Barriers, Strategies for Implementing Practice Changes in ICUs are Identified

Researchers from Indiana University have identified common barriers and strategies for successfully implementing practice changes in intensive care units (ICUs). The study, published in the August issue of the journal Infection Control and Hospital Epidemiology, reveals shared lessons learned from six ICUs as they implemented evidence-based practices to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections.

"Our research found that while implementation plans should be locally-derived, reducing and preventing the spread of infections in ICUs entails overcoming common barriers," says Amber Welsh, PhD of the Indiana University Center for Health Services & Research Outcomes.

In 2006, five Indianapolis-area hospitals began a systematic implementation of practices known to reduce the spread of MRSA, including active surveillance, hand hygiene, patient isolation, and the use of personal protective equipment (PPE) such as gowns and gloves. A group of researchers led by Dr. Brad Doebbeling then interviewed team members from each hospital to identify common themes of successful implementation shared by all hospitals.

The interviews produced five core themes common to all hospitals:

- Engage front line staff in implementation.

- Build a multi-disciplinary implementation team.

- Commit to data collection, management and feedback.

- Acquire support of top management.

- Use process mapping and other problem-solving tools.

"The tendency for any organization unit is to say, Were different, implying that change efforts must be tailor-made for each unique group or culture," Welsh says. "But our research shows that while units are unique, there are commonalities that can guide consideration and planning efforts to implement new practices. We hope that this study will help hospitals realize that change implementation is both a unique and universal activity."

Reference: Catherine Amber Welsh, Mindy E. Flanagan, Chris Kiess, and Bradley Doebbeling. Implementing the MRSA Bundle in ICUs: One City-Wide Collaboratives Key Lessons Learned. Infection Control and Hospital Epidemiology 32:8.