School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK.
BMC Health Serv Res. 2022 Jun 10;22(1):766. doi: 10.1186/s12913-022-08128-6.
Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs).
A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs ('applications') and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content.
Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications.
A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation.
在病房中恶化而未得到适当识别和/或应对的患者有增加发病率和死亡率的风险。跟踪和触发工具已在国际上实施，促使医疗保健从业者（通常是护理人员）识别与患者恶化一致的生理变化（例如血压、心率变化），然后与具有急性/危重病管理专业知识的从业者联系。尽管这些工具在改善患者结局方面有一些证据，但它们在国际上的临床实践中的应用并不一致。为了在使用国家早期预警评分工具（一种在英国和欧洲部分地区广泛使用的跟踪和触发工具）方面推动更大的指南依从性，使用理论信息实施干预措施（针对护理人员），该干预措施使用理论领域框架（TDF）版本 2 和行为改变技术（BCT）分类法。
采用三阶段流程：1. 从先前发表的实证工作中得出的代表目标行为的重要障碍和促进因素的 TDF 域映射到适当的 BCT；2. 使用研究团队内的共识方法对 BCT 进行了筛选；3. 将短名单上的 BCT 提交给两个在线小组讨论中的相关利益相关者，在讨论中应用了名义小组技术。名义小组参与者包括医疗保健领导者、高级临床医生和病房护理人员。利益相关者分别为操作选定 BCT 的具体策略（“应用”），并根据可接受性和可行性对其进行私下排名。排名数据用于指导干预内容的决策。
50 个 BCT（第 1 阶段映射）被筛选到 14 个（第 2 阶段），并与示例应用一起提交给名义小组的利益相关者。根据名义小组的排名数据，干预措施中包含了 12 个 BCT，将通过 18 个应用程序以面对面的方式向护理人员个人和小组提供。
报告了基于理论的行为改变干预措施的描述，该描述使用可复制的共识方法由利益相关者生成和/或优先考虑的 BCT 和应用程序填充。应在临床环境中测试拟议干预措施的可行性，并进一步阐述干预措施的内容，以允许复制和评估。
