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Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation
Journal article   Open access   Peer reviewed

Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation

Kate Curtis, Belinda Kennedy, Julie Considine, Margaret Murphy, Mary K. Lam, Christina Aggar, Margaret Fry, Ramon Z. Shaban and Sarah Kourouche
Implementation science : IS, Vol.19, 54
29/07/2024
DOI: https://doi.org/10.1186/s13012-024-01383-7
PMID: 39075496
Appears in  Recent Faculty of Health Publications
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Abstract

Emergency nursing Emergency department Patient assessment Randomized control trial Clinical deterioration Implementation Education Behaviour change Patient safety
Background Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the ‘how’ and ‘why’ of quantitative results. Results HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts.

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