•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 initiative 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 the culture in the intensive care unit that had a cumulative outcome.

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