Developing Guidelines for Clinical Protocol Development

Abstract

During the 2-year period from 2007 through 2009, the Visiting Nurse Service of New York (VNSNY) conducted the Renfield Evidence-Based Practice Improvement (EBPI) Fellows Program1 (hereinafter referred to as the Renfield Program). This program was cosponsored by the Department of Education and Clinical Development within the larger Departments of Quality Management Services (QMS) and Research. The Evidence-Based Practice Improvement (EBPI) model designed by the first author in conjunction with the VNSNY for conducting a clinical practice improvement project was the guiding framework for the program (Levin et al., 2010). The purposes of the Renfield Program were to * provide participants with the knowledge and skills to identify a clinical issue within an organizational context, search for the best and most relevant evidence, and appraise a variety of evidence from the literature; * guide participants in the development of a body of evidence related to a selected clinical problem (a) using evidence-based methods to evaluate the evidence relevant to the selected clinical problem, (b) evaluating the appropriateness of the evidence base for practice implementation, and (c) determining the need for small tests of change; * provide participants with the knowledge and skills to develop the EBPI project plan; and * facilitate participants' design of an EBPI project plan. Both quantitative and qualitative outcomes of this program demonstrated the fellows' growth in their beliefs about and their confidence in incorporating evidence- based practice into their daily work as well as their actual implementation of EBPI. Using Melnyk, and Fineout-Overholt's EBP Beliefs and Implementation Scales (2008), fellows' beliefs about EBP increased from baseline (mean = 55.8; SD = 3.0) to 12 months (mean = 56.5; SD = 3.2), but the increase was not significant (p = .37). Evidence-based practice implementation scores increased from 23 (SD = 18.3) to 30 (SD = 16.5) with higher scores showing more experience with EBP tasks (p = .13). Although the sample size is small (15 nurses completed baseline tools and 11 at follow-up) to show significant differences on these scales, the evaluation results demonstrate positive trends. Interestingly, group cohesion improved significantly from 16.7 (SD = 5.3) at baseline to 13.5 (SD = 5.8) at 12 months (p = .04). In addition, fellows commented very positively on their participation in this program and how the program helped them to view their practice through a different lens. Two EBPI projects, conducted by two different teams of fellows, led to important information that could help VNSNY improve clinical practice. One interesting aspect of the Renfield Program was to mentor selected individuals in the QMS department to become future educators of EBPI within the agency. The faculty-in-training during this project, Lorraine Ferrara and Bonnie Lauder, were mentored by the visiting faculty member from Pace University and the visiting scholar from the University of Pennsylvania. They have embraced and internalized all this learning, and have been teaching others in the QMS Department as well as participating with the first author in the evidence-based practice doctoral course she taught at Pace University and the workshops (described in the following texts) that she and Dr. Kathy Bowles, visiting scholar from University of Pennsylvania, have given at VNSNY. Building on the success of the Renfield EBPI Fellows Program, a series of workshops was conducted for the entire QMS staff on EBPI. Feedback from QMS participants was very positive. The next step in going forward and putting to use the information gleaned by workshop participants was the formation of a committee to develop Guidelines for Clinical Protocol/Guidelines/Procedures Development within VNSNY in an effort to standardize the process for such protocol development and incorporate an EBPI approach (see Figure 1). …