Hypertonic saline: a change of practice

Abstract

This practice development review describes how the introduction of hypertonic saline in the treatment of raised intracranial pressure was brought about in one critical care unit. It considers the need for staff education and patient safety as an integral part of the change process. The aim was to review making a practice change, using Lewin's three step change model and describes possible pitfalls in the process and ways of overcoming or avoiding them. The inclusion criterion for critiqued literature was: Worldwide, English language studies from the last 26 years. Exclusion was articles from non-academically recognized sources. The search was limited to primary and empirical sources. This article uses Lewin's change model to describe driving and restraining forces, highlighting potential problems and suggesting ways in which they can be overcome when implementing a change in practice. Critical to the success of any change is the importance of evaluation, and suitable methods of evaluating the change are also suggested. Critical care and neurosurgical nurses need to be aware of the potentially serious side effects, actions and correct methods of administration of hypertonic saline to ensure its safe use and ensure patient safety. Effects and side effects of hypertonic saline are described, highlighting the need for care in introducing such agents into a clinical area. The methodology used was an electronic search. The change in practice relates to the introduction of hypertonic saline, but could be adapted for any change in clinical nursing practice.