Empowering critical care nurses to improve compliance with protocols in the intensive care unit

• BACKGROUND Practitioners often do not comply with evidence-based protocols. • OBJECTIVE To improve compliance with evidence-based protocols in an intensive care unit. • METHODS A baseline compliance range was obtained by using a sampling of 9 protocols for a 100% audit of 35 beds in an adult intensive care unit. Nurses were given positive rewards to promote an initia-tive to improve compliance with protocols. The original audit tool was used to assess compliance at intervals during a trial period and for a follow-up audit 3 years after implementation of the initiative. • RESULTS One month after the initiative was started, compliance with protocols increased from a range of 62 % to 77 % to a compliance of almost 90%. Within 4 months, the compliance rate increased to a mean of more than 95%. Three years later, the compliance rate was greater than 90%. • CONCLUSION Extrinsic rewards improved compliance with protocols and resulted in a change in th