PMID: 16617946Apr 19, 2006Paper

When implementation fails: the case of a nursing guideline for fall prevention

Joint Commission Journal on Quality and Patient Safety
Jelle van der HelmPatrick Bossuyt

Abstract

Implementing guidelines can be very difficult. No magic bullet or step-by-step implementation plan is available, neither is any single implementation strategy superior. At the Academic Medical Center (AMC) in Amsterdam, a nursing guideline was developed in 1993 on prevention of patient falls. Falls decreased by 30% on six wards, yet an effort to implement the guideline into daily practice throughout the hospital failed. A renewed effort was made to implement the guideline in two wards (neurology and internal medicine) in 1999. IMPLEMENTING THE GUIDELINE: Preparations were made for implementation in the two wards. Barriers to change were identified and solutions were translated into day-to-day activities in the wards. The intervention period covered 18 months (January 2000-June 2001). A mix of implementation strategies was used, including a local consensus process, educational activities, and active support and feedback to management and staff. In the internal medicine ward, the target incidence of 6% was met for four of the 18 months in the intervention period. In the neurology ward, the incidence target of 11% was met in five months. Barriers to change and enabling factors may only become apparent during the implementation pro...Continue Reading

References

Aug 16, 1997·BMJ : British Medical Journal·R Grol
Oct 28, 1999·International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services·G Naylor
Mar 29, 2000·Family Practice·R Grol, R Jones
Jul 14, 2000·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·U NabitzJ Walburg
Jul 31, 2001·Family Practice·J Gené-BadiaC Moliner-Molins
Sep 15, 2001·BMJ : British Medical Journal·P E Plsek, T Greenhalgh
Jul 15, 2003·Journal of Nursing Care Quality·Astrid Semin-GoossensPatrick M M Bossuyt

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Citations

May 15, 2008·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Melissa J KraussVictoria J Fraser
Aug 2, 2011·Journal of Clinical Nursing·Diny van Harten-KrouwelRuth Pel-Littel
Aug 27, 2016·International Journal of Nursing Practice·Craig LockwoodMargaret Harrison

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