Abstract:BackgroundSepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the ‘Sepsis Six’ evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27–47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to ident… Show more
“…awareness raising, education, modelling, persuasion, reminders and prompts, and feedback). This finding is consistent with findings from other work studying the implementation of the Sepsis Six [32]. To this extent, the approach to implementation taken in the case-study sites we examined were well thought through and certainly were in line with psychological theories of behaviour change in implementation [31, 46].…”
Section: Discussionsupporting
confidence: 88%
“…One problem is often a lack of understanding of how interventions actually work and what is required to make them work [29, 30]. Even when an intervention is seemingly simple, like the Sepsis Six, the underlying changes that are required to embed it into practice, including widespread behaviour change, may be complex and require careful choice of implementation strategy [31, 32]. …”
BackgroundImplementation of the ‘Sepsis Six’ clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six.MethodsWe conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative. We conducted around 300 h of non-participant observation in emergency departments, acute medical receiving units and medical and surgical wards. We interviewed a purposive sample of 43 members of hospital staff. Data were analysed using a constant comparative approach.ResultsImplementation strategies to promote reliable use of the Sepsis Six primarily focused on education, engaging and motivating staff, and providing prompts for behaviour, along with efforts to ensure that equipment required was readily available. Although these strategies were successful in raising staff awareness of sepsis and engagement with implementation, our study identified that completing the bundle within an hour was not straightforward. Our emergent theory suggested that rather than being an apparently simple sequence of six steps, the Sepsis Six actually involved a complex trajectory comprising multiple interdependent tasks that required prioritisation and scheduling, and which was prone to problems of coordination and operational failures. Interventions that involved allocating specific roles and responsibilities for completing the Sepsis Six in ways that reduced the need for coordination and task switching, and the use of process mapping to identify system failures along the trajectory, could help mitigate against some of these problems.ConclusionsImplementation efforts that focus on individual behaviour change to improve uptake of the Sepsis Six should be supplemented by an understanding of the bundle as a complex trajectory of work in which improving reliability requires attention to coordination of workflow, as well as addressing the mundane problems of interruptions and operational failures that obstruct task completion.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0518-z) contains supplementary material, which is available to authorized users.
“…awareness raising, education, modelling, persuasion, reminders and prompts, and feedback). This finding is consistent with findings from other work studying the implementation of the Sepsis Six [32]. To this extent, the approach to implementation taken in the case-study sites we examined were well thought through and certainly were in line with psychological theories of behaviour change in implementation [31, 46].…”
Section: Discussionsupporting
confidence: 88%
“…One problem is often a lack of understanding of how interventions actually work and what is required to make them work [29, 30]. Even when an intervention is seemingly simple, like the Sepsis Six, the underlying changes that are required to embed it into practice, including widespread behaviour change, may be complex and require careful choice of implementation strategy [31, 32]. …”
BackgroundImplementation of the ‘Sepsis Six’ clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six.MethodsWe conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative. We conducted around 300 h of non-participant observation in emergency departments, acute medical receiving units and medical and surgical wards. We interviewed a purposive sample of 43 members of hospital staff. Data were analysed using a constant comparative approach.ResultsImplementation strategies to promote reliable use of the Sepsis Six primarily focused on education, engaging and motivating staff, and providing prompts for behaviour, along with efforts to ensure that equipment required was readily available. Although these strategies were successful in raising staff awareness of sepsis and engagement with implementation, our study identified that completing the bundle within an hour was not straightforward. Our emergent theory suggested that rather than being an apparently simple sequence of six steps, the Sepsis Six actually involved a complex trajectory comprising multiple interdependent tasks that required prioritisation and scheduling, and which was prone to problems of coordination and operational failures. Interventions that involved allocating specific roles and responsibilities for completing the Sepsis Six in ways that reduced the need for coordination and task switching, and the use of process mapping to identify system failures along the trajectory, could help mitigate against some of these problems.ConclusionsImplementation efforts that focus on individual behaviour change to improve uptake of the Sepsis Six should be supplemented by an understanding of the bundle as a complex trajectory of work in which improving reliability requires attention to coordination of workflow, as well as addressing the mundane problems of interruptions and operational failures that obstruct task completion.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0518-z) contains supplementary material, which is available to authorized users.
“…The Template for Intervention Description and Replication (TIDieR) was developed to improve the quality of descriptions of interventions [40], and can be used to report content of behavior change interventions, including what is delivered, who the intervention is delivered to, and what materials are used. TIDieR has previously been used to describe care bundle interventions [41]. The TIDieR framework has been used to outline the current implementation strategies in Table 4.Fig.…”
BackgroundUrinary tract infection (UTI) as the most common healthcare-associated infection accounts for up to 36% of all healthcare-associated infections. Catheter-associated urinary tract infection (CAUTI) accounts for up to 80% of these. In many instances indwelling urinary catheter (IDC) insertions may be unjustified or inappropriate, creating potentially avoidable and significant patient distress, embarrassment, discomfort, pain and activity restrictions, together with substantial care burden, costs and hospitalisation. Multifaceted interventions combining best practice guidelines with staff engagement, education and monitoring have been shown to be more effective in bringing about practice change than those that focus on a single intervention. This study builds on a nurse-led initiative that identified that significant benefits could be achieved through a systematic approach to implementation of evidence-based practice.MethodsThe primary aim of the study is to reduce IDC usage rates by reducing inappropriate urinary catheterisation and duration of catheterisation. The study will employ a multiple pre-post control intervention design using a phased mixed method approach. A multifaceted intervention will be implemented and evaluated in four acute care hospitals in NSW, Australia. The study design is novel and strengthened by a phased approach across sites which allows for a built-in control mechanism and also reduces secular effects. Feedback of point prevalence data will be utilised to engage staff and improve compliance. Ward-based champions will help to steward the change and maintain focus.DiscussionThis study will improve patient safety through implementation and robust evaluation of clinical practice and practice change. It is anticipated that it will contribute to a significant improvement in patient experiences and health care outcomes. The provision of baseline data will provide a platform from which to ensure ongoing improvement and normalisation of best practice. This study will add to the evidence base through enhancing understanding of interventions to reduce CAUTI and provides a prototype for other studies focussed on reduction of hospital acquired harms. Study findings will inform undergraduate and continuing education for health professionals.Trial registration
ACTRN12617000090314. Registered 17 January 2017. Retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2268-2) contains supplementary material, which is available to authorized users.
“…In previous research using the BCW framework, researchers also used interviews, field observation and/or questionnaires to identify factors that need to change in order for the desired behaviour to occur (Mc Sharry, Murphy, & Byrne, 2016;Steinmo, Fuller, Stone, & Michie, 2015). In our study, we supplemented this approach, as recommended in the MRC, with knowledge from systematic reviews.…”
Purpose: Over the past two decades, attempts have been made to describe the nurse's role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff. Method: A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK's Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel's (BCW) stepwise approach, we sought behaviours related to nursing staffs' roles and functions. Results: We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff's Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient's goals. Conclusion: We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory-and evidence based.
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