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A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis

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 t...

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Autores principales: Craswell, Alison, Massey, Debbie, Sriram, Deepa, Wallis, Marianne, Polkinghorne, Kevan, Talaulikar, Girish, Cass, Alan, Gallagher, Martin, Gray, Nicholas, Kotwal, Sradha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Nephrology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278776/
https://www.ncbi.nlm.nih.gov/pubmed/36758195
http://dx.doi.org/10.34067/KID.0000000000000076
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author Craswell, Alison
Massey, Debbie
Sriram, Deepa
Wallis, Marianne
Polkinghorne, Kevan
Talaulikar, Girish
Cass, Alan
Gallagher, Martin
Gray, Nicholas
Kotwal, Sradha
author_facet Craswell, Alison
Massey, Debbie
Sriram, Deepa
Wallis, Marianne
Polkinghorne, Kevan
Talaulikar, Girish
Cass, Alan
Gallagher, Martin
Gray, Nicholas
Kotwal, Sradha
author_sort Craswell, Alison
collection PubMed
description 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.
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spelling pubmed-102787762023-08-03 A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis Craswell, Alison Massey, Debbie Sriram, Deepa Wallis, Marianne Polkinghorne, Kevan Talaulikar, Girish Cass, Alan Gallagher, Martin Gray, Nicholas Kotwal, Sradha Kidney360 Original Investigation 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. American Society of Nephrology 2023-02-10 /pmc/articles/PMC10278776/ /pubmed/36758195 http://dx.doi.org/10.34067/KID.0000000000000076 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/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) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , 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.
spellingShingle Original Investigation
Craswell, Alison
Massey, Debbie
Sriram, Deepa
Wallis, Marianne
Polkinghorne, Kevan
Talaulikar, Girish
Cass, Alan
Gallagher, Martin
Gray, Nicholas
Kotwal, Sradha
A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title_full A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title_fullStr A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title_full_unstemmed A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title_short A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
title_sort process evaluation of the national implementation of a bundle for central venous catheter care for hemodialysis
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10278776/
https://www.ncbi.nlm.nih.gov/pubmed/36758195
http://dx.doi.org/10.34067/KID.0000000000000076
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