Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation.
Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel. The purpose of this study wa...
| Publicado en: | Australian Critical Care Vol. 35; no. 2; pp. 113 - 123 |
|---|---|
| Autores principales: | , , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Mar2022
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155366002&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155366002 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10367314 GZL jtl: Australian Critical Care issn: 10367314 maglogo: N pubinfo: dt: Mar2022 vid: 35 iid: 2 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 155366002 155366002 155366002 10.1016/j.aucc.2021.04.003 155366002 ppf: 113 ppct: 10 formats: tig: atl: Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation. aug: au: Kourouche, Sarah Curtis, Kate Munroe, Belinda Asha, Stephen Edward Carey, Ian Considine, Julie Fry, Margaret Lyons, Jack Middleton, Sandy Mitchell, Rebecca Shaban, Ramon Z. Unsworth, Annalise Buckley, Thomas affil: Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia sug: subj: Wounds, Nonpenetrating Therapy Thoracic Injuries Therapy Protocols Hospitals, Community Australia Human Australia Pretest-Posttest Design Implementation Science Patient Compliance Descriptive Statistics Confidence Intervals Odds Ratio Nasal Cannula Medical Practice, Evidence-Based Spirometry Analgesia Patient-Controlled Analgesia Conceptual Framework Behavioral Changes ab: Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel. The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals. This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. Sample medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-sample z-test. Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min; there was no difference in time to activation between business hours and after-hours; time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval {CI} = 4.8–9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2–17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5–3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5–5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3–2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1–16.1]). High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|