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What validated instruments, that measure implementation outcomes, are suitable for use in the Paediatric Intensive
Elizabeth Dodds1,2,3, Sarah Redsell4,5, Stephen Timmons6
1Paediatric Critical Care Unit, Nottingham University Hospital NHS Trust, Nottingham, UK. liz.dodds@nuh.nhs.uk.
Insights
Validated instruments for measuring implementation outcomes in paediatric intensive care units (PICUs) are scarce. This review identified two potentially adaptable instruments, highlighting the need for further research to ensure effective evidence-based practice implementation.
Area of Science:
- Healthcare Research
- Implementation Science
- Pediatric Critical Care
Background:
- Implementation outcomes are crucial for assessing evidence-based practice (EBP) success.
- These outcomes are rarely measured in Paediatric Intensive Care Units (PICUs), with existing measures often lacking validation.
- This study addresses the need for validated instruments in PICU settings.
Purpose of the Study:
- To systematically review existing literature to identify validated instruments for measuring implementation outcomes.
- Focus on instruments applicable to new EBP interventions within a PICU context.
Main Methods:
- A systematic review of systematic reviews was conducted in two phases.
- Phase one involved database searches and selection of relevant systematic reviews.
- Phase two focused on extracting and analyzing implementation outcome instruments, mapping them to the Consolidated Framework for Implementation Research (CFIR).
Main Results:
- Searches yielded 3195 unique papers, with five systematic reviews included.
- Most instruments reviewed had limited evidence of validity, reliability, and poor psychometric properties.
- After screening 93 instruments, two were identified as potentially adaptable for PICU settings and mapped to CFIR domains.
Conclusions:
- The methodological quality of current implementation outcome measurement instruments is insufficient.
- Two instruments show promise for adaptation and validation in PICU settings.
- Further research is essential to adapt and validate these instruments for practical use in implementing EBP.
Background/Aims:
The measurement of implementation outcomes can establish the success of implementing evidence into practice. However, implementation outcomes are seldom measured in acute healthcare settings, such as Paediatric Intensive Care Units (PICU), and if they are used, are likely to be non-validated, site or intervention-specific measures. To address this literature gap, this systematic review of systematic reviews aims to identify validated instruments to measure implementation outcomes of new EBP interventions in a PICU setting.
Methods:
A systematic review of systematic reviews was conducted in two phases. Phase One: Five electronic databases were searched between 06/10/22 and 14/10/22. Systematic reviews were selected using pre-determined eligibility criteria. Methodological quality was assessed using the Critical Appraisal Skills Programme tool and a data extraction table was used to allow further synthesis. Phase Two: Secondary eligibility criteria were used to extract and review instruments from the systematic reviews selected in Phase One. Instruments were analysed and mapped to the Consolidated Framework of Implementation Research (CFIR).
Results:
Phase One: Searches resulted in 3195 unique papers. Five systematic reviews were eligible for inclusion. All examined the psychometric properties of each instrument, utilising different methods to do so; three considered their pragmatic or usability properties; and one identified instruments that were transferrable to different settings. Each systematic review identified that most included instruments had limited evidence of their validity or reliability and had poor psychometric properties. Phase two: 93 instruments were screened, and nine were eligible for analysis. After analysis and CFIR mapping, two instruments were identified as potentially adaptable to the PICU setting.
Conclusions:
The methodological quality of implementation outcome measurement instruments is inadequate, warranting further validation research. Two instruments were identified that cover multiple CFIR domains and have scope to be adapted for use when implementing evidence-based practice into the PICU. Further work is needed to adapt and further validate an instrument for use in practice.
Trial Registration:
For transparency of procedures and methods, the protocol for this systematic review was registered with PROSPERO (registration number CRD42022361638L).
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