Paper
Wednesday, July 13, 2005
This presentation is part of : Clinical Scholars for Evidence-Based Practice: Direct Care Providers Challenge the Status Quo
Challenges to Implementation of EB Change in Nursing Practice
Cynthia Honess, RN, MSN, Center for Clinical and Professional Development, Maine Medical Center, Portland, ME, USA and Suzanne Chenoweth, RN, BSN, Dept. of Nursing, Post Cardiac Interventional Unit, Maine Medical Center, Portland, ME, USA.

Traditional rationale for prolonging patients' bedrest after a percutaneous coronary interventional (PCI) procedure is to prevent bleeding at the femoral puncture site and decrease risk of vascular complications, e.g. hematomas. On our 24 bed post PCI nursing unit, approximately 185 patients every month, 75 % of the patient population, undergo a PCI requiring prolonged bedrest. By reducing duration of bedrest from six hours to four hours following PCI, approximately 370 hours of nursing care could hypothetically be reduced. Patient discomfort from prolonged bedrest is a major dissatisfier among this group. Decreasing bedrest duration without increasing complications may decrease length of hospital stay and increase patient satisfaction. MEDLINE and CINAHL were indexed for research articles that investigated duration of bedrest and subsequent sequelae following a PCI. Five research articles were found. Each article was critiqued, and integrated tables developed on duration of bedrest, anticoagulation, French catheter size, and procedural sheath dwell time. Evidence integration suggests that the optimal bedrest duration following a femoral artery puncture is not known but there is not an increase in untoward vascular sequelae at four hours as compared to six hours of bedrest. Confident in the integrated tables of evidence, we presented our proposal for decreased bedrest to the interventional cardiologists in our facility. We had internal evidence regarding low occurrences of post-procedure complications. We were asked to seek the support of all cardiologists at the institution after the proposal was well received by the interventionalists. These additional expectations have slowed our progress but plans are currently in place to collect pre-implementation data in January 2005. This presentation will include the critique and synthesis of the evidence, the challenges, anticipated and unanticipated, and the team approach for garnering support of our project.