Prioritising Responses Of Nurses To deteriorating patient Observations PRONTO protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and costReportar como inadecuado




Prioritising Responses Of Nurses To deteriorating patient Observations PRONTO protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Implementation Science

, 12:85

First Online: 11 July 2017Received: 14 June 2017Accepted: 29 June 2017

Abstract

BackgroundVital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals.

Methods-designA pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines CPGs to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward.

DiscussionThis study uses an innovative, networked approach to facilitation to enable uptake of CPGs. Findings will inform the intervention utility and knowledge translation measurement approaches. If successful, the study methodology and intervention has potential for translation to other health care standards.

Trial registrationAustralian New Zealand Clinical Trials Registry ANZCTR, ACTRN12616000544471p

KeywordsImplementation Facilitation Knowledge translation Clinical decision-making Patient safety Guidelines Vital signs Randomised controlled trial Process evaluation Economic analysis AbbreviationsANZCTRAustralian New Zealand Clinical Trials Registry

CHEERSConsolidated health economic evaluation reporting standards

CMHCochran-Mantel-Haenszel

CPGsClinical practice guidelines

C-RCTCluster-randomised controlled trial

eACLElectronic activity and communication log

EAGExpert Advisory Group

eCRFelectronic case report form

FLIPF acil itation I ntervention for P ractice improvement

GCPGood clinical practice

GEEsGeneralized estimation equation models

HFLIPHospital facilitator

HLOSHospital length of stay

ICUIntensive care unit

ITTIntention to treat

KTKnowledge translation

METMedical emergency teams

NMsNurse managers

NQSHSNational Quality and Safety Health Service

PARIHSPromoting Action on Research Implementation in Health Services

PRONTOPrioritising Responses Of Nurses To deteriorating patient Observations

RAsResearch assistants

RRSRapid response systems

SAEsSerious adverse events

VSVital signs

WFLIPWard facilitator

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Autor: Tracey K. Bucknall - Gill Harvey - Julie Considine - Imogen Mitchell - Jo Rycroft-Malone - Ian D. Graham - Mohammadreza M

Fuente: https://link.springer.com/



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