Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Survey Development
2.2.1. Survey Preparation
2.2.2. Survey Item Generation
2.2.3. Final Survey
2.2.4. Survey Dissemination
2.3. Data Analysis
3. Results
3.1. Participants and Guidelines
3.2. Survey Part 1: Reported Barriers and Facilitators by All Respondents
3.3. Survey Part 2: Reported Barriers and Facilitators per Group
3.4. Survey Part 3: Reported Barriers and Facilitators by EOS Calculator Users
4. Discussion
4.1. Strengths and Limitations
4.2. Clinical Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Discipline | Chi-Square (p-Value) | |||||
---|---|---|---|---|---|---|
PN n = 149 | PO n = 84 | NO n = 108 | NN n = 124 | Total n = 465 | ||
n (%) Agree/Important | ||||||
Relevant Barriers | ||||||
Inner setting | ||||||
Lack of capacity on departments where neonates receive care | 40 (26.8) a | 38 (45.2) b | 54 (50.0) b | 31 (25.0) a | 163 (35.1) | <0.001 |
Problems with handover of maternal information, from obstetric to neonatology ward | 77 (52.0) a | 14 (16.7) b | 10 (9.3) b | 21 (16.9) b | 122 (26.3) | <0.001 |
Relevant facilitators | ||||||
Intervention characteristics | ||||||
Reduction of short- and long-term neonatal side effects (e.g., catheter-related infections, gastro-intestinal symptoms, altered microbiome, increased allergy risk) | 148 (99.3) | 82 (100) | 101 (93.5) | 120 (96.8) | 451 (97.4) | NA |
Reduction of neonatal antibiotic prescriptions | 140 (94.0) | 69 (83.1) | 97 (90.7) | 117 (94.4) | 423 (91.4) | NA |
Reduction of mother-child separation | 131 (88.5) | 78 (94.0) | 105 (98.1) | 118 (95.2) | 432 (93.5) | NA |
Reduction of blood tests in neonates at risk for infection | 100 (67.1) | 62 (76.5) | 98 (90.7) | 105 (84.7) | 365 (79.0) | NA |
Net shorter hospital stay of neonates at risk for infection | 112 (75.2) | 71 (85.5) | 97 (89.8) | 105 (85.4) | 385 (83.2) | NA |
Outer setting | ||||||
Endorsement of EOS calculator by NVK | 109 (73.2) | 54 (69.2) | 54 (58.1) | 72 (64.9) | 289 (67.1) | NA |
Inner setting | ||||||
Integration of EOS calculator in electronic health record | 114 (76.5) | 69 (84.1) | 91 (85.0) | 88 (73.9) | 362 (79.2) | NA |
Individual characteristics | ||||||
Believing the EOS calculator is safe to use | 123 (82.6) | 63 (75.0) | 88 (81.5) | 104 (83.9) | 378 (81.3) | NA |
Believing the EOS calculator will be effective in reducing antibiotic prescriptions | 126 (84.6) | 63 (75.0) | 85 (78.7) | 107 (86.3) | 381 (81.9) | NA |
Implementation process | ||||||
Providing education on the EOS calculator | 109 (73.2) | 61 (75.3) | 99 (91.7) | 111 (89.5) | 380 (82.3) | NA |
Providing feedback on implementation results of own department | 87 (58.4) | 46 (56.1) | 75 (69.4) | 86 (69.9) | 294 (63.3) | NA |
Discipline | ||||
---|---|---|---|---|
PN n = 149 | PO n = 84 | NO n = 108 | NN n = 124 | |
n (%) Agree/Important | ||||
Relevant Barriers | ||||
Individual characteristics | ||||
Expecting more neonates to be admitted to the hospital | NA | 10 (12.2) | NA | NA |
Expecting increased workload | NA | 29 (35.4) | NA | NA |
Not thinking obstetric nurses are adequately trained to check neonatal vital signs | 54 (37.8) | 11 (13.4) | NA | NA |
Not feeling competent to adequately measure heart rate | NA | NA | 11 (11.4) | NR |
Not feeling competent to adequately measure respiratory rate | NA | NA | 14 (14.4) | NR |
Implementation process | ||||
Not timely being informed about changes in physicians’ protocols | NA | NA | 57 (58.8) | 54 (50.9) |
Relevant facilitators | ||||
Intervention characteristics | ||||
Availability of an EOS calculator smartphone application | NR | NR | 50 (52.1) | NR |
Inner setting | ||||
Feeling the current NVK guideline should be replaced | 111 (74.5) | NR | NR | NR |
Feeling that currently antibiotics are prescribed too often | 113 (79.0) | NA | NA | NA |
Clear communication with physicians about reasons for policy choices | NA | NA | 93 (95.9) | 102 (96.2) |
Implementation process | ||||
Local implementation team, as accessible point of contact | NR | NR | 65 (61.9) | 65 (57.0) |
Discipline | ||||
---|---|---|---|---|
PN n = 149 | PO n = 84 | NO n = 108 | NN n = 124 | |
n (%) Agree/Important | ||||
Relevant Barriers | ||||
Intervention characteristics | ||||
Encountering textual or substantive uncertainties when using the EOS calculator | 5 (11.4) | NA | NA | NA |
Relevant facilitators | ||||
Intervention characteristics | ||||
Care for neonates with sepsis risk is more uniform since implementation of EOS calculator | 30 (68.2) | 12 (75.0) | 10 (66.7) | 15 (60.0) |
Individual characteristics | ||||
Thinking parents of neonates agree with EOS calculator recommendations | 36 (81.8) | 10 (62.5) | 11 (73.3) | 21 (84.0) |
The EOS calculator supports in making clinical decisions | 39 (88.6) | NA | NA | NA |
Identified Implementation Determinant | Recommendations |
---|---|
Visibility of relative advantages/fostering tension for change |
|
Stakeholder education |
|
Evaluation and feedback |
|
Integration of EOS calculator in EHR |
|
EOS calculator smartphone application |
|
Lack of capacity (staff and room shortage) |
|
Problems with maternal information handover |
|
Obstetric nurses not well trained to measure vital signs |
|
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van Veen, L.E.J.; van der Weijden, B.M.; van Bodegom-Vos, L.; Hol, J.; Visser, D.H.; Achten, N.B.; Plötz, F.B. Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study. Children 2023, 10, 1682. https://doi.org/10.3390/children10101682
van Veen LEJ, van der Weijden BM, van Bodegom-Vos L, Hol J, Visser DH, Achten NB, Plötz FB. Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study. Children. 2023; 10(10):1682. https://doi.org/10.3390/children10101682
Chicago/Turabian Stylevan Veen, Liesanne E. J., Bo M. van der Weijden, Leti van Bodegom-Vos, Jeroen Hol, Douwe H. Visser, Niek B. Achten, and Frans B. Plötz. 2023. "Barriers and Facilitators to the Implementation of the Early-Onset Sepsis Calculator: A Multicenter Survey Study" Children 10, no. 10: 1682. https://doi.org/10.3390/children10101682