Audit and Feedback as a Clinical Practice Guideline Implementation Strategy: A Model for Acute Care Nurse Practitioners

Abstract

Background: The transfer of research evidence into practice and changing provider behavior is challenging, even when the advantages are strong. Despite the availability of supportive care clinical practice guidelines (CPG), consistent integration of these principles into practice has not been achieved. The failure of dissemination strategies has been identified as a key barrier to successful implementation. A potentially effective approach to facilitating the transfer of research evidence into practice is audit and feedback. Audit and feedback is a summary of provider performance over a specified period of time, with or without recommendations to improve practice. Rationale: Cancer pain is an optimal symptom to examine when studying the effect of an audit and feedback intervention. It is a common condition with important consequences, established CPG are available, measurable outcomes are defined, and there is potential for improvement in current practice. Acute care nurse practitioners (NPs) are often responsible for overseeing and directly managing symptoms such as pain and are well positioned to implement CPG and study the effects of adherence to guidelines on patients' pain outcomes. Methodology: A systematic review of published articles, MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library computerized databases was performed to evaluate the state of the science on audit and feedback as a professional practice change strategy. A behavior change model is proposed for its application to advanced practice nursing. Implications for Practice: Recognized in medicine as a valuable intervention to improve healthcare quality, audit and feedback is a strategy that has not been widely studied in nursing. Although cancer pain cannot always be entirely eliminated, appropriate use of available therapies can effectively relieve pain in a majority of patients. This article is a review of the literature on audit and feedback as a professional practice change strategy and indicates a model for operationalizing the intervention.