Intensive insulin therapy implementation by means of planned versus emergent change approach.
BACKGROUND
Nurses' participation in decisions about new care procedures and protocols is potentially of benefit for patient outcomes. Whether nurses' participation in decisions is allowed in the implementation of innovations depends on the implementation approach used for the introduction. A planned change implementation approach does not allow it, an emergent change implementation approach does.


OBJECTIVE
To compare a planned change and an emergent change implementation approach to introduce an intensive insulin therapy to an intensive care unit (ICU).


METHODS
A prospective comparative study in an ICU in the Netherlands of two teams of nurses using either implementation approach.


METHODS
Pre-introduction of the comparability of the two teams was assessed. The nurse compliance to the protocol was assessed as being nurses' behaviour according to the protocol and leading to acceptable glucose values. The effectiveness of the implementation was assessed by measuring the percentage of patients' glucose values within the target range, the occurrence of hypoglycaemic events and the time to glucose value normalization. Data were collected from December 2007 till January 2009.


RESULTS
In the emergent change approach team there was better nurse compliance measurements than in the planned change approach team (83.5% vs 66,8% conform protocol), a better percentage of glucose values in the target range (53,5% vs 52.8%) and a shorter time to glucose value normalization.


CONCLUSIONS
The implementation approach allowing nurse participation was associated with better nurse compliance and patient outcome measurements. The implementation approach did not conflict with introducing an evidence-based innovation. It was also associated with more effective adaptation of the protocol to changing circumstances.


CONCLUSIONS
When a new treatment requires adaptability to changing circumstances to be most effective, nurses' participation in decisions about the implementation of the treatment should be considered.
Intensive Care Unit, Sint Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Marie-Louise
ML
Luiking
Department of Nursing Science, University Medical Center Utrecht, The Netherlands.
Roland
R
van Linge
Department of Anaesthesiology, Sint Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Leo
L
Bras
Department of Nursing Science, Ghent University, Belgium.
Maria
M
Grypdonck
Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands.|Sint Antonius Hospital, 3435GM Nieuwegein, The Netherlands.|University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.|Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Leon
L
Aarts
D000328:Adult; D001291:Attitude of Health Personnel; D001786:Blood Glucose; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration* / Q000523:psychology; D019983:Guideline Adherence / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D009426:Netherlands; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Implementation; Intensive care; Intensive insulin therapy; Nursing compliance; Nursing interventions