PMID- 34144864 OWN - NLM STAT- MEDLINE DCOM- 20220314 LR - 20220314 IS - 1036-7314 (Print) IS - 1036-7314 (Linking) VI - 35 IP - 2 DP - 2022 Mar TI - Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation. PG - 113-122 LID - S1036-7314(21)00058-8 [pii] LID - 10.1016/j.aucc.2021.04.003 [doi] AB - BACKGROUND: Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel. OBJECTIVE: The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals. METHODS: This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. Sample medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-sample z-test. RESULTS/FINDINGS: Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min; there was no difference in time to activation between business hours and after-hours; time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval CI = 4.8-9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2-17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5-3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5-5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3-2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1-16.1]). CONCLUSIONS: High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context. CI - Copyright (c) 2021 Australian College of Critical Care Nurses Ltd. All rights reserved. FAU - Kourouche, Sarah AU - Kourouche S AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: Sarah.Kourouche@sydney.edu.au. FAU - Curtis, Kate AU - Curtis K AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia; Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong NSW, Australia. Electronic address: Kate.Curtis@sydney.edu.au. FAU - Munroe, Belinda AU - Munroe B AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia. Electronic address: Belinda.Munroe@health.nsw.gov.au. FAU - Asha, Stephen Edward AU - Asha SE AD - Emergency Department, St George Hospital, Kogarah, NSW, Australia; St George Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia. Electronic address: Stephen.Asha@health.nsw.gov.au. FAU - Carey, Ian AU - Carey I AD - School of Medicine, Medicine and Health, University of Wollongong, Wollongong 2522, NSW, Australia. Electronic address: irc026@uowmail.edu.au. FAU - Considine, Julie AU - Considine J AD - School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Experience - Eastern Health Partnership, Box Hill, VIC, Australia. Electronic address: julie.considine@deakin.edu.au. FAU - Fry, Margaret AU - Fry M AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; University of Technology Sydney Faculty of Health, NSW, Australia; Northern Sydney Local Health District, NSW, Australia. Electronic address: Margaret.Fry@uts.edu.au. FAU - Lyons, Jack AU - Lyons J AD - School of Medicine, Medicine and Health, University of Wollongong, Wollongong 2522, NSW, Australia. Electronic address: jl595@uowmail.edu.au. FAU - Middleton, Sandy AU - Middleton S AD - Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, NSW Australia. Electronic address: Sandy.Middleton@acu.edu.au. FAU - Mitchell, Rebecca AU - Mitchell R AD - Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2113. Electronic address: r.mitchell@mq.edu.au. FAU - Shaban, Ramon Z AU - Shaban RZ AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW 2006, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, 2145, Australia; New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, NSW, 2145, Australia. Electronic address: ramon.shaban@sydney.edu.au. FAU - Unsworth, Annalise AU - Unsworth A AD - South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, NSW 2006, Australia. FAU - Buckley, Thomas AU - Buckley T AD - Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: Tom.Buckley@sydney.edu.au. LA - eng PT - Journal Article DEP - 20210616 PL - Australia TA - Aust Crit Care JT - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JID - 9207852 MH - Australia MH - Hospitals MH - Humans MH - *Patient Care Bundles MH - *Thoracic Injuries/therapy MH - *Wounds, Nonpenetrating/therapy OTO - NOTNLM OT - Behaviour change OT - Blunt chest wall injury OT - Emergency OT - Fidelity of delivery OT - Implementation plan OT - Implementation strategy OT - Intervention fidelity OT - Nursing OT - Process evaluation OT - Treatment fidelity COIS- Conflict of Interest The authors declare no conflict of interest. EDAT- 2021/06/20 06:00 MHDA- 2022/03/15 06:00 CRDT- 2021/06/19 05:35 PHST- 2021/02/07 00:00 [received] PHST- 2021/04/08 00:00 [revised] PHST- 2021/04/11 00:00 [accepted] PHST- 2021/06/20 06:00 [pubmed] PHST- 2022/03/15 06:00 [medline] PHST- 2021/06/19 05:35 [entrez] AID - S1036-7314(21)00058-8 [pii] AID - 10.1016/j.aucc.2021.04.003 [doi] PST - ppublish SO - Aust Crit Care. 2022 Mar;35(2):113-122. doi: 10.1016/j.aucc.2021.04.003. Epub 2021 Jun 16.