Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Abstract

Sustaining improvements achieved through clinical inquiry projects is challenging. Often improvements are observed early after a change; however, over time, clinical staff will frequently revert to their previous practices, even if efforts to “hardwire” the practice change were initially put into place. One key reason why improvements are not sustained is that long-term monitoring of processes is not sustained. Identifying a few, simple metrics that can be easily measured over time to gauge how (or if) the processes are still in place is warranted.1 In clinical practice, these process metrics are often measured through tasks such as auditing nurse's documentation compliance with specific interventions. Only when process and outcome metrics are tracked can clinical staff see signals that the evidence-based change is not being sustained. By identifying these signals early, clinicians can quickly work to identify barriers and improve processes, outcomes, and ultimately, patient care. When learning skills for conducting and completing evidence-based practice (EBP) and quality improvement (QI) initiatives, it is imperative for nurses to also understand the importance of sustainability and how to maintain gains made over time.