These guidelines are designed to push for quality improvement using evidence-based practice across the entire care pathway. They aim to achieve consistent advancement in people’s health and lead to access of good-quality care.
Putting these guidelines into practice benefits everyone; this includes the staff directly involved in patient care, those involved in managing the health facility, local healthcare organisations and members of the public. It can help to monitor service improvements, demonstrate that high-quality care is being provided and also highlight areas for improvement.
One of the most difficult aspects of working with guidelines is how best to implement them into routine daily practice. Many of us provide patient care according to usual routines (‘how it’s always been done’) instead of looking at developments and change in practice to reflect the latest evidence-based research. Barriers to implementation can include organisational constraints, such as a lack of time, obstructive opinions of key people who may not agree with the evidence or do not want to change their practice, and lack of leadership to effect change. Additionally, there may be a perceived poor sense of competence by staff who question their skills.
In order for change to be effective there must be an identified need, a willingness to adapt and promote current practices, a driving force behind it and acceptance from all levels, be it individual, team or organisational . For these guidelines to be successfully implemented, the following is recommended.
High-level support and clear leadership
Successful implementation plans have a person on the board, such as a medical director, who drives the implementation agenda forward as well as a clear implementation policy approved at the highest level.
A nominated lead for the organisation
One person should be identified who is responsible for driving the education and development of these guidelines into practice. They should be involved in coordinating, disseminating and monitoring the implementation as well as for arranging educational events to promote the use of these guidelines in the workplace. The responsibility for this could be included into an existing role such as that of the clinical governance manager or anyone involved in quality assurance.
A multidisciplinary forum
The multidisciplinary forum should have decision-making powers and report to the chief executive or senior managers of the organisation. New guidelines should be reviewed after they are published and their relevance to the organisation assessed. A clinical lead for each guideline should be identified and steps taken to disseminate to the appropriate personnel. Implementation is most effective if a wide range of disciplines are involved in the forum.
A local policy
Organisations should have a clear, structured policy in place for implementing new guidelines. This policy should be endorsed at the highest level of management and be available for all .
What can you do as an individual?
Become a project champion. One way to begin implementation in your workplace is to take the initiative and volunteer to represent your department. Review these guidelines and compare them with the current ones you have in place. Note any changes to practice that need to be addressed in order to standardise your organisation with current best practice.
In staff meetings, bring up the idea of implementation and seek feedback from other staff members on the best way to do this. Collaborate with colleagues across all boards and emphasise the importance of team communication and cohesion. Print handouts, send out links to workmates and arrange for flowchart posters to be placed in relevant areas.
If you have a clinical educator at your site, inform them of the current updates and discuss ways they can influence training and provide moulage-based simulation scenarios. Often training with the staff you work with on a regular basis can help to foster communication and a real sense of teamwork.
Speak with your organisation about placing access to the Victorian trauma guidelines on your intranet to allow easy access to the site.
As always, your feedback is encouraged. If you have any comments or suggestions, or would like to share how you have adopted these guidelines into your practice, we would appreciate your thoughts.
References
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. The Lancet. 2003. Vol. 362. Oct 11
National institute for health and care excellence. Using NICE guidance and quality standards to improve practice. Available at: http://publications.nice.org.uk/ using-nice-guidance-and-quality-standards-to-improve-practice-pg1/introduction (Accessed April 2 2014).