Clinical staff perspectives on the implementation of a national care bundle for care of Central venous catheters for haemodialysis
Dr Alison Craswell1, Assoc Prof Debbie Massey1, Professor Marianne Wallis1, Dr Deepa Sriram1, Dr Nicholas Gray2, Dr Sradha Kotwal3
1University Of The Sunshine Coast, Sippy Downs, Australia
2Sunshine Coast Hospital and Health Service, Birtinya, Australia
3The George institute for Global Health, Sydney, Australia
Central Venous Catheters (CVC) are essential to providing haemodialysis to patients with chronic renal failure. Guidelines for CVC insertion and care aim to reduce infection rates. In Australia, evidence suggests there is considerable variation in dialysis catheter practices. The National Reducing the burden of dialysis catheter complications study involved implementation of a care bundle to standardise practice. Care bundle success is influenced by implementation processes and behaviour change. This study evaluated the implementation of a care bundle for CVC insertion, maintenance, and removal.
Semi-structured face-to-face interviews were conducted with Australian renal health professionals pre- and post-implementation of the care bundle. Participants were recruited from eight of the 37 renal units in Australia participating in the larger study. A qualitative content analysis approach was used, based on a priori categories.
Key enablers of care bundle uptake included site identified bundle champions driving practice change. Most sites were practicing the majority of the care bundle directives prior to implementation, perceiving minimal need for practice change. Additionally, knowledge of low infection rates, at many sites, justified staff perceptions that change was not required. Barriers to successful care bundle uptake arose from silos of practice, decreasing coordination of the teams involved. The standardised information sheet for consumers led to deviation from the bundle at most sites.
Practice change through national standardisation of care is challenging. Existing evidence-based catheter guidelines belie high acceptance of evidence driven practice. Perspectives of health professionals involved in such changes are critical to informing sustainability of this evidence-based care bundle.
Biography:
Dr Craswell RN, PhD is a Senior Research Fellow in a collaborative appointment between University of the Sunshine Coast and Caboolture hospital. She has expertise in health services and clinical research, emergency department model of care development and evaluation, qualitative methods, health informatics, data linkage, and project management. She led the qualitative arm of this national evaluation of the implementation of a care bundle across more than 35 hospitals.