Can protocolised-weaning developed in the United States transfer to the United Kingdom context: a discussion

Weaning patients from mechanical ventilation using standardised protocols has been demonstrated to be safe and effective in reducing mechanical ventilation time, intensive care unit (ICU) stay and costs. Studies supporting this have all been conducted in the United States of America and weaning protocols are not widely used in the United Kingdom. With such a strong scientific evidence-base for protocolised-weaning, it is unclear why the introduction of evidence-based practice in this area is so low in the UK. There may be a number of reasons for this. First, it may be that the evidence is considered not to apply to different settings, particularly between the USA and UK where there are many differences in health care cultures. Second, it is suggested that the strength of evidence is not the only factor to account for when trying to introduce research evidence into practice [Qual. Health Care 7 (1998) 149]. The context or environment into which the research is to be implemented and how the implementation process is facilitated are equally important factors to be considered. Kitson et al. [Qual. Health Care 7 (1998) 149] argue that the interplay between the three factors of evidence, context and facilitation, enable the successful implementation of evidence-based practice. This discussion paper explores the factors that influence the introduction of weaning protocols. The discussion is structured around the three core elements from Kitson et al.'s conceptual framework and it draws upon examples of UK and USA contextual differences from Northern Ireland (NI) and Virginia (VA).