Decision-Making on Procedure/Practice Modification

Share an example from your nursing practice setting of how a decision was made to change a procedure or practice.

What steps were used in the decision-making process?

What evidence was considered for decision-making?

Was the change effective? Provide rationale

Suppose a hospital’s intensive care unit (ICU) has noticed an increase in the incidence of central line-associated bloodstream infections (CLABSIs) among their patients. A decision is made to review and modify the current practice of central line care to decrease the incidence of CLABSIs.

The following steps could be used in the decision-making process:

Define the problem: The problem of increased CLABSI incidence among ICU patients is identified.

Gather data and evidence: The ICU team gathers data on the incidence, causes, and risk factors of CLABSIs. They also review the current central line care practice, including insertion, maintenance, and removal.

Identify potential solutions: The team identifies potential solutions to decrease the incidence of CLABSIs, such as using a chlorhexidine-impregnated dressing, improving hand hygiene, and implementing daily review of line necessity.

Evaluate the potential solutions: The team evaluates the potential solutions based on the available evidence, including systematic reviews, clinical practice guidelines, and local data on effectiveness and feasibility.

Select a solution: The team selects a solution based on the evidence and the feasibility of implementation. They decide to use a chlorhexidine-impregnated dressing and implement daily review of line necessity.

Implement the change: The team communicates the change to all ICU staff and provides education and training on the new practice. They also monitor the compliance and the incidence of CLABSIs after the implementation.

Evaluate the effectiveness of the change: The team evaluates the effectiveness of the change by monitoring the incidence of CLABSIs and comparing it to the baseline data. They also monitor the compliance with the new practice and any unintended consequences.

In this example, the evidence considered for decision-making includes systematic reviews, clinical practice guidelines, and local data on the effectiveness and feasibility of potential solutions. The change may be effective if the incidence of CLABSIs decreases after the implementation, and if the compliance with the new practice is sustained. The rationale for the change is to improve patient outcomes and safety by decreasing the incidence of a preventable and potentially serious complication of central line care.

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