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Barriers and Enablers to Implementing the Children's Hospital Early Warning Score: A Pre- and Post-Implementation
Christine E Cassidy1, Lauren MacEachern2, Shauna Best2
1IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada.
Insights
Implementing the Children's Hospital Early Warning Score (CHEWS) faced barriers in clinical decision-making and collaboration. Addressing these challenges can improve pediatric patient safety and care quality.
Area of Science:
- Pediatric Nursing
- Healthcare Quality Improvement
- Patient Safety
Background:
- Early warning scores are crucial for timely intervention in pediatric care.
- The Children's Hospital Early Warning Score (CHEWS) aims to standardize pediatric patient monitoring.
- Understanding implementation facilitators and barriers is key to successful adoption.
Purpose of the Study:
- To identify and compare barriers and enablers to CHEWS implementation.
- To analyze these factors in both pre- and post-implementation phases on a pediatric unit.
Main Methods:
- Qualitative descriptive design utilizing the Theoretical Domains Framework.
- Semi-structured focus groups and individual interviews with nurses.
- Directed content analysis followed by inductive thematic analysis.
Main Results:
- Barriers included challenges in clinical decision-making, interprofessional relationships, unit context, and negative emotions.
- Enablers focused on improving quality of care and patient safety.
- Both barriers and enablers were mapped to 13 Theoretical Domains Framework domains.
Conclusions:
- CHEWS implementation presents varied barriers and enablers.
- Tailored strategies are necessary to address nurses' concerns about clinical decision-making and collaboration.
- Overcoming barriers can enhance the use of CHEWS for improved pediatric patient care and safety.
Purpose:
The purpose of this study was to identify and compare barriers and enablers to the implementation of the Children's Hospital Early Warning Score (CHEWS) on a pediatric inpatient unit pre- and post-implementation.
Design And Methods:
A qualitative descriptive design, guided by the Theoretical Domains Framework, was used to conduct semi-structured focus groups and individual interviews with nurses on a pediatric inpatient unit to identify barriers and enablers in the pre- and post- CHEWS implementation phases. Data were analyzed using a directed content analysis approach followed by inductive thematic analysis.
Results:
Two pre-implementation focus groups (N = 15) and 8 post-implementation individual interviews with nurses were conducted. We identified pre- and post- CHEWS implementation barriers related to clinical decision making, interprofessional relationships, the unit context, and negative emotions, and enablers related to quality of care and patient safety. The identified barriers and enablers to implementation were categorized within 13 TDF domains.
Conclusions:
Our findings illustrate a range of barriers and enablers to CHEWS implementation during the pre- and post-implementation phases. Tailored strategies are needed to overcome barriers related to nurses' perceptions of CHEWS impeding clinical decision-making and interprofessional collaboration. By addressing the identified barriers, we can leverage nurses' motivations for using CHEWS to improve the quality of patient care and enhance patient safety.
Practice Implications:
The barriers and enablers identified in this study can be used to select implementation strategies to support the use of early warning systems in pediatric nursing practice.