Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION—a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers’ implementation strategy

Abstract

Background The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. Methods Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. Discussion The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. Trial registration The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

Facilitating person-centered patient participation in kidney care—a process evaluation of a quasi-experimental study incorporating a tool and training of local implementation teams

“…This indicates a need for a stronger relationship between managers and facilitators in knowledge implementation [46,48]. This has lately been highlighted as a need to address both rst-line managers, and upper-level management to facilitate implementation [49,50]. Promoting a fair context and scaffolding a person-centered context, managers' attitudes to change need to focus on improvement processes, with rst line managers acting as role models if and when new methods and evidence are introduced [51,52].…”

Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients: a multicentre observational study

“…The study was part of a cluster-randomized trial—the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) study [ 17 ]. There were 55 eligible orthopaedic care units performing hip surgery in Sweden.…”

Evidensbaserad blåsövervakning vid ortopedisk vård : Patienters erfarenheter och personals följsamhet till riskbedömning vid höftkirurgi

“…När jag fick möjligheten att involvera mig som licentiat i ett forskningsprojekt innefattande både ortopedi, evidensbaserad vård, implementering och en möjlighet att förbättra vården för patienter så tackade jag intresserat ja. Onset PrevenTIon of urinary retention in Orthopaedic Nursing and Rehabilitation (OPTION) som jag är involverad i, är en randomiserad svensk studie inom ortopedisk vård -för att förhindra komplikationen urinretention hos patienter som genomgår höftkirurgi (1).…”