Case studies

DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. They identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice. The assessment and identification of barriers allowed change teams to develop effective strategies for implementation with the input of stakeholders.

For example, for the implementation of the RNAO best practice guideline Assessment and management of foot ulcers for people with diabetes, barriers included

• nursing shortages across China,
• a lack of training to support the development of knowledge and skills in evidence-based nursing practice,
• the costs of guideline implementation. and
• practice recommendations that exceeded local nursing scope.

SOURCE: Transforming Nursing Through Knowledge, 2018.

Spectrum Health Care (Spectrum), an RNAO Best Practice Spotlight Organization® (BPSO®), is a home health organization with more than 200 nursing staff across three locations in the province of Ontario, Canada.

Spectrum chose to implement the 2015 Person- and Family-Centred Care (PFCC) Best Practice Guideline (BPG) to enhance person- and family-centred care and to reduce complaints regarding care. Members of the senior leadership team at Spectrum Health Care led implementation together with Spectrum’s Patient and Family Advisory Council.  

To support the practice change, Spectrum used the following implementation interventions:

• Conducting a gap analysis to determine the knowledge/practice gap;
• Holding education sessions for staff on person- and family-centred care best practices;
• Revising their care processes to include review of care plans with the person and/or members of their family
• Surveying staff members on their attitudes about person- and family-centred care via surveys
• Developing staff education on communication strategies to support the assessment of a person’s care needs and care plans.

After implementing these interventions, Spectrum assessed the number of complaints received from persons receiving care per 1,000 care visits and compared that to their baseline. 

They found a decrease of 42 per cent of complaints from persons received over an 18-month time period at one of the sites that was implementing the PFCC BPG at Spectrum Health Care. 

At another site, an 80 per cent reduction in complaints was found following the staff education intervention.    

Data analyses overall indicated that the implementation of the PFCC BPG was highly successful in reducing persons' complaints regarding care.

Read more about Spectrum Health care’s results of implementing the PFCC BPG here: Slide 2 (rnao.ca)

The Region of Peel, an RNAO Best Practice Spotlight Organization® (BPSO®) started implementing the RNAO Assessment and Management of Pain best practice guideline (BPG) in 2014 and has sustained its use since then. For example, in their 2019 BPSO annual report, they cited a continuous downward trend in the number of clients who reported a worsening of their pain. Pain experienced by the residents was better controlled, and the staff was found to assess, identify, and manage pain better by using the BPG.

Their keys to success include:

• building on what works (for example, existing practices and policies)
• empowering champions and growing their champion network
• involving residents and families
• gaining support from leaders and partners including RNAO, Peel of Region Leadership, Health Quality Ontario).
• collaborating with an interdisciplinary team
• conducting a formal sustainability evaluation

To learn more about The Region of Peel’s journey in sustaining the use of the Assessing and Managing Pain BPG, along with other BPGs, check out this webinar.