Successful and sustained implementation of a behaviour change strategy for emergency nurses: A multicentre implementation evaluation
Tracks
Concurrent Stream 1
| Thursday, October 17, 2024 |
| 10:50 AM - 11:10 AM |
| Ionic Room |
Overview
Sarah Kourouche
Speaker
Dr Sarah Kourouche
Senior Lecturer
University Of Sydney
Successful and sustained implementation of a behaviour change strategy for emergency nurses: A multicentre implementation evaluation
10:50 AM - 11:10 AMAbstract
Background: Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers. We developed and implemented a behaviour change strategy for an 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.
Aim: To evaluate the effectiveness of an evidence-driven behaviour change strategy to maximise implementation and uptake of HIRAID® on reach, effectiveness, adoption, implementation 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 emergency departments. Evaluation of our implementation 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 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 implementation 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.
Conclusion: 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.
Aim: To evaluate the effectiveness of an evidence-driven behaviour change strategy to maximise implementation and uptake of HIRAID® on reach, effectiveness, adoption, implementation 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 emergency departments. Evaluation of our implementation 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 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 implementation 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.
Conclusion: 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.
Biography
Dr Sarah Kourouche is an emergency nurse, lecturer and researcher at the University of Sydney. Sarah is a Senior Research Fellow and Lecturer of Acute Care Nursing at the Faculty of Medicine and Health at the University of Sydney. She completed her PhD at the University of Sydney investigating the implementation of a care bundle for patients with blunt chest injury in emergency departments. She is interested in translational research in emergency care.
