Implementing a Goal-Directed Care Bundle after Acute Intracerebral Haemorrhage: Process Evaluation for the Third INTEnsive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial Study in China.
Implementing a Goal-Directed Care Bundle after Acute Intracerebral Haemorrhage: Process Evaluation for the Third INTEnsive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial Study in China.
复制标题
急性脑出血后实施目标导向护理组合：中国急性脑出血试验研究中第三次降压重症监护组合的过程评估。
DOI：
10.1159/000520669
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Ouyang M
中科院分区：
文献类型：
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作者：
Ouyang M
背景：第三项在急性脑出血患者中进行降压治疗的综合护理组合试验是一项正在进行的国际、多中心、阶梯楔形、随机分组试验，旨在确定与标准治疗相比，目标导向护理组合（早期强化降压、血糖控制、发热治疗和抗凝治疗）对急性脑出血（ICH）后以患者为中心的结局的有效性。嵌入式过程评价旨在确定与干预措施的吸收和实施有关的因素。在此，我们提出了在China.Methods/Design的医院网站的过程评估结果：一个混合的方法，包括调查，重点小组讨论和采访临床医生，常规监测，和招聘日志被用来收集数据的目的抽样医院。以医学研究理事会指导和规范化过程理论为设计、数据分析和综合的理论框架。结果：2019-2020年期间，与临床医生完成了20次定量调查，进行了26次访谈和2次焦点小组讨论。护理包通常按计划提供，并被医生和护士接受，但据报告，难以达到方案规定的血压和血糖控制目标水平。实施护理包的阻力发生在被认为是在高风险的不良反应的患者。阻碍实施的常见组织背景因素包括延迟的过程和有限的药物供应，而既定的背景护理程序，专业知识和能力影响其融入常规实践。促进实施的领域包括优化可用资源内的工作流程，有一个专门的团队，并认识到潜在的好处intervention.Conclusions：不同的既定的护理协议跨网站，不同层次的背景知识，以及缺乏工作人员的能力阻碍了目标导向的护理捆绑到中国ICH患者的日常实践的整合。及时识别并努力解决这些障碍，可以促进未来指南推荐的ICH患者管理干预措施的采用。
Background:The third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral Haemorrhage Trial is an ongoing international, multicentre, stepped wedge, cluster-randomized trial to determine the effectiveness of a goal-directed care bundle (early intensive blood pressure [BP] lowering, glycaemic control, treatment of pyrexia, and reversal of anticoagulation), as compared to standard of care, on patient-centred outcomes after acute intracerebral haemorrhage (ICH). An embedded process evaluation aims to identify factors related to the uptake and implementation of the intervention. Herein, we present the process evaluation results for hospital sites in China.Methods/Design:A mixed methods approach, including surveys, focused group discussions and interviews with clinicians, routine monitoring, and recruitment logs were used to collect data across purposively sampled hospitals. Medical Research Council guidance and normalization process theory were used as theoretical frameworks for design, data analysis, and synthesis.Results:Twenty quantitative surveys were completed with clinicians, and 26 interviews and 2 focus group discussions were conducted during 2019–2020. The care bundle was generally delivered as planned and acceptable by doctors and nurses, but difficulties were reported in achieving the protocol-defined target levels of BP and glycaemic control. Resistance to implementing the care bundle occurred for patients perceived to be at high risk of adverse effects. Common organizational contextual factors that impeded implementation included delayed processes and limited medication supply, while established background care procedures, expertise, and capacity influenced its integration into routine practice. Areas to facilitate implementation included optimizing workflow within available resources, having a dedicated team, and recognizing the potential benefits of the intervention.Conclusions:Varied established care protocols across sites, different levels of background expertise, and lack of staff capacity impeded the integration of goal-directed care bundle into routine practice for ICH patients in China. Ready identification, and efforts to address, these barriers could facilitate uptake of future guideline-recommended interventions for the management of patients with ICH.