This Advanced Clinical Practice fellowship (ACPF) has provided an excellent opportunity to dive into the intricacies of monitoring and evaluating the implementation of the best practice guideline (BPG), End of Life During the Last Days and Hours. Participation in this fellowship has provided an opportunity to develop skills and expertise in activities related to the overall implementation of the Registered Nurses Association of Ontario’s BPGs with respect to knowledge transfer and uptake. This was achieved by supporting and increasing the capacity of nurses to implement evidence-based practice by measuring the implementation of BPG recommendations.

Over the last few decades there has been significant work completed on the development, implementation and evaluation of guidelines. Based on the current environment pertaining to healthcare reforms, public awareness, scarce resources and an increase in demand for accountability both from a system and professional perspective (Doran, 2003, VanDeVelde, 2012) healthcare organizations need to be able to account for care provided to patients. Monitoring and evaluating the implementation of best practices will provide opportunities to identify the impact of care provided to patients and areas in which quality can be improved.

It has been identified that that over the next 10 to 20 years there is going to be a significant increase in the number of Canadians dying each year (QELCCC, 2010) which brings an increased focus to end-of-life care in the community sector. Knowing there is significant variability in the quality of palliative care delivered in the home and this being a concern, it is vital that healthcare clinicians ensure an evidenced based approach to care is taken with regards to implementation and evaluation.

This Advanced Clinical Practice Fellowship, has supported learning and development of capacity with respect to on the monitoring and evaluation of best practice guidelines, specifically related to the implementation of the Best Practice Guideline End-of-Life (EOL) ,Care During the Last Days and Hours.

The fellow’s accomplishments and learnings based on the fellowship experience include:

• Monitoring and evaluation planning for quality improvement
• Development of data collection tools to aide in monitoring and evaluation
• Indicator development
• Methods for displaying data
• Dissemination of evaluation results
• Operationalize a formal monitoring and evaluation plan

Healthcare organizations need to ensure that the implementation of the End-of-Life BPG and all related clinical practices continue to be evaluated in an effective manner. Undoubtedly, this will lead to improved client outcomes and additionally capture relevant and timely outcome data to ultimately help contribute to databases such as RNAO’s Nursing Quality Indicators for Reporting and Evaluation (NQUIRE). Learnings from this fellowship have provided concrete recommendation on how to approach continuous quality improvement through implementing RNAO best practice guidelines.

I would like to thank my colleagues at Red Cross Care Partners for their support during my fellowship by providing me an opportunity to share my learning’s through my delivering presentations and working through new processes in evaluating BPG’s. I would like to extend a sincere thank you to Cathy Walker for providing me the opportunity to participate in this ACPF.

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