Asley Agus (United Kingdom)
Northern Ireland Clinical Trials Unit (NICTU) , Belfast, UK Royal HospitalsAuthor Of 1 Presentation
IMPLEMENTATION AND DELIVERY OF THE SEDATION AND WEANING IN CHILDREN (SANDWICH) INTERVENTION: THE IMPORTANCE OF UNDERSTANDING CONTEXT AND PROCESS
Abstract
Background and Aims
The SANDWICH trial tested a behavioural change intervention in 18 paediatric intensive care units (PICUs) aimed at reducing the duration of mechanical ventilation. The intervention was dependent upon unit-wide staff adherence. We aimed to identify barriers and facilitators to adherence by exploring intervention implementation, receipt and delivery.
Methods
We conducted a process evaluation. Qualitative data were collected using semi-structured interview guides in individual and focus group interviews. A range of multi-disciplinary PICU staff were interviewed across the trial timeline. Data were analysed using thematic content analysis. The lead author had primary responsibility for analysis, with standard measures to ensure validity.
Results
Analysis of interview data (n=378 participants) identified eight themes that captured perceived barriers and facilitators of protocol implementation, receipt and delivery. These included: trial design and delivery; balance between intervention flexibility and prescription; primacy of immediate/essential patient care; demonstrable relevance of the intervention; vulnerability of the trial to individual staff engagement; impulse to maintain preferred/engrained practice; fit with unit organisation and routines; and unit culture and staff customary working. Attendant consequences of trial participation were identified, suggesting enhanced (bedside) nurse clinical understanding and involvement; multidisciplinary communication / collaboration; sedation management; and weaning practice and related patient care.
Conclusions
The process evaluation delivered important insights into how and why the trial outcomes were achieved. It illuminated staff perceptions on intervention delivery to explain why the positive effect was smaller than anticipated; and factors likely to maximise the reach, acceptability and effectiveness of the intervention in other PICUs.