Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study

Abstract

[eng] Background: Incorporating the best available evidence into clinical practice is a determining challenge for health‑ care professionals and organisations. The role of advanced practice nurses is viewed as a facilitator to adapt guideline recommendations to suit specifc contexts and to overcome barriers to implementation. In this study, we evaluate the impact of advanced practice nurses on clinical indicators of hospitalised patients and on adherence to recommen‑ dations derived from two clinical practice guidelines (pressure ulcer prevention and treatment and vascular access device management). Methods: Quasi-experimental study in fve intervention (IU) and fve control (CU) hospital units at three hospitals in Spain (period 2018-19). Five advanced practice nurses were incorporated into IU, with the intention that would produce attitudinal changes and enhance the skills and knowledge of the nursing team regarding 18 clinical practice recommendations. In this study, 41 indicators were evaluated through direct observation of all patients admitted, at monthly intervals for 1 year. Outcomes were assessed by means of a descriptive, multi-line regression and association analysis. Results: The study population was composed of 3742 inpatients admitted for pressure ulcer assessment and 2631 ftted with vascular access devices. By the end of the study period, all variables had improved in the IU, where average compliance with recommendations was statistically signifcantly higher (pressure ulcer guidance 7.9±1.9 vs 6.0±1.7. OR 1.86, 95% CI 1.67-2.05; vascular access devices guidance 5.4±1.4 vs 4.4±1,6. OR 1.06, 95% CI 0.95-1.17). The prev‑ alence of pressure lesions and catheter-related adverse events decreased statistically signifcantly in the IU compared to the CU. The prevalence of pressure ulcers decreases (5.7% in IU vs 8.7% in CU p<0.005) as well as the prevalence of adverse events related to the catheter (14% In IU vs 21.6% in CU p<0.005). The unnecessary catheters decressed in IU 10.9% VS CU 15.8% (p<0.005). Conclusions: The incorporation of an advanced practice nurse statistically signifcantly improves clinical indicators related to the prevention and treatment of pressure ulcers and to the management of vascular access devices. Trial registration: ISRCTN18259923 retrospectively registered on 11/02/2022.