Using Diffusion of Innovations Theory to Implement an Evidence-Based Practice Change

Purpose:
A previous attempt to implement delirium assessment in our ICU was unsuccessful. The purpose of this initiative was to identify the barriers and use Rogers' Diffusion of Innovations Theory as a guide for developing strategies to assist nurses with adopting this evidence-based practice change.

Significance:
Delirium is a common occurrence in the ICU, which often goes unrecognized and can lead to increased costs, multiple complications and adverse outcomes for mechanically ventilated patients. Routine screening with a valid delirium assessment tool is essential for prompt recognition and treatment.

Strategy and Implementation:
Our initial attempt to pilot the use of the Confusion Assessment Method for the Intensive Care Unit was unsuccessful; specifically, less than 10% of the expected assessments were performed. Interviews with the nurses revealed barriers to its use, which were consistent with studies that sought to increase RN compliance with the use of this delirium assessment tool. Since Rogers' Diffusion of Innovations Theory has been identified as a strategy that can assist with the adoption of a change in practice, we used this theoretical framework as guide for developing strategies to increase the frequency of delirium assessments. The strategies used for this quality improvement initiative were developing by using the 5 stages identified by Rogers, knowledge, persuasion, decision, implementation and confirmation. The strategies included, staff inservices/education, research articles, collaboration with medical staff, champions, communication of weekly compliance rates and support from leadership.

Evaluation:
Based on results of previous studies, the benchmark for successful implementation was 80%. During the 8 week pilot, the nurses performed 159 (85%) of the 187 expected assessments. Data 2 weeks and 18 weeks after the conclusion of the pilot revealed that the nurses continued to exceed the benchmark.

Implications for Practice:
This quality improvement initiative provides evidence that Rogers' Diffusion of Innovations Theory can be effective for guiding the process of implementing the CAM-ICU, the frequency of its use and adoption of this and other evidence-based practice changes.