Marjon Borgert

14 Chapter 1 ϭ͘ ^ƵŵŵĂƌŝnjĞ ƚŚĞ ĞǀŝĚĞŶĐĞ Ϯ͘ /ĚĞŶƚŝĨLJ ůŽĐĂů ďĂƌƌŝĞƌƐ ƚŽ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ͗ ƵŶĚĞƌƐƚĂŶĚ ƚŚĞ ƉƌŽĐĞƐƐ ĂŶĚ ĐŽŶƚĞdžƚ ŽĨ ǁŽƌŬ ϯ͘ DĞĂƐƵƌĞ ƉĞƌĨŽƌŵĂŶĐĞ ϰ͘ ŶƐƵƌĞ Ăůů ƉĂƚŝĞŶƚƐ ƌĞĐĞŝǀĞ ƚŚĞ ŝŶƚĞƌǀĞŶƚŝŽŶƐ /ĚĞŶƚŝĨLJ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŝŵƉƌŽǀĞĚ ŽƵƚĐŽŵĞƐ ^ĞůĞĐƚ ŝŶƚĞƌǀĞŶƚŝŽŶ ǁŝƚŚ ƚŚĞ ůĂƌŐĞƐƚ ďĞŶĞĨŝƚƐ ĂŶĚ ůŽǁĞƐƚ ďĂƌƌŝĞƌƐ ƚŽ ƵƐĞ ŽŶǀĞƌƚ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ƚŽ ďĞŚĂǀŝŽƵƌƐ KďƐĞƌǀĞ ƐƚĂĨĨ ƉĞƌĨŽƌŵŝŶŐ ƚŚĞ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ͚ǁĂůŬ ƚŚĞ ƉƌŽĐĞƐƐ͛ ƚŽ ŝĚĞŶƚŝĨLJ ĚĞĨĞĐƚƐ ŝŶ ĞĂĐŚ ƐƚĞƉ ŽĨ ŝŶƚĞƌǀĞŶƚŝŽŶ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ ŶůŝƐƚ Ăůů ƐƚĂŬĞŚŽůĚĞƌƐ ƚŽ ƐŚĂƌĞ ĐŽŶĐĞƌŶƐ ĂŶĚ ŝĚĞŶƚŝĨLJ ƉŽƚĞŶƚŝĂů ŐĂŝŶƐ ͬůŽƐƐĞƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŝŶƚĞƌǀĞŶƚŝŽŶ ŝŵƉůĞŵĞŶƚĂƚŝŽŶ ^ĞůĞĐƚ ŵĞĂƐƵƌĞƐ ;ƉƌŽĐĞƐƐ ĂŶĚͬŽƌ ŽƵƚĐŽŵĞͿ ĞǀĞůŽƉ ĂŶĚ ƉŝůŽƚ ƚĞƐƚ ŵĞĂƐƵƌĞƐ DĞĂƐƵƌĞ ďĂƐĞůŝŶĞ ƉĞƌĨŽƌŵĂŶĐĞ Engage džƉůĂŝŶ ǁŚLJ ƚŚĞ ŝŶƚĞƌǀĞŶƚŝŽŶƐ ĂƌĞ ŝŵƉŽƌƚĂŶƚ Educate ^ŚĂƌĞ ƚŚĞ ĞǀŝĚĞŶĐĞ ƐƵƉƉŽƌƚŝŶŐ ƚŚĞ ŝŶƚĞƌǀĞŶƚŝŽŶƐ Execute ĞƐŝŐŶ ĂŶ ŝŶƚĞƌǀĞŶƚŝŽŶ ͚ƚŽŽůŬŝƚ͛ ƚĂƌŐĞƚĞĚ ƚŽ ďĂƌƌŝĞƌƐ ĞŵƉůŽLJŝŶŐ ƐƚĂŶĚĂƌĚŝnjĂƚŝŽŶ͕ ŝŶĚĞƉĞŶĚĞŶƚ ĐŚĞĐŬƐ ĂŶĚ ƌĞŵŝŶĚĞƌƐ͕ ĂŶĚ ůĞĂƌŶŝŶŐ ĨƌŽŵ ŵŝƐƚĂŬĞƐ Evaluate ZĞŐƵůĂƌůLJ ĂƐƐĞƐƐ ƉĞƌĨŽƌŵĂŶĐĞ ŵĞĂƐƵƌĞƐ Translating Evidence into Practice ŶǀŝƐŝŽŶ ƚŚĞ ƉƌŽďůĞŵ ǁŝƚŚŝŶ ƚŚĞ ůĂƌŐĞƌ ŚĞĂůƚŚ ĐĂƌĞ ƐLJƐƚĞŵ ŶŐĂŐĞ ŽůůĂďŽƌĂƚŝǀĞ ŵƵůƚŝͲĚŝƐĐŝƉůŝŶĂƌLJ ƚĞĂŵƐ ĐĞŶƚƌĂůůLJ ;ƐƚĂŐĞƐ ϭ͕Ϯ Θ ϯͿ ĂŶĚ ůŽĐĂůůLJ ;ƐƚĂŐĞ ϰͿ Figure 1. Model for translating evidence into practice. 28 Pronovost et al. used this model to improve the reliability of care for patients with central venous catheters in the ICU. 28 This quality improvement project aimed to reduce the number of central line infections associated with central line insertions. 28 During the study period of 18 months, the overall central line infection rate was reduced by 66%. Despite this success, implementing evidence-based practices in the ICU remains a challenge on the whole. 17,25 Patient safety improvements show varying results. 25,29 In most cases, new evidence-based practices are introduced rapidly, with no structured implementation plan available for changing behaviour. Successful implementation usually depends on a systematic approach that has been thoroughly planned and analysed. 25