| Learning Objective #1: Understand the pragmatic strategies to evaluate evidence-based clinical and health services changes | |||
| Learning Objective #2: Appreciate the scope and level of outcomes required to evaluate the implementation of an evidence-based protocol |
Objective: An initiative to deliver ‘best practice’ with chronic wound care was undertaken in one large Canadian community. This involved: evaluating international practice guideline recommendations, developing the local protocol, conducting a prevalence survey and regional needs assessment, assisting the planners with the clinical/organizational redesign for the new service. Design: One-year pre-post evaluation study has been completed from the clinical and health services perspective.
Population, Setting, Years: Chronic wound population, Canadian, urban-rural area of 1,000,000. Home care and Nurse Clinics. Study period 2000-2002. Intervention, Outcome Variables: With the new service, nurses provided care to all clients regionally with chronic leg ulcers referred to home care using an evidenced-based clinical protocol. The service model involved all-RN team of primary and secondary nurses with streamlined links to specialist physicians. The results of the one-year pre-post analysis will be presented comparing clinical, service, and economic outcomes.
Results: We followed 161 clients pre-implementation, and following implementation, 409 clients were admitted with venous, mixed and/or arterial leg ulcers. There were no significant differences between pre- and post-groups in socio-demographic and clinical variables (comorbidities, chronicity, size, location, duration of ulcer). After implementation, significant differences were found in healing rates: 23% healed at 3 months pre- compared with 52% post-implementation. The venous ulcer healing rate was 24% pre-implementation compared with 64% after. Visits per week dropped from 3.2 to 2.4, with the proportion of daily visits decreasing from 44% to 8%. Weekly supply costs decreased from $119 to $48.
Conclusions: Implementation of evidence-based care in the community for the leg population has resulted in more effective, less expensive services. Healing rates at 3 months have more than doubled; scarce nursing time is being utilized more efficiently. Implications: The region is providing care to more people with leg ulcer problems for less cost and with less nursing staff.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003