Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study
Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the imple...
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| Veröffentlicht in: | Journal of pediatric nursing 2024-07, Vol.77, p.e520-e530 |
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| creator | Holbert, Maleea D. Duff, Jed Wood, Fiona Holland, Andrew J.A. Teague, Warwick Frear, Cody Crellin, Dianne Phillips, Natalie Storey, Kristen Martin, Lisa Singer, Yvonne Dimanopoulos, Tanesha A. Cuttle, Leila Vagenas, Dimitrios McPhail, Steven Calleja, Pauline De Young, Alexandra Kimble, Roy M. Griffin, Bronwyn R. |
| description | Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.
A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
•Adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burns.•Despite the demonstrated efficacy, this treatment has not been implemented as part of acute pediatric burn care.•A determinant framework was used to explore barriers to the imp |
| doi_str_mv | 10.1016/j.pedn.2024.05.018 |
| format | Article |
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A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
•Adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burns.•Despite the demonstrated efficacy, this treatment has not been implemented as part of acute pediatric burn care.•A determinant framework was used to explore barriers to the implementation of adjunctive NPWT and develop matched strategies.•To implement NPWT into clinical practice, additional resources, education, training, and updates to policies are required.</description><identifier>ISSN: 0882-5963</identifier><identifier>ISSN: 1532-8449</identifier><identifier>EISSN: 1532-8449</identifier><identifier>DOI: 10.1016/j.pedn.2024.05.018</identifier><identifier>PMID: 38762422</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Australia ; Burn Units - organization & administration ; Burns - therapy ; Child ; Female ; Humans ; Implementation barriers ; Implementation science ; Male ; Negative pressure wound therapy ; Pediatric burn ; Re-epithelialization ; Surveys and Questionnaires</subject><ispartof>Journal of pediatric nursing, 2024-07, Vol.77, p.e520-e530</ispartof><rights>2024</rights><rights>Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-7bcd86796bc280e23f898a650584e7b83a670409db8882ffe17a2771764edb873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0882596324002008$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38762422$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holbert, Maleea D.</creatorcontrib><creatorcontrib>Duff, Jed</creatorcontrib><creatorcontrib>Wood, Fiona</creatorcontrib><creatorcontrib>Holland, Andrew J.A.</creatorcontrib><creatorcontrib>Teague, Warwick</creatorcontrib><creatorcontrib>Frear, Cody</creatorcontrib><creatorcontrib>Crellin, Dianne</creatorcontrib><creatorcontrib>Phillips, Natalie</creatorcontrib><creatorcontrib>Storey, Kristen</creatorcontrib><creatorcontrib>Martin, Lisa</creatorcontrib><creatorcontrib>Singer, Yvonne</creatorcontrib><creatorcontrib>Dimanopoulos, Tanesha A.</creatorcontrib><creatorcontrib>Cuttle, Leila</creatorcontrib><creatorcontrib>Vagenas, Dimitrios</creatorcontrib><creatorcontrib>McPhail, Steven</creatorcontrib><creatorcontrib>Calleja, Pauline</creatorcontrib><creatorcontrib>De Young, Alexandra</creatorcontrib><creatorcontrib>Kimble, Roy M.</creatorcontrib><creatorcontrib>Griffin, Bronwyn R.</creatorcontrib><title>Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study</title><title>Journal of pediatric nursing</title><addtitle>J Pediatr Nurs</addtitle><description>Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.
A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
•Adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burns.•Despite the demonstrated efficacy, this treatment has not been implemented as part of acute pediatric burn care.•A determinant framework was used to explore barriers to the implementation of adjunctive NPWT and develop matched strategies.•To implement NPWT into clinical practice, additional resources, education, training, and updates to policies are required.</description><subject>Australia</subject><subject>Burn Units - organization & administration</subject><subject>Burns - therapy</subject><subject>Child</subject><subject>Female</subject><subject>Humans</subject><subject>Implementation barriers</subject><subject>Implementation science</subject><subject>Male</subject><subject>Negative pressure wound therapy</subject><subject>Pediatric burn</subject><subject>Re-epithelialization</subject><subject>Surveys and Questionnaires</subject><issn>0882-5963</issn><issn>1532-8449</issn><issn>1532-8449</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc-O1SAUh4lx4lxHX8CFYemmFWgL1Li5TvwzySRuxjWhcHqHmxYq0NH7ML7r0NzRpSsI5zu_E86H0BtKakoof3-sF7C-ZoS1NelqQuUztKNdwyrZtv1ztCNSsqrreXOJXqZ0JITSTvQv0GUjBWctYzv055OO0UFMWHuLTagsJHfwYHHKUWc4OEh4DBHne8BuXiaYwWedXfA4jNjDodwfAC8RUloj4F9hLUGFjno5YeexNmsudbBO5-gMHtbosdEFLcX9uo2ZnP6A93h2v8vcGfJ92Mav9vQKXYx6SvD66bxCP758vrv-Vt1-_3pzvb-tTNPRXInBWMlFzwfDJAHWjLKXmnekky2IQTaaC9KS3g6ybGQcgQrNhKCCt1DeRHOF3p1zlxh-rpCyml0yME3aQ1iTakjHOW853VB2Rk0MKUUY1RLdrONJUaI2LeqoNi1q06JIp4qW0vT2KX8dZrD_Wv56KMDHMwDllw_Fh0rGgTdlaxFMVja4_-U_Aq53oRo</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Holbert, Maleea D.