• Elizabeth Williams and Nichola von Fintel.
• Queens Medical Centre, Adult Intensive Care Nottingham, UK.
• Nurs Crit Care. 2012 Mar 1; 17 (2): 99-104.

BackgroundThis practice development review describes how the introduction of hypertonic saline in the treatment of raised intracranial pressure was brought about in one critical care unit. It considers the need for staff education and patient safety as an integral part of the change process.AimThe aim was to review making a practice change, using Lewin's three step change model and describes possible pitfalls in the process and ways of overcoming or avoiding them.MethodsThe inclusion criterion for critiqued literature was: Worldwide, English language studies from the last 26 years. Exclusion was articles from non-academically recognized sources. The search was limited to primary and empirical sources.DiscussionThis article uses Lewin's change model to describe driving and restraining forces, highlighting potential problems and suggesting ways in which they can be overcome when implementing a change in practice. Critical to the success of any change is the importance of evaluation, and suitable methods of evaluating the change are also suggested.Relevance To Clinical PracticeCritical care and neurosurgical nurses need to be aware of the potentially serious side effects, actions and correct methods of administration of hypertonic saline to ensure its safe use and ensure patient safety. Effects and side effects of hypertonic saline are described, highlighting the need for care in introducing such agents into a clinical area. The methodology used was an electronic search. The change in practice relates to the introduction of hypertonic saline, but could be adapted for any change in clinical nursing practice.© 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

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