Journal article
A process evaluation of the national implementation of a bundle for CVC care for haemodialysis
Kidney360, Vol.4(4), pp.e496-e504
2023
PMID: 36758195
Abstract
Background: Implementation of a care bundle standardising insertion, management and removal practices to reduce infection related to central venous catheters used for haemodialysis was evaluated in a stepped wedge, cluster randomised 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 semi structured interviews with 38 (19 nursing, 19 medical) and 44 (25 nursing, 19 medical) Australian health professionals involved in haemodialysis central venous catheter 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 individualised delivery of patient education created barriers to uptake. Unintended impacts of increased costs and lack of interoperability of systems for data collection were reported. As 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 that 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.
Details
- Title
- A process evaluation of the national implementation of a bundle for CVC care for haemodialysis
- Authors
- Alison Craswell (Corresponding Author) - University of the Sunshine Coast, Queensland, School of Health - NursingDebbie Massey (Author) - Southern Cross UniversityDeepa Sriram (Author) - University of the Sunshine Coast, Queensland, School of Health - NursingMarianne Wallis (Author) - University of the Sunshine Coast, Queensland, School of HealthKevan Polkinghorne (Author) - Monash UniversityGirish Talaulikar (Author) - Act HealthAlan Cass (Author) - Charles Darwin UniversityMartin Gallagher (Author) - UNSW SydneyNicholas Gray (Author) - University of the Sunshine Coast, Queensland, School of HealthSradha Kotwal (Author) - UNSW Sydney
- Publication details
- Kidney360, Vol.4(4), pp.e496-e504
- Publisher
- American Society of Nephrology
- Date published
- 2023
- DOI
- 10.34067/KID.0000000000000076
- ISSN
- 2641-7650
- PMID
- 36758195
- Copyright note
- This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
- Grant note
- APP1103241/ National Health and Medical Research Council (NHMRC) MRF1150335/ Medical Research Future Fund Next Generation TRIP Fellowship
- Organisation Unit
- School of Health - Nursing; UniSC Clinical Trials Centre; University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99706997902621
- Output Type
- Journal article
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- Urology & Nephrology
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