Congress Abstracts 2004

64

IMPLEMENTATION OF CLINICAL PRACTICE GUIDELINES: A CRITICAL COMPONENT OF EVIDENCE-BASED PRACTICE. Caryl Fulcher, MSN, RN, CS, and Kerry Harwood, MSN, RN, Duke University Health Systems, Durham, NC.

Implementing evidence-based practice is a charge to all professionals. Introducing published practice guidelines into practice is one way to meet this objective, and the advanced practice nurse (APN) is well qualified to lead such initiatives.

Guideline implementation is increasingly being recognized as a critical step to practice change. Barriers to implementation may include disagreement between experts, vested interests, inadequate resources, ineffective education, or simply institutional inertia. The purpose of this project is to describe the process used by a university medical center to implement the National Comprehensive Cancer Network Practice Guidelines for the Management of Distress, beginning with a feasibility pilot.

An APN-led interdisciplinary task force was created to lead the process of implementing these guidelines. This process included assessment of existing institutional practice as compared with the guidelines benchmarking other institutions’ successes, involving stakeholders to elicit support, providing educational programs, evaluating distress management tools, planning for barriers, and designing a feasibility pilot for guideline use.

Comprehensive practice assessment identified gaps in consistent psychosocial assessment and access to psychiatric services as well as strengths in existing resources to support distressed patients. Assessed barriers included skepticism regarding the efficacy of distress management and concerns about additional time required and potential overload of resources. Actual barriers to pilot implementation included funding and time constraints, the challenge of educating a diverse group of stakeholders, and the need to ensure compliance with HIPAA regulations.

Experiences with this project have demonstrated the APN to be an appropriate project leader for guideline implementation, using her multiple competencies as clinical expert, educator, researcher, and consultant. Lessons learned have wide applicability for nurses interested in implementing both nursing and interdisciplinary clinical practice guidelines.