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Implementation frameworks, strategies and outcomes in optimizing central venous access device practice in
Elouise R Comber1,2, Samantha Keogh3, Linda N Nguyen1,2
1Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
Insights
Implementing evidence-based practices for central venous access devices (CVADs) in children can prevent complications. However, research shows limited use of implementation frameworks, hindering effective translation to clinical practice.
Area of Science:
- Pediatric healthcare research
- Implementation science
- Clinical intervention effectiveness
Background:
- Central venous access devices (CVADs) are crucial for pediatric patients with complex conditions.
- CVAD complications, such as infections, affect nearly one-third of patients.
- Evidence-based practices can mitigate these complications.
Purpose of the Study:
- To explore recent interventional research on pediatric CVAD management.
- To examine these interventions through an implementation science lens.
Main Methods:
- A scoping review using the Arksey and O'Malley framework.
- Searches across major databases (EMBASE, CINAHL, PubMed, Web of Science, CENTRAL).
- Inclusion of English-language studies from 2012-2023 involving children.
Main Results:
- 46 studies were included, focusing on CVAD maintenance and health professionals.
- Many studies used quality improvement approaches rather than formal implementation frameworks.
- Common strategies included education, bundles, and working groups; outcomes focused on effectiveness and infection reduction.
Conclusions:
- Translating evidence-based practices for pediatric CVADs into clinical settings is challenging.
- Adoption of formal implementation frameworks is limited, with 'quality improvement' being an exception.
- Further research should explore the link between implementation strategies, frameworks, and outcomes.
Abstract:
Paediatric patients with complex or acute conditions may require a central venous access device, however, almost one-third of these devices have associated complications (e.g. infections). Implementation of evidence-based practices regarding central venous access devices can reduce and potentially prevent complications.
Aims:
This scoping review aimed to explore recent interventional research in CVAD management through an implementation lens.
Design:
This scoping review used the Arksey and O'Malley framework. Studies were included if they were written in English, published in 2012 to July 2023, involved children and were relevant to the study aims. Risk of bias was appraised by the Mixed Methods Appraisal Tool.
Data Sources:
Searches were undertaken in EMBASE, CINAHL (Ebsco), PubMed, Web of Science and Cochrane Library (CENTRAL).
Results:
Of the 1769 studies identified in a systematic search, 46 studies were included. Studies mostly focused on health professionals and central venous access device maintenance and had quantitative pre-post study designs. Adherence to implementation frameworks was lacking, with many studies employing quality improvement approaches. Implementation strategies were typically multipronged, using health-professional education, bundles and working groups. Bundle compliance and reductions in central line-associated bloodstream infections were the most featured outcomes, with most studies primarily focusing on effectiveness outcomes.
Conclusion:
Translation of evidence-based practices to the clinical setting is difficult and current adoption of implementation frameworks (apart from 'quality improvement') is limited. Implementation strategies are diverse and dependent on the local context, and study outcomes typically focus on the effectiveness of the physical intervention, rather than measuring the implementation effort itself.
Implications For Patients:
Future intervention research requires a more uniform and deliberate application of implementation frameworks and strategies.
Impact:
Greater exploration of relationships between frameworks and strategies and implementation and service outcomes is required to increase understanding of their role in maximizing resources to improve health care. Adhered to best reporting guidelines as per PRISMA-ScR (Tricco et al., 2018).
Patient Or Public Contribution:
No patient or public contribution.
