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


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.





Published Version (Please cite this version)


Publication Info

Allen, Deborah H, Katia Anello, Yvette Destine, Monique Fleurant, Bing Yang, Bradi B Granger and Staci S Reynolds (2022). Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing. AACN advanced critical care, 33(3). pp. 283–288. 10.4037/aacnacc2022624 Retrieved from

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Bradi Bartrug Granger

Research Professor in the School of Nursing

Dr. Bradi Granger is a Research Professor at Duke University School of Nursing, Director of the Duke Heart Center Nursing Research Program, and adjunct faculty at the University of Gothenburg, Sweden. She is also a core faculty at the Duke-Margolis Center for Health Policy. Dr. Granger received her doctorate in nursing from the University of North Carolina at Chapel Hill, her MSN from Duke University, and her BSN from the University of Tennessee at Knoxville.

Dr. Granger has extensive clinical experience in cardiovascular nursing, and her clinical work as a Clinical Nurse Specialist has been dedicated to overcoming barriers to the use and conduct of research in the service setting through the development of pragmatic tools that change the way nurses learn about, apply, and conduct nursing science. She has developed an innovative model for clinical inquiry and research in the hospital setting, which has been adopted in clinical settings across the U.S. and abroad. Dr. Granger is an active member of the Council for the Advancement of Nursing Science, the American Association of Critical Care Nurses, the American Heart Association, and the European Society for Patient Adherence, Compliance, and Persistence. 


Staci Reynolds

Clinical Professor in the School of Nursing

Dr. Staci Reynolds joined Duke in January 2016, with a joint position between Duke University School of Nursing and Duke University Hospital (DUH).  At DUSON, Dr. Reynolds teaches in the ABSN Program (neuroscience nursing) and DNP program (healthcare quality improvement methods).  Clinically, she served as a neuroscience Clinical Nurse Specialist (CNS) for the inpatient neuro units at DUH from 2016 - 2019 and for the Infection Prevention and Hospital Epidemiology department from 2019 - 2023. Dr. Reynolds coordinated the Duke Advancement of Nursing, Center of Excellence (DANCE) academic-practice partnership from 2016 - 2023, and was the faculty lead for the post-DNP Quality Implementation Scholars Program from 2019 - 2022.  In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality.  Before coming to DUSON, she was a neuro critical care nurse and a neuroscience Clinical Nurse Specialist at Indiana University Health Methodist Hospital.

Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) in Indianapolis, Indiana.  She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016.  Dr. Reynolds’ dissertation focused on implementation of clinical practice guidelines, and her current research interests includes evidence-based practice implementation and quality improvement.

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