• clinical practice nursing research;
  • evidence-based medicine;
  • practice guidelines;
  • professional practice;
  • tracheostomy


Purpose  This report presents an evaluation of the implementation of a Best Practice Information Sheet related to tracheal suctioning of adults with an artificial airway. The Centre for Evidence-Based Nursing Aotearoa based in Auckland, New Zealand, conducted a systematic review of the evidence and produced a Best Practice Information Sheet. The present study is an evaluation of the impact of this information sheet. The study also describes the process used to implement the Best Practice Information Sheet at each of three study sites.

Method  A survey of 105 nurses was conducted at three sites: one in New Zealand and two in Australia. Using a before/after design, data were collected at the time of release of the Best Practice Information Sheet and then approximately 12 months later. Suctioning practice was observed with a focus on assessment of the patient by the nurse, the procedure used to suction and the bases for decisions made about suctioning. Before and after data were compared to capture the possible effects on practice of the recommendations in the Best Practice Information Sheet. Those involved in leading the implementation process at each site were interviewed by telephone, notes from the interviews were thematically analysed and comparisons were drawn.

Results  The degree of uptake of the evidence was variable across the three sites and across the recommendations. For a number of recommendations, there was a modest trend towards the uptake of the recommendations of the Best Practice Information Sheet. Other recommendations were congruent with existing usual practice and therefore no change was observed. Each study site employed a range of strategies to implement the Best Practice Information Sheet. Improved practice was seen in relation to a greater number of recommendations at one site. This site appears to have used more sources of information to evaluate the quality of practice, which may have raised the profile of suctioning and its impact on patients.

Conclusions  This study suggests a trend towards a modest uptake of best practice recommendations into nursing practice demonstrated by some behavioural changes within a 12-month period in the context of an implementation plan and a Best Practice Information Sheet.