背景:实施证据表明,由于公认的障碍,包括由ED患者的未分化性质引起的高度不确定性,急诊科(ED)的实践改变是出了名的困难。资源短缺,工作负载不可预测性,员工流失率高,和不断变化的环境。我们制定并实施了行为改变知情策略,以减轻临床试验的这些障碍,以实施基于证据的急诊护理框架HIRAID®(历史包括感染风险,红旗,评估,干预措施,诊断,通信,和重新评估)以减少临床变异,提高急诊护理的安全性和质量。
目标:为了评估基于行为改变的HIRAID®实施策略,有效性,收养,质量(剂量,保真度)和维护(可持续性)。
方法:使用有效性实施混合设计,包括阶梯式楔形集群随机对照试验(SW-cRCT),在29个澳大利亚农村地区与1300名急诊护士一起实施HIRAID®,区域,和都市ED。通过RE-AIM评分工具对我们的行为改变知情策略进行评估,并使用来自(i)HIRAID®实施后急诊护士调查的数据进行测量,(ii)HIRAID®讲师调查,以及(iii)为期12周和6个月的文件审核。使用描述性统计对定量数据进行分析,以确定所达到的RE-AIM各组成部分的水平。使用内容分析对定性数据进行了分析,并用于了解定量结果的“如何”和“为什么”。
结果:HIRAID®在所有29个ED中实施,实施后12周,145名护士接受了讲师培训,1123名护士(82%)完成了提供者培训的所有四个部分。对行为改变知情策略的修改微乎其微。该策略主要按预期使用,具有100%剂量和非常高的保真度。我们在6个月时实现了极高的个人可持续性(95%使用HIRAID®文档模板),在3年时实现了100%的可持续性。
结论:农村急诊护理框架HIRAID®的行为改变知情策略,区域,澳大利亚大都市非常成功,覆盖率和采用率极高,剂量,保真度,个体和设置在不同的临床环境中的可持续性。
背景:ANZCTR,ACTRN12621001456842。2021年10月25日注册。
BACKGROUND: Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care.
OBJECTIVE: To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability).
METHODS: An effectiveness-implementation hybrid design including a step-wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the \'how\' and \'why\' of quantitative results.
RESULTS: HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years.
CONCLUSIONS: The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts.
BACKGROUND: ANZCTR, ACTRN12621001456842 . Registered 25 October 2021.