March 2002 toolkit - rnao.ca

1 March 2002toolkitclinical practiceguidelinesimplementation of Registered Nurses Association of OntarioNursing Best Practice Guidelines Project111 Richmond Street, Suite 1208 Toronto, OntarioM5H Nurses Association of OntarioHead Office438 University Avenue, Suite 1600 Toronto, OntarioM5G 2K8 Implementation oftoolkitclinical practice guidelinesCopyrightWith the exception of those portions of this document for which a specific prohibition or limitation against copying appears, the balance of this document may be produced, reproduced and published in its entirety only, in any form, including in electronic form, for educational or non-commercial purposes, without requiring the consent or permission of the RegisteredNurses Association of Ontario, provided that an appropriate credit or citation appears in the copied work as follows:Registered Nurses Association of Ontario (2002).

2 toolkit : Implementation of clinical practice , Canada:Registered Nurses Association of the Stage.. 5 chapter 1 Step 1: Selecting Your Clinical Practice Guideline .. 13chapter 2 Step 2: Identifying, Analyzing, and Engaging Your Stakeholders.. 23chapter 3 Step 3: Assessing Your Environmental Readiness.. 39chapter 4 Step 4: Deciding on Your Implementation Strategies.. 47chapter 5 Step 5: Evaluating Your Success .. 57chapter 6 Step 6: What About Your Resources?.. 65summary .. 75bibliography.. 80appendicesA: Revising and Updating the toolkit .

3 83B: Glossary.. 84table of contentsAlba DiCenso, RN, PhDChairCHSRF/CIHR/MOHLTC Nursing ChairProfessor, Nursing & ClinicalEpidemiology and BiostatisticsMcMaster University Hamilton, OntarioIrmajean Bajnok, RN, PhDDirector, Centre for Professional Nursing ExcellenceRegistered Nurses Association of OntarioToronto, OntarioElizabeth Borycki, RN, MNApplication SpecialistMount Sinai HospitalFormer BPG Resource NurseToronto, OntarioBarbara Davies, RN, PhDAssociate ProfessorSchool of Nursing,University of OttawaCareer Scientist,Ontario Ministry of Health & Long-Term CareOttawa, OntarioIan Graham, PhDSenior Social ScientistClinical Epidemiology Unit Health Research InstituteAssociate Professor, MedicineUniversity of OttawaOttawa, OntarioMargaret Harrison, RN, PhDAssociate ProfessorSchool of NursingQueen s UniversityKingston, OntarioNurse Scientist, Ottawa Hospital andOHRI Clinical Epidemiology UnitOttawa, OntarioJo Logan, RN, PhDAssociate ProfessorSchool of NursingUniversity of OttawaOttawa, OntarioLynn McCleary, RN, PhDClinical Scientist.

4 NursingChildren s Hospital of Eastern OntarioResearch InstituteOttawa, OntarioMichael Power, BA, MIMD irector, Regional PlanningAdministrationNorthwestern Regional Cancer ClinicThunder Bay, OntarioJulia Scott, RN, MBAP roject ManagerRecruitment and Retention ProjectRegistered Nurses Association of OntarioToronto, Ontario2 toolkit :Implementation of Clinical Practice Guidelinestoolkit development panelThe Registered Nurses Association of Ontario (RNAO) established a panel of nurses and researchers to develop a toolkit for Implementing Clinical PracticeGuidelines.

5 The panel consisted of the following contributors:The toolkit was conceptualized and developed by the entire , leadership on specific chapters was provided as follows:setting the stage:.. Tazim Viranichapter 1:.. Ian Graham, Tazim Viranichapter 2:.. Irmajean Bajnok, Elizabeth Boryckichapter 3:.. Irmajean Bajnok, Julia Scottchapter 4:.. Ian Graham, Margaret Harrison, Jo Logan, Lynn McClearychapter 5:.. Barbara Davies, Alba DiCensochapter 6:.. Michael Power, Tazim Viranisummary:.. Tazim Viraniscenario:.. Elizabeth Borycki, Lynn McClearyTazim Virani, RN, MScN.

