Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia

Abstract

Objective. To develop and field test an Implementation Assessment Tool for assessing progress of hospital Units in implementing improvements for prevention of ventilator associated pneumonia (VAP) in a two-state collaborative, including data on actions implemented by participating teams and contextual factors that may influence their efforts. Using the data collected, learn how implementation actions can be improved, and analyze effects of implementation progress on outcome measures. Design. We developed the tool as an interview protocol that included quantitative and qualitative items addressing actions on CUSP and clinical interventions, for use in guiding data collection via telephone interviews. Setting/Participants/Patients. We conducted interviews with leaders of improvement teams from Units that participated in the two-state VAP prevention initiative. Methods/Interventions. We collected data from 43 hospital Units as they implemented actions for the VAP initiative, and performed descriptive analyzes of the data with comparisons across the two states. Results. Early in the VAP prevention initiative, most Units had made only moderate progress overall in using many of the CUSP actions known to support their improvement processes. For contextual factors, a relatively small number of barriers were found to have important negative effects on implementation progress, in particular, barriers related to workload and time issues. We modified coaching provided to the participating Unit teams to reinforce training in weak spots the interviews identified. Conclusion. These assessments provided important new knowledge regarding the implementation science of quality improvement projects, for feedback during implementation and to better understand which factors most affect implementation.

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

“…Team leaders provided feedback to collaborative organizers regarding progress during individual quarterly coaching calls. Formal assessments, targeting a spectrum of providers on each unit, were used to dynamically address barriers, celebrate successes, and address education gaps (15). The application of TRiP combined with CUSP has been associated with decreased rates of hospital-acquired infections state- and country-wide (16–19).…”

Barriers and facilitators of a near real-time feedback approach for measuring patient experiences of hospital care

“…The mode of administration has been shown to affect ratings provided by patients [14]. In addition, some modes place greater burden on staff, with regards to data collection and data entry [15].…”

Nursing workload and compliance with non‐pharmacological measures to prevent ventilator‐associated pneumonia: a multicentre study

“…However, despite evidence‐based guidelines (Álvarez Lerma et al, ; Tablan et al, ), the application of these measures remains inadequate, and various studies show heterogeneous practices and insufficient compliance with the guidelines (Akın Korhan et al, ; Jansson et al, ; Lawrence and Fulbrook , ). Among the reasons that nurses report for failing to apply scientific evidence in their practice are routine‐based, rather than evidence‐based, working arrangements, lack of knowledge, demotivation, lack of time, excessive workloads and aspects related to the working environment and organizational structure of the system (Ali et al, ; Hassan and Wahsheh, ; Hugonnet et al, ; Jansson et al, ; Stone et al, ). Training is essential for the application of the guidelines, and it is related to most factors involved in the failure to comply.…”