Clinical pathway implementation in EDs; a learner’s guide to successful translation

Ms Amanda Harley2, Dr Debbie Massey3, Dr Luregn Schlapbach4,5, Dr Amy Johnston1,5
1Department of Emergency Medicine, Princess Alexandra Hospital , Brisbane , Australia, 2Statewide Paediatric Sepsis, Critical Care Nursing Management Team, Children’s Health Queensland Hospital and Health Service, Level 7, Centre for Children’s Health Research, Brisbane , Australia, 3School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sunshine Coast, Australia, 4Paediatric Intensive Care Unit and Statewide Paediatric Sepsis Critical Care Management Team, Lady Cilento Children’s Hospital, Brisbane, Australia, 5The University of Queensland, Brisbane , Australia

Implementation of best practice guidelines in many areas of ED nursing, including recognition and responding to sepsis, is a critical part of quality paediatric emergency care provision. The first paediatric sepsis pathway is currently being introduced to EDs across QLD. However, implementation of clinical practice guidelines is notoriously difficult, with numerous processes and procedures to navigate. For relatively inexperienced nurses, adopting or championing a new clinical pathway can be an overwhelming challenge and can result in ineffective processes being executed with each new guideline implementation. In this study we sought to identify key elements or components required for a multidisciplinary team to successfully implement a clinical pathway into mixed EDs across QLD. We explore and report on processes required for, and barriers to, pathway integration into paediatric EDs.

The implementation strategy adopted encompassed elements of best practice(1, 2). These included overcoming internal and external barriers such as lack of interest in changing current practices, lack of perceived usefulness of the guideline, lack of support from administrative or leadership staff, lack of education, lack of required equipment or space, lack of time, and a heavy patient workload(2). A process of national and international consultation in the development of the guidelines and implementation strategies was used to help ensure engagement and ongoing capacity to tailor the pathway to specific EDs, with the awareness of contextual and local variances across each department. Educational outreach visits by experienced ED nurses who are familiar with the clinical context in which the pathway is to be used, coupled with a local champion, were adopted to enhance awareness of and familiarity with the pathway components. This also provided an opportunity to trouble-shoot in each setting. Visions for the longevity of the pathway were also considered, with the integration of resourcing an online learning module for sustainability. Finally, ongoing audit and dynamic feedback-moderation were used to enhance utility of the pathway.

Amanda Harley is a Clinical Nurse Consultant based at Lady Cilento Children’s Hospital, Brisbane QLD. Her current role is as the Statewide CNC in the Paediatric Sepsis Collaborative, responsible for the development, implementation and evaluation of a statewide paediatric sepsis pathway to Emergency Departments throughout QLD.

Amanda is passionate about sepsis recognition and management and, by undertaking clinical practice with research and quality improvement, is encouraging others to do the same. She has been involved in and instigated a number of research projects around sepsis in the ED. Incorporating many different roles in her repertoire has allowed for her multidimensional practice and broadened her understanding of the skills required to be an effective ED nurse delivering world class patient care.