title: Effecting change using careplans: experience from two fractured neck of femur pathways.
abstract: OBJECTIVE
  To use a qualitative track of the effects of two fractured neck of femur careplans (1 & 2) implemented at the Ipswich Emergency Department in 2002 and 2003 in order to comment on the reasons for comparative successes and failures as instruments for change in clinical practice. Careplan 1 was initiated by local clinicians in 2002, rescinded in 2003 to make way for the system wide careplan 2, then informally restituted in 2004 after careplan 2 was withdrawn. Careplan 2 did not articulate specific ED management plans.
  
  
  METHODS
  Biennial retrospective chart audits of two newly introduced evidence-based clinical practices over time was used to track changes from careplan 1. These were the use of regional anaesthesia by medical staff, and the compliance with indwelling urinary catheter insertion by nursing staff.
  
  
  RESULTS
  Elements of careplan 1 continued despite lack of promotion. There has been significant increase in nerve block (2.8% to 27%) and indwelling catheter insertion (26% to 75%) from 2000 to 2009. Formal use of careplan 1 has declined to 13-20% in 2009. Careplan 2 was withdrawn for review in 2004.
  
  
  CONCLUSIONS
  Careplans are one way to effect lasting changes in clinical behaviours which may persist beyond their implementation and promotion phases. For acceptance, corporate plans should incorporate local practices. For longevity, local plans should comply with the corporate vision of continuity of care, but local investment in the plan will facilitate uptake.
authors.affiliation: Emergency Department, Ipswich General Hospital, Chelmsford Avenue, Ipswich, QLD 4305, Australia. kylie_baker@health.qld.gov.au
authors.forename: Kylie
authors.initials: K
authors.lastname: Baker
authors.forename: Stephen
authors.initials: S
authors.lastname: Brierley
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.forename: John
authors.initials: J
authors.lastname: Roe
mesh_terms: D019091:Critical Pathways; D005270:Femur Head / Q000293:injuries*; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008485:Medical Audit; D010347:Patient Care Planning / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D011793:Queensland; D012189:Retrospective Studies