient process to read about the current literature on practices that affect acute and critical care nursing. The Practice Alerts are currently divided into four main sections. The first section of a Practice Alert contains the expected practice in brief bulleted points. The second section includes the supportive evidence and contains both graded levels of evidence and referenced supportive evidence. The third section provides information on what you should do, followed by the fourth section, which includes a complete reference list.

Value and knowledge of research is another barrier for implementing Practice Alerts. The Practice Alerts are designed to provide the research knowledge and shorten both the time and skill needed for evaluating current research by providing a format in which experts have already done the research syntheses. In addition, several Practice Alerts include educational and performance improvement tools that can be downloaded to help educate clinical staff and monitor the implementation of the specific Practice Alert.

Resistance to change is another barrier for incorporating practice changes in the work setting. Working with colleagues who resist change can be a difficult barrier that requires expertise to overcome. Instead of “I have always done it this way,” “what does the evidence show?” should be our mantra. Best practice should not be an option; it should be an expectation. Improving the quality of care and patient outcomes should be our highest priority.

Other institutional factors that may present barriers to the implementation of Practice Alerts may be access to computers and data bases, lack of knowledge about the use of these guidelines by other healthcare providers, including administration, and staffing issues that limit time for the staff to institute practice changes. Successful use of the Practice Alerts requires involvement of not only the individual but the institution.

Strategies for Overcoming Barriers
The barriers to implementing Practice Alerts can present challenges for teams attempting to change care in their acute and critical care units. A designated leader, either management or clinical nurse specialist, can assist the team in this process. Under the designated leader, the team can set a plan with stages of change to overcome these barriers and implement the Practice Alert.4 Strategies for overcoming barriers can be targeted to the individual and the institution. The following will help overcome barriers:
• Be a role model for actualizing the Practice Alert in your care
• Educate and re-educate the staff about the Practice Alert
• Provide time for staff to learn about the practice change
• Schedule opportunities for staff to learn about research and evidence-based practice through journal clubs, posters, and handouts
• Enlist the staff champions to motivate other staff to use the Practice Alert
• Encourage uninvolved staff to participate in the practice change
• Recognize staff for their participation in implementing the Practice Alert through praise or other tangible rewards
• Meet with other healthcare providers and administration to educate them on the use of the Practice Alerts and factors that will facilitate their implementation

Final Thoughts
The future vision for acute and critical care nursing and evidence-based care was summed up by past AACN President Debbie Brinker, RN, MSN, CCNS, CCRN, in her speech at NTI 2006, “Nurses and other healthcare professionals insist on working only in healthy work environments, those where evidence-based practice is the norm, where systems are truly driven by the needs of the patients and their families, and where all team members make their optimal contribution … hold yourself and your teammates accountable for applying evidence in your practice using AACN’s Practice Alerts.

1. Retsas A. Barriers to using research evidence in nursing practice. J Adv Nurs. 2000; 31:599-606.
2. Pravikoff, DS, Tanner AB, Pierce ST. Readiness of US nurses for evidenced-based practice. Am J Nurs.2005; 105:40-52.
3. Ring N, Malcolm C, Coull A, et al. Nursing best practice statements: an exploration of their implementation in clinical practice. J Clin Nurs.2005; 14:1048-1058.
4. Bennett, M. Implementing new clinical guidelines: the manager as agent of change. Nurs Manage. 2003; 10(7):20-23.
5. Byram D. Leadership: a skill, not a role. AACN Clin Issues. 2000; 11(3):463-469.
6. Shulman C, Powers J. Implementation of AACN Practice Alerts. AACN News. Dec. 2006.
7. Buonocore D. Leadership in action: creating a change in practice. AACN Clin Issues. 2004; 15(2):170-181.
8. Brinker D. American Association of Critical-Care Nurses 2006 National Teaching Institute, President’s Address: Engage and Transform. (2006, May 22).

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