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A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis
Journal article   Open access

A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis

Alison Craswell, Debbie Massey, Deepa Sriram, Marianne Wallis, Kevan Polkinghorne, Girish Talaulikar, Alan Cass, Martin Gallagher, Nicholas Gray and Sradha Kotwal
Kidney360, Vol.4(4), pp.e496-e504
04/2023
DOI: https://doi.org/10.34067/KID.0000000000000076
PMID: 36758195
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Published (Version of record)CC BY-NC-ND V4.0,  Open Access
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Abstract

Process evaluation Renal dialysis Nephrology Nurse-led intervention Qualitative Care bundle Acute care Nephrology and urology Expanding knowledge in the health sciences Treatment of human diseases and conditions
Background: Implementation of a care bundle standardising insertion, management and removal practices to reduce infection related to central venous catheters used for haemodialysis was evaluated in a stepped wedge, cluster randomised controlled trial conducted at 37 Australian hospitals providing kidney services, with no reduction in catheter related blood stream infection detected. This process evaluation explored the barriers, enablers and unintended consequences of the implementation to explain the trial outcomes. Methods: Qualitative process evaluation using pre post semi-structured interviews with 38 (19 nursing, 19 medical) and 44 (25 nursing, 19 medical) Australian health professionals involved in haemodialysis central venous catheter management. Analysis was guided by the process implementation domain of the Consolidated Framework for Implementation Research. Results: Key influences on bundle uptake were that clinicians were open to change that was evidence-based and driven by guidelines and had a desire to improve practice and patient outcomes. However, resistance to change in environments of low infection, working in silos of practice, and a need for individualised delivery of patient education created barriers to uptake. Unintended impacts of increased costs and lack of interoperability of systems for data collection were reported. As the trial was in progress at the time of qualitative data collection, perceptions of the bundle may have been influenced by the fact that practices of participants were being observed as a part of the trial. Conclusion: This national process evaluation revealed that health professionals who reported experiencing a benefit viewed the bundle positively. Those that already provided most of the recommended care or perceived that their patient population was not included in the research evidence that underpinned the interventions, resisted the implementation of the bundle. Potentially, formal change management processes using facilitation may improve implementation of evidence-based practice.

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