Paper
Wednesday, July 21, 2004
This presentation is part of : Chronic Care
Using Evidence-Based Clinical Practice Guidelines to Prevent Pressure Ulcers in Singapore
Premarani Kannusamy, PhD, Division of Graduate Medical Studies, Faculty of Medicine, Division of Graduate Medical Studies, Faculty of Medicine, National University of Singapore, Singapore, Singapore
Learning Objective #1: Discuss the various strategies for successful integration and implementation of evidence-based practice in hospitals and institutions
Learning Objective #2: Identify barriers for implementation and sustainability of evidence-based practice
Fostering evidence-based practice (EBP) is a priority due to healthcare restructuring and an increased emphasis on the delivery of high quality, cost-effective care. To provide quality care, Singapore developed a clinical practice guideline (CPG) for preventing pressure ulcers. The CPG, which contains 29 recommendations, were disseminated to hospitals.

Design, Setting & Objective:

A cross-sectional survey was conducted at the end of one year in six hospitals to determine whether the CPG was successfully integrated into clinical practice and identify the barriers and facilitators for implementation and sustainability of EBP.

Method, Population & Sample:

The study sample comprised 1100 nurses. From each hospital, a random sample of five units was drawn. All nurses working in the 30 units were then sampled. Data was collected using the Process Evaluation Monitor (Folkedahl, Frantz & Goode, 1997) and the Nursing Research Utilization Survey (Titler, 1995).

Findings:

The response rate was 83.8 %. Among various findings, the results showed that full compliance to the recommendations of the pressure ulcer prevention CPG averaged only 50%. Of concern was that nurses reported that they prevented pressure ulcers through non evidence based practices, e.g. massaging areas at risk for pressure ulcers (10%) and using water filled gloves (8%) and donut-shaped devices (7%) as pressure relieving devices.

Implications:

Roger’s (1995) theory on the diffusion of innovations will be used to explain the results of this study. An important lesson to be learned is that dissemination alone is not effective. Although dissemination is necessary in the early stages of the process, it is however, particularly important to devise robust strategies to facilitate adoption and integration into clinical practice so that the desired outcomes can be achieved. The author will also discuss the barriers for implementation of EBP and recommend strategies to enhance adoption of EBP in hospitals.

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Sigma Theta Tau International
July 21, 2004