2.2.2 Protocol-based care evaluation project (PEP) (428)

Jo Rycroft-Malone, Reader, Centre for Health-Related Research, University of Wales, Bangor, Bangor, Wales, United Kingdom Co authors: Marina Fontenla, Debra Bick & Kate Seers J.Rycroft-Malone@bangor.ac.uk

Abstract:

Background:

The proliferation of guidelines and protocols are visible confirmation of an emphasis on delivering care founded on evidence of ‘what works’. Protocol-based care is concerned with providing clear statements and standards for the delivery of local care across a range of environments and different professions. Whilst an increasingly popular way to deliver care, questions remain about the nature, benefits and impact of protocol-based care on roles, service delivery, and clinical decision-making, about the nursing contribution to its development and delivery, and, about workforce and team working issues.

Aim:

This presentation will share the findings from two research studies funded by the Department of Health evaluating the impact of protocol-based care on practice, patient care, and clinical decision-making in the UK’s health service.

Method:

A multi-site, multiple method case study evaluation and a focussed ethnography were conducted, both underpinned by realistic evaluation methodology. 7 sites, including community and acute settings were purposively sampled. Qualitative data collection methods included participant and non-participant observation of practice, interviews with staff and patients, feedback sessions and document analysis.

Findings:

Findings include that protocols: are mainly develop to reduce practice variation and improve service delivery, are used as checklists; particularly by junior or new members of staff, can become ‘internalised’; cause a tension for staff between individualising and standardising care; do not necessarily simplify decision-making, and can have both positive and negative impacts on care and roles. Protocol-based care supported nurses’ autonomous practice, and an extension of their role beyond the traditional scope of practice. Patients were usually were not aware that protocols, guidelines etc. were guiding their care but expected practitioners to follow ‘procedures’.

Discussion:

Findings will be discussed in the context of their implications for nurses’ roles, patient-centred care and the future of protocol-based care as an approach to service delivery.

Biography:

Research interests: Knowledge utilisation and transfer issues including: evidence based practice, evidence based guideline development, clinical effectiveness, facilitating change and implementing evidence into practice, impact of evidence in practice, theoretical development of key concepts. Patient participation and involvement. Medication management. top » Professional activities: Membership/Steering/Advisory Groups: Department of Health's Health Development Agency - Evidence into Practice Steering Group. Co-founder of the International Knowledge Utilisation & Transfer Colloquium Network - rcn-ku.org.uk. RCN Institute - Organisational characteristics for developing nursing leadership - steering group member. Editorial Activity: Editor, Worldviews on Evidence-based Nursing - www.nursingsociety.org. Joint collaboration between Sigma Theta Tau and Blackwell Publishing. Academic reviewing: Quality and Safety in Health Care Journal for Nursing Management Primary Health Care Research & Development Journal of Nursing Scholarship Journal of Clinical Excellence External reviewing: Wellcome Trust ESRC