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Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis

Bucknall, Tracey K., Harvey, Gill, Considine, Julie, Mitchell, Imogen, Rycroft-Malone, Jo, Graham, Ian D., Mohebbi, Mohammadreza, Watts, Jennifer and Hutchinson, Alison M. 2017, Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis, Implementation science, vol. 12, pp. 1-9, doi: 10.1186/s13012-017-0617-5.

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Title Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis
Author(s) Bucknall, Tracey K.ORCID iD for Bucknall, Tracey K. orcid.org/0000-0001-9089-3583
Harvey, Gill
Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
Mitchell, Imogen
Rycroft-Malone, Jo
Graham, Ian D.
Mohebbi, MohammadrezaORCID iD for Mohebbi, Mohammadreza orcid.org/0000-0001-9713-7211
Watts, JenniferORCID iD for Watts, Jennifer orcid.org/0000-0001-8095-8638
Hutchinson, Alison M.ORCID iD for Hutchinson, Alison M. orcid.org/0000-0001-5065-2726
Journal name Implementation science
Volume number 12
Article ID 85
Start page 1
End page 9
Total pages 9
Publisher Biomed Central
Place of publication London, Eng.
Publication date 2017-07-11
ISSN 1748-5908
Keyword(s) Clinical decision-making
Economic analysis
Facilitation
Guidelines
Implementation
Knowledge translation
Patient safety
Process evaluation
Randomised controlled trial
Vital signs
Summary Background
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.

Discussion
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.
Language eng
DOI 10.1186/s13012-017-0617-5
Field of Research 11 Medical And Health Sciences
08 Information And Computing Sciences
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30100639

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.