Implementation of Clinical Practice Guidelines of the Registered Nurses Association of Ontario-RNAO: A Nursing Experience in a Colombian Hospital

Abstract

Introduction: The implementation or Clinical Practice Guidelines (CPG) is a strategy that whose goal is to increase the use of evidence in the context of decision making and building health policies. Nurses of The “Cardioinfantil-IC” Foundation (FCI-IC) established a collaborative agreement with the Registered Nurses Association of Ontario, Canada (RNAO), in order to implement and evaluate three of its GPC in adult inpatients. Objective: This paper describes the design, process and preliminary evaluation of an implementation plan between July 2012 and December 2014. Methodology: The selection of the CPG was made after an initial needs diagnosis and a feasibility analysis. Two CPGs were based on prevention: one about fall and another one about pressure ulcers (PU); and one more based on direct care related to assessment and management of diabetic foot ulcers. The indicators selected for CPG about prevention were frequency of evaluation and confirmation of risk and event rate (falls and UP). In the CPG about care was evaluated the percentage of assessed patients (lower limbs and feet) in admissions, the percentage of patient/family education, and the percentage of patients with foot injury reduction (50%). Results: The evaluation of the risk for falls and pressure ulcers with a reassessment ranging from 24 to 72 hours was performed in all patients that were admitted. There was a reduction in the use of guardrails, and a low reduction in falls. There was no change in the rate of pressure ulcers but the incidence of ulcers was limited to grade II. The assessment in lower limbs, the education, and care about foot ulcers in diabetic patients increased. Conclusions: The implementation process of GPC, as a result of the networking with the RNAO, has guided nursing care practice based on the assessment of risk and events. Some limitations in the level of evidence of some recommendations have promoted the development of a new research. [Cortés OL, Serna-Restrepo A, Salazar-Beltrán LD, Rojas-Castañeda YA, Cabrera-González S, Arévalo-Sandoval I. Implementation of Clinical Practice Guidelines of the Registered Nurses Association of Ontario-RNAO: A Nursing Experience in a Colombian Hospital. MedUNAB 2016; 19(2): 103-114].