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Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration

BACKGROUND: Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS: In a pragmatic cluster randomised controll...

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Autores principales: Bucknall, Tracey K, Considine, Julie, Harvey, Gillian, Graham, Ian D, Rycroft-Malone, Jo, Mitchell, Imogen, Saultry, Bridey, Watts, Jennifer J, Mohebbi, Mohammadreza, Bohingamu Mudiyanselage, Shalika, Lotfaliany, Mojtaba, Hutchinson, Alison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606509/
https://www.ncbi.nlm.nih.gov/pubmed/35450936
http://dx.doi.org/10.1136/bmjqs-2021-013785
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author Bucknall, Tracey K
Considine, Julie
Harvey, Gillian
Graham, Ian D
Rycroft-Malone, Jo
Mitchell, Imogen
Saultry, Bridey
Watts, Jennifer J
Mohebbi, Mohammadreza
Bohingamu Mudiyanselage, Shalika
Lotfaliany, Mojtaba
Hutchinson, Alison
author_facet Bucknall, Tracey K
Considine, Julie
Harvey, Gillian
Graham, Ian D
Rycroft-Malone, Jo
Mitchell, Imogen
Saultry, Bridey
Watts, Jennifer J
Mohebbi, Mohammadreza
Bohingamu Mudiyanselage, Shalika
Lotfaliany, Mojtaba
Hutchinson, Alison
author_sort Bucknall, Tracey K
collection PubMed
description BACKGROUND: Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS: In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses’ CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS: From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (−2.18 days, 95% CI (−3.53 to –0.82)). CONCLUSION: Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER: ACTRN12616000544471p
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spelling pubmed-96065092022-10-28 Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration Bucknall, Tracey K Considine, Julie Harvey, Gillian Graham, Ian D Rycroft-Malone, Jo Mitchell, Imogen Saultry, Bridey Watts, Jennifer J Mohebbi, Mohammadreza Bohingamu Mudiyanselage, Shalika Lotfaliany, Mojtaba Hutchinson, Alison BMJ Qual Saf Original Research BACKGROUND: Most hospitals use physiological signs to trigger an urgent clinical review. We investigated whether facilitation could improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for deteriorating patients. METHODS: In a pragmatic cluster randomised controlled trial, we randomised 36 inpatient wards at four acute hospitals to receive standard clinical practice guideline (CPG) dissemination to ward staff (n=18) or facilitated implementation for 6 months following standard dissemination (n=18). Expert, hospital and ward facilitators tailored facilitation techniques to promote nurses’ CPG adherence. Patient records were audited pre-intervention, 6 and 12 months post-intervention on randomly selected days. Escalation of care as per hospital policy was the primary outcome at 6 and 12 months after implementation. Patients, nurses and assessors were blinded to group assignment. Analysis was by intention-to-treat. RESULTS: From 10 383 audits, improved escalation as per hospital policy was evident in the intervention group at 6 months (OR 1.47, 95% CI (1.06 to 2.04)) with a complete set of vital sign measurements sustained at 12 months (OR 1.22, 95% CI (1.02 to 1.47)). There were no significant differences in escalation of care as per hospital policy between study groups at 6 or 12 months post-intervention. After adjusting for patient and hospital characteristics, a significant change from T0 in mean length of stay between groups at 12 months favoured the intervention group (−2.18 days, 95% CI (−3.53 to –0.82)). CONCLUSION: Multi-level facilitation significantly improved escalation as per hospital policy at 6 months in the intervention group that was not sustained at 12 months. The intervention group had increased vital sign measurement by nurses, as well as shorter lengths of stay for patients at 12 months. Further research is required to understand the dose of facilitation required to impact clinical practice behaviours and patient outcomes. TRIAL REGISTRATION NUMBER: ACTRN12616000544471p BMJ Publishing Group 2022-11 2022-04-21 /pmc/articles/PMC9606509/ /pubmed/35450936 http://dx.doi.org/10.1136/bmjqs-2021-013785 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bucknall, Tracey K
Considine, Julie
Harvey, Gillian
Graham, Ian D
Rycroft-Malone, Jo
Mitchell, Imogen
Saultry, Bridey
Watts, Jennifer J
Mohebbi, Mohammadreza
Bohingamu Mudiyanselage, Shalika
Lotfaliany, Mojtaba
Hutchinson, Alison
Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title_full Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title_fullStr Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title_full_unstemmed Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title_short Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
title_sort prioritising responses of nurses to deteriorating patient observations (pronto): a pragmatic cluster randomised controlled trial evaluating the effectiveness of a facilitation intervention on recognition and response to clinical deterioration
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606509/
https://www.ncbi.nlm.nih.gov/pubmed/35450936
http://dx.doi.org/10.1136/bmjqs-2021-013785
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