</creator><creator>Duff, Jed</creator><creator>Wood, Fiona</creator><creator>Holland, Andrew J.A.</creator><creator>Teague, Warwick</creator><creator>Frear, Cody</creator><creator>Crellin, Dianne</creator><creator>Phillips, Natalie</creator><creator>Storey, Kristen</creator><creator>Martin, Lisa</creator><creator>Singer, Yvonne</creator><creator>Dimanopoulos, Tanesha A.</creator><creator>Cuttle, Leila</creator><creator>Vagenas, Dimitrios</creator><creator>McPhail, Steven</creator><creator>Calleja, Pauline</creator><creator>De Young, Alexandra</creator><creator>Kimble, Roy M.</creator><creator>Griffin, Bronwyn R.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202407</creationdate><title>Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study</title><author>Holbert, Maleea D. ; Duff, Jed ; Wood, Fiona ; Holland, Andrew J.A. ; Teague, Warwick ; Frear, Cody ; Crellin, Dianne ; Phillips, Natalie ; Storey, Kristen ; Martin, Lisa ; Singer, Yvonne ; Dimanopoulos, Tanesha A. ; Cuttle, Leila ; Vagenas, Dimitrios ; McPhail, Steven ; Calleja, Pauline ; De Young, Alexandra ; Kimble, Roy M. ; Griffin, Bronwyn R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-7bcd86796bc280e23f898a650584e7b83a670409db8882ffe17a2771764edb873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Australia</topic><topic>Burn Units - organization & administration</topic><topic>Burns - therapy</topic><topic>Child</topic><topic>Female</topic><topic>Humans</topic><topic>Implementation barriers</topic><topic>Implementation science</topic><topic>Male</topic><topic>Negative pressure wound therapy</topic><topic>Pediatric burn</topic><topic>Re-epithelialization</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holbert, Maleea D.</creatorcontrib><creatorcontrib>Duff, Jed</creatorcontrib><creatorcontrib>Wood, Fiona</creatorcontrib><creatorcontrib>Holland, Andrew J.A.</creatorcontrib><creatorcontrib>Teague, Warwick</creatorcontrib><creatorcontrib>Frear, Cody</creatorcontrib><creatorcontrib>Crellin, Dianne</creatorcontrib><creatorcontrib>Phillips, Natalie</creatorcontrib><creatorcontrib>Storey, Kristen</creatorcontrib><creatorcontrib>Martin, Lisa</creatorcontrib><creatorcontrib>Singer, Yvonne</creatorcontrib><creatorcontrib>Dimanopoulos, Tanesha A.</creatorcontrib><creatorcontrib>Cuttle, Leila</creatorcontrib><creatorcontrib>Vagenas, Dimitrios</creatorcontrib><creatorcontrib>McPhail, Steven</creatorcontrib><creatorcontrib>Calleja, Pauline</creatorcontrib><creatorcontrib>De Young, Alexandra</creatorcontrib><creatorcontrib>Kimble, Roy M.</creatorcontrib><creatorcontrib>Griffin, Bronwyn R.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holbert, Maleea D.</au><au>Duff, Jed</au><au>Wood, Fiona</au><au>Holland, Andrew J.A.</au><au>Teague, Warwick</au><au>Frear, Cody</au><au>Crellin, Dianne</au><au>Phillips, Natalie</au><au>Storey, Kristen</au><au>Martin, Lisa</au><au>Singer, Yvonne</au><au>Dimanopoulos, Tanesha A.</au><au>Cuttle, Leila</au><au>Vagenas, Dimitrios</au><au>McPhail, Steven</au><au>Calleja, Pauline</au><au>De Young, Alexandra</au><au>Kimble, Roy M.</au><au>Griffin, Bronwyn R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study</atitle><jtitle>Journal of pediatric nursing</jtitle><addtitle>J Pediatr Nurs</addtitle><date>2024-07</date><risdate>2024</risdate><volume>77</volume><spage>e520</spage><epage>e530</epage><pages>e520-e530</pages><issn>0882-5963</issn><issn>1532-8449</issn><eissn>1532-8449</eissn><abstract>Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.
A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
•Adjunctive negative pressure wound therapy (NPWT) significantly improves time to re-epithelialization in pediatric burns.•Despite the demonstrated efficacy, this treatment has not been implemented as part of acute pediatric burn care.•A determinant framework was used to explore barriers to the implementation of adjunctive NPWT and develop matched strategies.•To implement NPWT into clinical practice, additional resources, education, training, and updates to policies are required.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38762422</pmid><doi>10.1016/j.pedn.2024.05.018</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Australia Burn Units - organization & administration Burns - therapy Child Female Humans Implementation barriers Implementation science Male Negative pressure wound therapy Pediatric burn Re-epithelialization Surveys and Questionnaires |
| title | Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study |
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