Development and implementation of a standardized care plan for carotid endarterectomy

Carotid endarterectomy (CEA) is a standardized surgical procedure and is the third most common vascular surgical procedure in Sweden. To improve the quality of pre- and postoperative care for patients undergoing elective CEA, a standardized care plan (SCP) was developed and implemented during Spring of 2007 at a vascular clinic in Sweden. In order to spread light on obstacles and possibilities in the implementation-process of this procedure, the aim was to evaluate the development and implementation process of the standardized care plan for CEA. During the first ten months after the implementation of the SCP for CEA, a review of 83 SCPs was performed. Further, fifteen registered nurses and fourteen assistant nurses answered a questionnaire aimed at evaluating the use of standardized care plans. The review of the used SCP for CEA showed that three out of eighty-four patients had not been cared for in accordance to the SCP and that some of the documentation was redundant and unnecessary. All 29 nurses (100%) reported that they totally or partly agree with the Usability Items. Twenty-four of all nurses (82%) reported that their documentation was restricted by using the SCP; on the other hand, all nurses (100%) agreed that the documentation was easy, saved time, and decreased redundant information. The total sample reported high median scores in the areas of Quality of Care and Implementation (32.0, respectively 13.0), but sixteen nurses (59%) agreed that they mostly relied on their work experience and not the SCP. All nurses generally had a positive attitude towards SCP and felt that these procedures do facilitate their work and improve quality of care. The introduction of SCPs is one important way of implementing evidence-based knowledge and pursuing high quality work.