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A New Model of Tracheostomy Care: Closing the Research–Practice Gap.


Clair JS3.


In: Henriksen K1, Battles JB1, Marks ES2, Lewin DI1, editors.


Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.

Author information

Agency for Healthcare Research and Quality
US Department of Defense
Walter Reed Army Medical Center, Washington, DC (JS)


Performance improvements have brought about fundamental changes in the past year at Walter Reed Army Medical Center (WRAMC), where a concerted effort is underway to put current research into clinical practice. Tracheostomy care and suctioning became the pilot procedure for these changes in November 2002. What began as a unit-level initiative quickly developed into a Department of Nursing project. The focus of the project is adapting the hospital's existing performance improvement model to better facilitate evidence-based practice. Initial surveys on tracheostomy care conducted throughout the hospital showed an inconsistent level of knowledge and a variation in clinical practice. These inconsistencies represented a patient safety threat in the form of nosocomial infections, prolonged hospitalizations, airway complications, and even death. To address these issues, the Nursing Performance Improvement and Nursing Research Departments entered into a research collaboration. Representatives from these departments worked with clinical experts to develop a plan and timeline for conducting a tracheostomy care project with the goal of implementing evidence into practice and thereby improving patient safety at the hospital. The group completed initial data collection in April 2003 and then began work on the evidence-based procedure. A literature review was completed using online search engines such as MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Collaboration, Medscape, the American Association of Critical-Care Nurses (AACN) practice guidelines, and the Joanna Briggs Institute. Pertinent articles were identified and evaluated by two independent reviewers. The Agency for Healthcare Research and Quality (AHRQ) levels of evidence were used to grade more than 30 articles. The results of this search were used to develop a WRAMC Department of Nursing Procedure for tracheostomy care, which was completed in September 2003. This new model of evidence-based nursing performance improvement has been in use at WRAMC for 2 years at the time of this writing, and it continues to close the research-practice gap. The WRAMC Department of Nursing is presently developing similar evidence-based procedures for pressure ulcer prevention, deep vein thrombosis prophylaxis, and for enteral feeding.

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