6 6 Project DirectorAnne Tait, RN, BScN ..Project CoordinatorHeather McConnell, RN, BScN, MA(Ed) ..Project CoordinatorCarrie Scott ..Project AssistantElaine Gergolas, BA ..Project Assistant3toolkit development support teamVisit the RNAO website at place an order for this :Implementation of Clinical Practice GuidelinesacknowledgementsRNAO wishes to acknowledge the following persons for the review of the toolkit :Bunny AlexanderChief Nursing OfficerNiagara Health System Welland, OntarioSusan BaileyPalliative ClinicianFormer BPG Resource NurseThunder Bay Regional HospitalThunder Bay, OntarioMarilyn DeachmanClinic Nurse ConsultantAbbott Laboratories Toronto, OntarioMaureen DobbinsAssistant ProfessorMcMaster UniversityHamilton, OntarioDoris GrinspunExecutive Director RNAOT oronto, OntarioDoris HowellDirector of Research and DevelopmentInterlinkToronto.

7 OntarioLinda JohnstonPalliative Care CoordinatorFormer BPG Resource NurseRoyal Victoria HospitalBarrie, OntarioSusan Mills-ZorzesEnterostomal NurseSt. Joseph s HospitalThunder Bay, OntarioVerna OrtghiesesClinical EducatorSt. Joseph s HospitalThunder Bay, OntarioMarg PolingPalliative Care AdvisorVictorian Order of NursesFormer BPG Resource NurseThunder Bay Regional HospitalThunder Bay, OntarioKaren RayProject ConsultantFormer BPG Resource NurseSaint Elizabeth Health CareToronto, OntarioJosie SantosClinical Nurse SpecialistFormer BPG Resource NurseHumber River Regional Hospital Toronto, OntarioKathy SirrsAssistant Administrator Clinical ServicesChief Nursing OfficerNorth Bay Psychiatric HospitalNorth Bay.

8 OntarioSelinah SogbeinAssistant Chief Nursing OfficerCoordinator of Clinical ServicesNorth Bay Psychiatric HospitalNorth Bay, OntarioKarima VeljiAdvance Practice NurseRadiation OncologyPrincess Margaret HospitalToronto, Ontariointroductionsetting the stageClinical practice guidelines (CPGs) are commonly referred to as: systematically developedstatements of recommended best practice in a specific clinical area, designed to providedirection to practitioners in their practice. CPGs are implemented to enable the accom-plishment of one or more of the following objectives: To deliver effective care based on current evidence; To resolve a problem in the clinical setting ( poor management of pain); To achieve excellence in care delivery by meeting or exceeding quality assurance standards; To introduce an innovation ( a new effective test or treatment).

9 As increasing numbers of CPGs are developed, there continues to be a large variation in health care practice, in general, and in nursing care specifically. Furthermore, there is concern that CPGs will not be fully utilized by health care practitioners if they are not effec-tively introduced, supported and implemented. There is strong support in the literature,albeit largely physician based studies, indicating inadequate use of well-known CPGs (Bero,Grilli, Grimshaw, Harvey, Oxman & Thomson, 1998; Davis & Taylor-Vaisey, 1997; Oxman, Thomson, Davis, &Haynes, 1995; Thomas, Cullum, McColl, Rousseau, Soutter, & Steen, 1999; Wensing, Van der Weijden, &Grol, 1998).

10 5 The RNAO nursing best practice guidelines can be found at :Implementation of Clinical Practice GuidelinesThis toolkit was designed to assist health care settings in maximizing the potential of CPGs,through systematic and well-planned implementation. It was also designed to accompanythe nursing best practice guidelines (NBPGs) developed by the Registered NursesAssociation of Ontario (RNAO) in order to facilitate their implementation. The likelihood of success in implementing CPGs increases when: A systematic process is used to identify a well-developed, evidence-based CPG; Appropriate stakeholders are identified and engaged; An assessment of environmental readiness for CPG implementation is conducted; Evidence-based implementation strategies are used that address the issues raisedthrough the environmental readiness assessment; An evaluation of the implementation is planned and conducted.