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Published on: May 2, 2025
Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn
Maleea D Holbert1, Jed Duff2, Fiona Wood3
1School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia.
Insights
Barriers to using negative pressure wound therapy in pediatric burns include resource and knowledge gaps. Tailored strategies are needed to improve adoption and sustainability of this effective treatment for children.
Area of Science:
- Pediatric Burn Care
- Wound Management
- Implementation Science
Background:
- Pediatric burn injuries present a significant global health challenge.
- Negative pressure wound therapy (NPWT) can improve re-epithelialization in pediatric burns.
- Consistent adoption of NPWT in acute pediatric burn care remains a challenge.
Purpose of the Study:
- Identify barriers to implementing NPWT in acute pediatric burn care.
- Co-design targeted strategies to overcome these barriers.
- Enhance the adoption and sustainability of NPWT for pediatric burns.
Main Methods:
- Sequential mixed methods design utilized.
- Online questionnaire distributed to 63 healthcare professionals across four Australian pediatric hospitals.
- Semi-structured interviews conducted with nine senior burn clinicians.
- Barriers analyzed using the Consolidated Framework for Implementation Research (CFIR).
Main Results:
- Eight key implementation barriers identified across all five CFIR domains.
- Barriers include resource limitations, knowledge gaps, individual readiness, patient factors, policy issues, intervention complexity, and planning deficits.
- Targeted implementation strategies were co-designed based on identified barriers.
Conclusions:
- Contextual factors significantly influence NPWT uptake in pediatric burn settings.
- Successful implementation requires additional resources, education, training, and updated policies.
- Co-designed strategies are anticipated to improve NPWT adoption and long-term use in pediatric burn care.
Purpose:
Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.
Methods:
A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
Results:
Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
Conclusion:
Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Trial Registration:
Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
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