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., and Griffin, Bronwyn R. (2024) Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study. Journal of Pediatric Nursing, 77. e520-e530.

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Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Item ID:	83395
Item Type:	Article (Research - C1)
ISSN:	1532-8449
Keywords:	Implementation barriers,Implementation science,Negative pressure wound therapy,Pediatric burn,Re-epithelialization
Related URLs:	https://www.scopus.com/inward/record.uri...
Copyright Information:	Crown Copyright © 2024 Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Funders:	National Health and Medical Research Council (NHMRC)
Projects and Grants:	NHMRC Partnership Projects PRC2 Funding ID: 2006970
Date Deposited:	13 Aug 2024 00:44
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