Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study

Abstract

Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators ( TDF domains ) were: understanding evidence-informed patient care and understanding risk factors ( Knowledge ); patient assessment skills and blunt chest injury management skills ( Physical skills ); identification with professional role ( Professional role and identity ); belief of consequences of care bundle (Belief about consequences ); provision of training and protocol design ( Environmental context and resources ); and social supports ( Social influences ). Barriers were: not understanding the term ‘care bundle’ ( Knowledge ); lacking regional analgesia skills ( Physical skills ); not remembering to follow protocol ( Memory, attention, and decision processes ); negative emotions relating to new protocols ( Emotions ); equipment and protocol access ( Environmental context and resources ). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implement...

Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

“…The Implementation Plan Implementation of ChIP commenced 22 November 2017 using an implementation plan developed using the BCW [3]. In previously published work, authors conducted a survey of staff from 12 departments across two sites to identify facilitators and barriers to behaviour change [23]. The survey was informed by the Theoretical Domains Framework and identi ed nine facilitators and six barriers to implementation across eight domains [23].…”

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

“…The implementation plan for ChIP was developed using the Behaviour Change Wheel [21] and is described elsewhere [20,21]. In brief, the barriers and facilitators to implementation of ChIP were identi ed following a survey of 198 staff, from the 12 impacted clinical departments of the two participating hospitals, and developed based on the Theoretical Domains Framework [22].…”

“…affordability, practicability, effectiveness, acceptability, side-effects, and equity) [23], a multi-faceted implementation plan containing seven intervention functions and 15 behaviour change techniques (BCT) [24] was developed per the Behaviour Change Wheel (S1. Appendix) [21]. The implementation plan targeted the behaviour of multidisciplinary staff involved in the activation or response of ChIP including nurses from emergency, ICU and hospital wards; emergency, surgical, ICU, geriatric and pain physicians.…”

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

“…The delity to the implementation strategy for ChIP has been evaluated and reported as 97.6% fully or partially implemented as intended [19,20]. The implementation strategy for ChIP was developed using the Behaviour Change Wheel (BCW) and is described elsewhere [21,22]. The barriers and facilitators to implementation of ChIP were identi ed following a survey of 198 staff from the 12 impacted clinical departments and developed based on the Theoretical Domains Framework [23].…”

“…The barriers and facilitators to implementation of ChIP were identi ed following a survey of 198 staff from the 12 impacted clinical departments and developed based on the Theoretical Domains Framework [23]. Alongside a consultation process that included an APEASE assessment (affordability, practicability, effectiveness, acceptability, side-effects, and equity), a multi-method implementation strategy containing seven intervention functions and 15 behaviour change techniques (BCT) [24] was developed (Additional le 1) [22]. Resources for the delivery of the implementation, including a staff video https://youtu.be/woc4cJGjjQo and storyboard for the video development, have been provided (Additional le 2).…”