Clinical Nursing Best Practice Guidelines developed by the Registered Nurses’ Association of Ontario (RNAO) are improving the quality of patient and client care in the province – thanks to the efforts of health-care organizations and individual nurses who are passionate about implementing evidence-based best practices.
The RNAO launched the program in November 1999 with funding from the Ontario Ministry of Health and Long-Term Care. To date, 30 clinical guidelines on topics ranging from the Primary Prevention of Childhood Obesity to Caregiving Strategies for Older Adults with Delirium, Dementia and Depression have been developed by nurses and other health-care professionals.
While each document includes a series of recommendations based on the best available evidence, the Nursing Best Practice Guidelines (BPG) are not intended to be used as a check-list of services, but rather as a jumping-off point for organizations that want to evaluate the nursing care they are currently delivering and introduce new policies and procedures that are best-suited to the needs of their patients. Throughout the province, the implementation of BPGs are driven by nurse-led committees that invite other members of the health-care team to join them in determining which of the recommendations to introduce and how best to move forward.
A number of health-care organizations, called “Spotlights” have demonstrated their commitment to implementing BPG by entering into a three-year partnership with RNAO. During this period, organizations implement a number of BPGs, share creative strategies for successful implementation, evaluate their implementation and outcome measures through ongoing audits and/or research and share their results and lessons learned. To date, nine organizations have completed their three-year Spotlight contracts and continue their affiliation with the RNAO by taking on new guidelines or continuing to work more deeply on their current guidelines while continually evaluating their impact on patient care and organizational and system outcomes. Twelve other organizations, called “Best Practice Spotlight Organization Candidates” have entered into three-year partnerships with the RNAO and are currently implementing and evaluating BPGs. On February 15, nurses from these Spotlight Organizations met in Toronto to share strategies for BPG implementation and to celebrate successes. Break out sessions on Staff Engagement, Inter-disciplinary Collaboration and Sustainability provided practical strategies on these aspects of implementation and opportunities for questions and networking. A series of round table sessions related to the implementation of specific guidelines, such as Client-Centred Care and Pain Assessment and Management, were also held.
During one of the large group sessions, Baiba Zarins, the Project Manager for the Best Practice Guidelines at University Health Network in Toronto, reflected on University Health Network’s (UHN) experience as a Spotlight Organization. She said the members of the organization feel proud that they achieved a collective goal. “We accomplished a lot during our brief, but very intensive partnership with the RNAO,” says Zarins. “It’s amazing to witness the movement of BPG recommendations off the written page and into practice.” UHN has implemented the BPGs related to: client-centred care; preventing falls; pain assessment and management; adult asthma care; diabetes management; smoking cessation; vascular access; dementia, delirium and depression; and pressure ulcers.
According to Zarins, the implementation of the BPGs have led to improvements in patient care and increased satisfaction for patients and staff. For example, as part of the implementation of the pain BPG, advanced practice nurses who are part of the acute pain service provided pain education during orientation for new nurses and also gave training sessions for hospital volunteers and members of the patient transport and housekeeping staff. Zarins says it was important to train non-nursing support staff as “those are the individuals who often interact more with the patients as they’re waiting for the elevators or as they’re going about their roles throughout the day.” Non-nursing staff were introduced to the numeric rating scale and learned to ask patients “Are you having pain?” and, if they feel comfortable, to continue by asking “On a scale of zero to 10, how do you rate your pain?” That information is then passed on to the nearest health-care provider who can intervene.
UHN has implemented the client-centred care guideline in a variety of ways. Some nurses have attended a formal course on client-centred care and a number of research studies are underway. Staff, patient and family satisfaction surveys have been introduced and staff are encouraged to post stories related to patient-centered care on the hospital’s intranet.
The results of BPG implementation at UHN have been very positive – patient satisfaction scores are increasing and staff are playing an active role and providing unique approaches. “We continue to challenge the status quo, taking education and training to the next level through innovative visioning such as our newly-launched e-learning strategy which now incorporates education models for 10 of the BPG to date,” says Zarins.
UHN is just one of the Spotlight organizations that is using the RNAO’s BPGs to improve the quality of patient care and increase the job satisfaction of nurses and other members of the health-care team. “I want to commend the nurses at all out Spotlights for implementing the RNAO BPGs and bringing evidence-based practice to the bedside,” says Tazim Virani, Program Director of the BPG Program at the RNAO. “Through their commitment to implementing, evaluating and disseminating BPGs, they are significantly changing the way nursing care is delivered.”