TY - JOUR
T1 - A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
AU - Craswell, Alison
AU - Massey, Debbie
AU - Sriram, Deepa
AU - Wallis, Marianne
AU - Polkinghorne, Kevan
AU - Talaulikar, Girish
AU - Cass, Alan
AU - Gallagher, Martin
AU - Gray, Nicholas
AU - Kotwal, Sradha
N1 - Funding Information:
The REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial was supported by a National Health and Medical Research Council Partnership Grant (APP1103241), Department of Health and Human Services (Victoria), Queensland Health, and 19 other partners contributing in-kind and financial support (see Supplemental Appendix 4 ). S. Kotwal was supported by a Medical Research Future Fund Next Generation TRIP Fellowship (MRF1150335). The funding bodies had no input into the design or conduct of, or decision to publish, the study. Acknowledgments
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Key Points Health professionals resisted practice change in environments of low infection where the perception of a need to change is small. Standardizing care of central venous catheters for hemodialysis requires breaking down silos of practice to benefit all patients Knowledge of and adherence to guidelines, formal change management, and ongoing facilitation are required to implement standardized care. Background Implementation of a care bundle standardizing insertion, management, and removal practices to reduce infection related to central venous catheters (CVCs) used for hemodialysis was evaluated in a stepped wedge, cluster randomized controlled trial conducted at 37 Australian hospitals providing kidney services, with no reduction in catheter-related blood stream infection detected. This process evaluation explored the barriers, enablers, and unintended consequences of the implementation to explain the trial outcomes. Methods Qualitative process evaluation using pre-post semistructured interviews with 38 (19 nursing and 19 medical) and 44 (25 nursing and 19 medical) Australian health professionals involved in hemodialysis CVC management. Analysis was guided by the process implementation domain of the Consolidated Framework for Implementation Research. Results Key influences on bundle uptake were that clinicians were open to change that was evidence-based and driven by guidelines and had a desire to improve practice and patient outcomes. However, resistance to change in environments of low infection, working in silos of practice, and a need for individualized delivery of patient education created barriers to uptake. Unintended effects of increased costs and lack of interoperability of systems for data collection were reported. Because the trial was in progress at the time of qualitative data collection, perceptions of the bundle may have been influenced by the fact that practices of participants were being observed as a part of the trial. Conclusion This national process evaluation revealed that health professionals who reported experiencing a benefit viewed the bundle positively. Those who already provided most of the recommended care or perceived that their patient population was not included in the research evidence that underpinned the interventions, resisted the implementation of the bundle. Potentially, formal change management processes using facilitation may improve implementation of evidence-based practice. Clinical Trial registry name and registration number: Australian New Zealand Clinical Trials Registry, ACTRN12616000830493.
AB - Key Points Health professionals resisted practice change in environments of low infection where the perception of a need to change is small. Standardizing care of central venous catheters for hemodialysis requires breaking down silos of practice to benefit all patients Knowledge of and adherence to guidelines, formal change management, and ongoing facilitation are required to implement standardized care. Background Implementation of a care bundle standardizing insertion, management, and removal practices to reduce infection related to central venous catheters (CVCs) used for hemodialysis was evaluated in a stepped wedge, cluster randomized controlled trial conducted at 37 Australian hospitals providing kidney services, with no reduction in catheter-related blood stream infection detected. This process evaluation explored the barriers, enablers, and unintended consequences of the implementation to explain the trial outcomes. Methods Qualitative process evaluation using pre-post semistructured interviews with 38 (19 nursing and 19 medical) and 44 (25 nursing and 19 medical) Australian health professionals involved in hemodialysis CVC management. Analysis was guided by the process implementation domain of the Consolidated Framework for Implementation Research. Results Key influences on bundle uptake were that clinicians were open to change that was evidence-based and driven by guidelines and had a desire to improve practice and patient outcomes. However, resistance to change in environments of low infection, working in silos of practice, and a need for individualized delivery of patient education created barriers to uptake. Unintended effects of increased costs and lack of interoperability of systems for data collection were reported. Because the trial was in progress at the time of qualitative data collection, perceptions of the bundle may have been influenced by the fact that practices of participants were being observed as a part of the trial. Conclusion This national process evaluation revealed that health professionals who reported experiencing a benefit viewed the bundle positively. Those who already provided most of the recommended care or perceived that their patient population was not included in the research evidence that underpinned the interventions, resisted the implementation of the bundle. Potentially, formal change management processes using facilitation may improve implementation of evidence-based practice. Clinical Trial registry name and registration number: Australian New Zealand Clinical Trials Registry, ACTRN12616000830493.
KW - care bundle
KW - nephrology
KW - nurse-led intervention
KW - process evaluation
KW - qualitative
KW - renal dialysis
UR - http://www.scopus.com/inward/record.url?scp=85161688017&partnerID=8YFLogxK
U2 - 10.34067/KID.0000000000000076
DO - 10.34067/KID.0000000000000076
M3 - Article
C2 - 36758195
AN - SCOPUS:85161688017
SN - 2641-7650
VL - 4
SP - E496-E504
JO - Kidney360
JF - Kidney360
IS - 4
ER -