Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Faculty of Health, Geelong, VIC, 3220, Australia.
Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
Implement Sci. 2017 Jul 11;12(1):85. doi: 10.1186/s13012-017-0617-5.
Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals.
METHODS/DESIGN: A pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses' vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines (CPGs) to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward.
This study uses an innovative, networked approach to facilitation to enable uptake of CPGs. Findings will inform the intervention utility and knowledge translation measurement approaches. If successful, the study methodology and intervention has potential for translation to other health care standards.
Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616000544471p.
生命体征是生理状态的主要指标，也是确定是否需要紧急临床治疗的依据。然而，如果恶化的生理迹象被忽视、误解或处理不当，那么可能会导致严重疾病、非计划入住重症监护病房、心脏骤停和死亡。尽管有证据表明早期识别和治疗恶化患者有益，但未能升级护理和管理恶化患者在医院中仍然较为常见。
方法/设计：将采用实用的聚类随机对照试验设计来衡量一项促进干预措施的临床效果和成本，该干预措施旨在改善护士对异常生命体征患者的生命体征测量、解释、治疗和护理升级。成本后果分析将评估干预成本和效果，过程评估将确定干预的实施如何促进结果。我们将比较标准实施临床实践指南（CPGs）和促进实施 CPG 的临床结果和成本。主要结局指标是护士对 CPG 的依从性，即根据组织政策进行护理升级。该研究将在澳大利亚四个主要大都市教学医院进行。在每个医院，将随机分配 8 到 10 个病房到干预组和对照组。对照组病房将接受 CPG 的标准实施，而干预组病房将接受标准 CPG 实施加促进，使用针对病房环境量身定制的促进方法和流程。干预将在 6 个月内在病房层面提供给所有护理人员。在每个医院，将提供两种类型的促进者：一名医院层面的促进者作为负责人；以及每个病房的两名病房层面的促进者。
本研究采用创新的网络化促进方法来实施 CPG。研究结果将为干预措施的实用性和知识转化衡量方法提供信息。如果成功，该研究方法和干预措施有可能推广到其他医疗保健标准。
澳大利亚和新西兰临床试验注册中心（ANZCTR），ACTRN12616000544471p。
