Uniform Nurse Care Policies

[lizva101]

Hi All,

I have noted lately that many procedure policies vary from one insitution to another. Example : Some hospital policies say flush central lines with 3 cc heparin per shift, some say per 72 hours. Hospitals have different policies to prevent vent pneumonia, different policies for admin high alert meds, just look at the message boards and you will see different responses to clinical questions, many answers influenced by the respondents insitutional nursing policies.

I really feel like there is such a thing as a best policy based on several factors, ie pt outcomes, pt safety, cost effectiveness. I also feel that as travel nursing is becoming so integrated, there should be a way to form uniform policies from hospital to hospital. I think this would cut down on the cost of staff training and would better the field of nursing.

Does anyone know of any way to look into this matter? I am really interested if anyone has any background in this or if they have any input to add. Also, what do you think of this idea? I think it would be great, I think unit managers are always hunting for the most cost effective ways to improve practice but don't necessarily have the time to do the research. And if there was a body that would do the research for them, then maybe the managers would have more time to spend on the floor, rather than worrying about how to change and implement new policy.

I would like to create a task force or join one addressing this topic.

Any thoughts? Thank you.

[czyja, MSN, RN]

I really feel like there is such a thing as a best policy based on several factors, ie pt outcomes, pt safety, cost effectiveness.

Disclaimer - I am a cell biologist about to start a nursing school. (Yippieee!) I am not yet a nurse (but I know a bit or two about research).

One would think that there would be universally applicable best policies.But science, despite popular perception, is rarely black and white. The collective body of scientific knowledge often points one in a direction rather provide a specific and universally applicable policy.

For example, it is well understood that elevating a pt's head (and other things) greatly reduces VAP. Yet, it is noteworthy that elevating the head may result in an increased incidence of pressure ulcers. So we have a standard of care (keeping head elevated) that both increases and decreases pt health at the same time.

A judgment must be made. One must prioritize different metrics of "health." Even deciding on ways to measure outcome are very difficult indeed. Is a lowered risk of VAP "worth" the increase in pressure ulcers? If so, how much lower does the risk have to be? And how can we really "measure" risk? Is cost effectiveness more important than an increase in pt comfort? How much money needs to be saved before we ask pt's to "accept" and increase in risk? What about pt "satisfaction?" ie what if they report "feeling better" because of a given intervention. Is that worth in increase in cost? How much? What about an increase in risk? How much?

The nurses in charge of policy in different institutions make different judgments. This results in different policy. (maybe not in the case of VAP, but I hope you get my point).

[lizva101]

Thank you.

I understand what you are saying. I think there are practices where there just isn't enough outcome data to decide best practice. But is there a body that is collecting data? I know nurses within facilities are doing great research and continuing to search for ways to improve practice. So some policies may be ahead of others based on more comprehensive clinical evidence. I just think that there may be a disparity within nursing caused by different practices.

[czyja, MSN, RN]

Thank you.

I So some policies may be ahead of others based on more comprehensive clinical evidence. I just think that there may be a disparity within nursing caused by different practices.

You're welcome!

You bet there is disparity of care. Indeed, your original question speaks to this disparity. Some institutions will implement decisions based on the most comprehensive clinical evidence and others will not because of cost, ignorance, difficulty, or just plain obstinacy.

There is no central body that decides on best practice. Various government and professional bodies make recommendations based on evidence. A good place to find evidence is the the National Guideline Clearinghouse.

http://www.guideline.gov/

It is a searchable database of peer reviewed journal articles run by the smart folks at the Dept of Health and Human Services. So any citizen-nurse (or non-citizen for that matter, or non-nurse) can type in VAP or Foley Insertions or Central Line Infection at three in the morning from their computer at home and find high quality research papers that offer evidence based practice guidelines. How cool is that?

The cool thing is that Joe Q. RN, med-surg staff nurse at Middleofnowhere Community Hospital has the capability to easily find out best practice and suggest it to his managers, offering supporting evidence. Sadly, what his mangers do with the info is not always based in sound science.

[aeauooo]

Other than searching the literature, I suggest looking at professional nursing associations for standards of practice.

Incidentally, it's been a long time since I've used heparin to flush lines.

[WSUCougarBSN]

You're welcome!

You bet there is disparity of care. Indeed, your original question speaks to this disparity. Some institutions will implement decisions based on the most comprehensive clinical evidence and others will not because of cost, ignorance, difficulty, or just plain obstinacy.

There is no central body that decides on best practice. Various government and professional bodies make recommendations based on evidence. A good place to find evidence is the the National Guideline Clearinghouse.

http://www.guideline.gov/

It is a searchable database of peer reviewed journal articles run by the smart folks at the Dept of Health and Human Services. So any citizen-nurse (or non-citizen for that matter, or non-nurse) can type in VAP or Foley Insertions or Central Line Infection at three in the morning from their computer at home and find high quality research papers that offer evidence based practice guidelines. How cool is that?

The cool thing is that Joe Q. RN, med-surg staff nurse at Middleofnowhere Community Hospital has the capability to easily find out best practice and suggest it to his managers, offering supporting evidence. Sadly, what his mangers do with the info is not always based in sound science.

I have been doing research about VAP, and trying to help update our policy at our hospital with NEW research - it seems that everything I have found is at least 5 years old. This website you mentioned was incredibly helpful. It was updated just 1 year ago. I appreciate the info ... thanks!

~C