Nurse-Physician Team Finds Protocol Promotes Best Practices

Adoption of research-proven best practices in health care is slow and far from universal. Despite advances in knowl-edge and practice, little more than half of all patients are receiving recommended general medical care. Nowhere is the need for adoption of best practices in care more urgent than in the intensive care unit (ICU) where the difference between best practice and the current practice in many settings can be lethal.

According to Johns Hopkins University School of Nursing faculty member Cheryl R. Dennison, PhD, RN, ANP, and a team of critical care physicians and researchers, a known-effective, lung-protecting ventilation technique-low tidal volume ventilation (LTVV)-is far from the norm in ICUs treating patients with critical lung injuries. As part of the Improving Care of Acute Lung Injury Patients study, the team assessed patient- and ICU-related factors that might contribute to the use of LTVV among over 200 lung-injured patients on ventilators.

Reporting in Critical Care Medicine (May 2008), Dennison and colleagues found that only half of patients received LTVV, even though it has been advocated as a best practice for over seven years. One ICU-related factor-the presence of a protocol for LTVV use-was most strongly associated with the actual implementation of this lung-saving best practice for acutely ill ventilated patients in the ICU.

Dennison cautions, “The existence of protocols and guidelines helps, but it doesn’t guarantee that patients will receive evidence-based interventions.  For that to occur, we need to effect system- and provider-level change at the basic teaching and practice levels and include all members of the treatment team.”     -TF