# data[].attributes.body
in clinical settings, there is clear evidence that gaps exist between what is known to be the best available evidence practice and what happens in reality even though it is hard to quantify with accuracy. There are multiple, diverse reasons behind variation in clinical practice, reflecting personal, organisational and systemic levels. According to Kennedy P. J (2010), compliance with evidence-based care processes can lead to significant improvements in public health and patient outcomes whereas non-compliance is considered to pose a serious threat to quality of care and overall patient health.

Based on my work experience in health care settings, apart from improving safety and quality care, more standardised practices can also lead to greater efficiencies. PROMPT is a resource we access and use as evidence-based clinical instruction in my workplace, it is more accurate, updated and easily accessible when it is in need. I believe that some variation in practice is unavoidable sometimes. However, it needs to be authorised by the most available senior healthcare provider and also needs to be clinically evident-based.

In my opinion, unwarranted clinical practice variation needs to be reduced from a quality and safety perspective. Having said that, barriers of compliance of guidelines must be tackled to foster best practice and reduce variation in practice.

Yana Wu

# data[].attributes.body
I believe that standardisation is important , particularly  with respect to education and training of staff. I have heard many complaints over the years regarding the lack of consistent information imparted by clinicians. A similar story from patients  who have received conflicting advice from health professionals

# data[].attributes.body
Standardisation of care provides a benchmark for all care provided, and should be the baseline from which all care stems from. This ensures that basic patient and staff safety is met, and that quality care is provided.

However the elements of standardised care may not always be applicable to every patient and situation, and room for variation and the application of critical thinking must exist. By always keeping the baseline of standard care in our minds, we can ensure we are not straying into the realms of poor practice.

# data[].attributes.body
Working as a clinical facilitator I now have very strong feelings about following work unit guidelines and hospital policies. I always need to refer to policies with students for IDC and NG insertion for example. These teach the best evidence based practice. My experience in clinical areas is that very few staff know how to access policies let alone follow them. I need to be able o pass on the correct way not my way to student nurse and practice that myself.

# data[].attributes.body
Standardised practice will provide the same high quality BASIC care for all patients.It is the maintenance of clinical best practice and ensures staff and patients have better health outcomes and experiences. However, standardised practice  may increase the risk  of failing to notice patients' individual problems if variation is necessary to provide the highest care possible.I think there is a room for variation in practice as long as it is compared with best practice to highlight areas for improvement.When I was  in the UK, the rate of nosocomial infection was on the rise particularly MRSA. As a result, health care workers were required to wear gloves and apron (including hand hygiene) for every direct patient contact.Since nosocomial infection is under control in my current workplace, a number of my colleagues will not perform five moments of hand hygiene after patient contact.Another example would be the criteria for MET call.If the patient is palliative, a document such as modification of vital signs is updated by attending physician. Standardised practice reduces waste and uncertainty within the health system but clinical variation within specialities may be necessary to provide safety and quality in health care.

# data[].attributes.body
I think, as with anything, there are positives and negatives to standardisation in nursing. Absolutely there are procedures and protocols which standardise specific care and are In place to keep both the patient and the staff member safe.

Standardising the minutiae, however can make nurses feel like they have been disempowered and cannot use their critical thinking as they have been trained to do. In my opinion, when everything has a pathway or is standardised, nurses become 'lazy' in their thinking, second guessing themselves and losing trust in their intuition and experience.

# data[].attributes.body
I have touched on the standardisation of health care in my discussion post for Assessment 2. I believe that standardisation of care allows for the reduction of harm to patients through risk management. Policies, guidelines, and documents are often created due to errors or harm from mistakes or unidentified risks.

However, with standardised practice it does not take into account the individual cases that present. For example, in the early warning score system a patient with a heart rate greater than 140 beats per minute automatically generates a medical emergency team review. However, in the clinical environment I work one third of our patient population have rapid atrial fibrillation with a heart rate greater than 140 beats per minute. Therefore, the standardised approach doesn't take the nuisances into consideration. This can then cause additional strain on the resources in the hospital as well as a decrease in critical thinking of staff as the decision making processes are taken away in place of following guides to care.

# data[].attributes.body
Standardization of healthcare practices continues to generate a heated debate plunging administrators and health professionals at either end of the spectrum. Mentioning the word “standardization” to healthcare experts will most likely culminate in a heated debate. The perception that the administrators and policy makers have of standardized care differs from that of physicians and advanced practice nurses. While the former views standardized care as a means of providing quality services to patients, the latter considers standardization as an administrative tool that is counterproductive to their interests and that of their patients. Personally, I belong to the school of thought that health care practices differ one region to another and regionalized care is a healthcare system reality that is there to stay.

In as much as standardized care accrues many benefits such as efficiency, patient safety, reduced costs and consistent outcomes, it fails to address specific issues that personalized healthcare practices address adequately (Swan, 2009). Fundamentally, personalized healthcare is against a standardized one-shoe-fits-all approach to healthcare practice. In my professional experience, I have encountered many patients who prefer the concept of a family doctor who knows each member of the family at a personal level, understands their specific health concerns and responds to their concerns individually. I yearn for a healthcare system that can work the same way, knowing specific patient concerns and treating them as unique individuals. In the modern healthcare environment, the participation of patients in their health and outcomes is increasingly becoming important. This is mainly because personalized care increases patient engagement whereby patients take ownership of their health outcomes. Only when they are encouraged to become active participants in their health journeys can patients be motivated to take precautionary measures to safeguard their health (Ginsburg & McCarthy, 2010).

# data[].attributes.body
Firstly, I think its important to distinguish practice from procedure as they have very different meanings within any profession. Practice, within nursing, i.e. how we "do things" can vary between staff members, as we are not robots as such, therefore we cannot be expected to care for our patients exactly the same as one another, or manage our time, prioritise care and so on. Procedures, i believe, do need to be somewhat standardised either at a hospital, state or national level. Guidelines need to be followed for patient and personal safety, as does clinically proven best practice, aseptic technique, drug administration etc etc. If there was an absence of professional procedural guidelines, policies or standards it would result in too greater a variance between each staff members technique, possibly to the detriment of the patient, staff member or both.

# data[].attributes.body
I think much of what we do as nurses is standardised practice. Basic cares, ADL’s, vital signs, etc have little room or necessity for varied practice. The more complex the care the more visible, reliable and important standardized practice becomes. It offers predicted outcomes, cost effectiveness and measure of quality and safety. Deviation from standardized practice increases patient and staff risk, open the organisation and individual to litigation which can influence the credibility of the organisation and health care.
When considering intravenous cannulation, for example, a Health and Hospital Service learning package provides the theory and guidelines for practice. Variation in practice has the potential to occur with the application of the theory. Whilst the foundational techniques are defined, it is the dexterity or manual capability of the individual that brings the variation. One needs to be careful however, to ensure there is no breach in the safety of either patient or staff member during this task.

Variation in practice often occurs when following the direct orders of a medical officer or when an individual as learned the same practice in different methodology. It is neither right nor wrong, it is just different. An example of this may be synchronised cardioversion, guidelines suggest anterior:posterior is best placement for defibrillation pads, however a medical officer may choose to alter the pad placement based upon his/her previous experience.  Another example where 12 lead ECG electrode placement is modified to ‘work around’ surgical dressings that inhibit exact lead location or skin contact. The need for vital information from the ECG overrides the requirement to follow perfect lead placement.

Flexibility within standardized practice is necessary as it allows care to be adjusted to meet the needs or presentation of our patient, and our colleague’s preferences, experiences and skill provided the focus remains on the patient, their safety and quality outcome of their health care.