title: Implementation of clinical guidelines for adults with asthma and diabetes: a three-year follow-up evaluation of nursing care.
abstract: OBJECTIVE
  To report on a three-year follow-up evaluation in Canada of nursing care indicators following the implementation of the Adult Asthma Care Best Practice Guideline and the Reducing Foot Complications for People with Diabetes Best Practice Guideline and to describe the contextual changes in the clinical settings.
  
  
  BACKGROUND
  The Registered Nurses' Association of Ontario in Canada has developed and published more than 42 guidelines related to clinical nursing practice and healthy work environments. To date, evaluation has involved one-year studies of the impact of guideline implementation on the delivery of care in hospital and community settings, but little is known about whether changes in practice that were made during the initial implementation period have been sustained.
  
  
  METHODS
  Longitudinal follow-up study.
  
  
  METHODS
  Site observations and interviews were conducted with key informants at two hospitals. Indicators of nursing care changes identified six months post-implementation were compared with indicators found during a retrospective chart audit at the same sites three years later. Fisher exact tests were used to compare outcomes for the two time periods.
  
  
  RESULTS
  Three out of 12 indicators related to asthma care remained consistently high (≥ 84% of audited charts) and four indicators declined significantly (p < 0.01). There were significant (p ≤ 0.05) improvements in nine out of 12 indicators related to diabetes foot care. Important contextual changes were made to better address the guideline recommendations for foot care in the out-patient program and the electronic documentation system.
  
  
  CONCLUSIONS
  Sustainability of guideline implementation recommendations was enhanced with the use of an electronic documentation system.
  
  
  CONCLUSIONS
  Long-term follow-up of both clinical indicators and contextual factors are important to monitor to promote sustained implementation of guidelines.
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, ON, Canada. khiguchi@uottawa.ca
authors.forename: Kathryn Smith
authors.initials: KS
authors.lastname: Higuchi
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Davies
authors.forename: Nancy
authors.initials: N
authors.lastname: Edwards
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.forename: Tazim
authors.initials: T
authors.lastname: Virani
mesh_terms: D001249:Asthma / Q000451:nursing*; D003920:Diabetes Mellitus / Q000451:nursing*; D005500:Follow-Up Studies; D006801:Humans; D009864:Ontario; D017410:Practice Guidelines as Topic