Introducing clinical effectiveness to nursing practice: not so easy!

Abstract

Objective: To improve clinical effectiveness through the development of amultidisciplinary hospital health-care record (common documentation) for patients with Grade 2 critical lower-limb ischaemia admitted to the Leeds General Infirmary, UK. Methodology: A multidisciplinary clinical guideline was developed by asking staff to identify key clinical activities, audit criteria and standards, and expected clinical outcomes for this group of patients. Staff were also requested to cite the evidence substantiating their practice, and to identify essential information which should be routinely collected. A common documentation record was designed to incorporate these attributes, and used to document the csre of 20 patients with lower-limb ischaemia. An audit compared the amount of essential information contained in these records with that contained in the traditional case records of 20 similar patients. Findings and observations: Significantly more of the essential nursing information was recorded in the common documentation records than in traditional records for admission and daily review. No differences were observed with respect to recorded discharge information between the two types of record. The amount of information recorded in both types of record fell short of that which had been identified as being essential. Nurses were able to identify the key activities of nursing interventions for guideline development, and a later audit indicated that they adhered well to these. However, nurses had difficulty in providing evidence in support of their practice and in identifying and agreeing audit criteria and standards. Audit revealed that agreed standards were not being met. Problems were also experienced in defining and recording clinical outcomes. Conclusions: If clinical effectiveness is to be achieved, organizational initiatives such as education and training, research and development and clinical audit must also be combined with strategies to change the organizational culture, as well as the attitudes and behaviours of individual health-care professionals.