Effecting change using careplans: experience from two fractured neck of femur pathways
Kylie Baker A B E , Stephen Brierley B C , Geoffrey Mitchell B and John Roe DA Emergency Department, Ipswich General Hospital, Chelmsford Avenue, Ipswich, QLD 4305, Australia.
B University of Queensland School of Medicine, Ipswich Campus, Salisbury Rd, Ipswich, QLD 4305, Australia.
C Emergency Department, Mater Adult Hospital, Raymond Tce, South Brisbane, QLD 4101, Australia.
D Orthopaedic Department, Ipswich General Hospital, Chelmsford Ave, Ipswich, QLD 4305, Australia.
E Corresponding author. Email: kylie_baker@health.qld.gov.au
Australian Health Review 36(3) 308-312 https://doi.org/10.1071/AH11021
Submitted: 8 March 2011 Accepted: 12 October 2011 Published: 6 July 2012
Abstract
Objective. To use a qualitative track of the effects of two fractured neck of femur careplans (1 & 2) implemented at the Ipswich Emergency Department in 2002 and 2003 in order to comment on the reasons for comparative successes and failures as instruments for change in clinical practice. Careplan 1 was initiated by local clinicians in 2002, rescinded in 2003 to make way for the system wide careplan 2, then informally restituted in 2004 after careplan 2 was withdrawn. Careplan 2 did not articulate specific ED management plans.
Method. Biennial retrospective chart audits of two newly introduced evidence-based clinical practices over time was used to track changes from careplan 1. These were the use of regional anaesthesia by medical staff, and the compliance with indwelling urinary catheter insertion by nursing staff.
Results. Elements of careplan 1 continued despite lack of promotion. There has been significant increase in nerve block (2.8% to 27%) and indwelling catheter insertion (26% to 75%) from 2000 to 2009. Formal use of careplan 1 has declined to 13–20% in 2009. Careplan 2 was withdrawn for review in 2004.
Conclusions. Careplans are one way to effect lasting changes in clinical behaviours which may persist beyond their implementation and promotion phases. For acceptance, corporate plans should incorporate local practices. For longevity, local plans should comply with the corporate vision of continuity of care, but local investment in the plan will facilitate uptake.
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