Abstract:
BACKGROUND:Implementation of the 'Sepsis Six' clinical care bundle within an hour of recognition of sepsis is recommended as an approach to reduce mortality in patients with sepsis, but achieving reliable delivery of the bundle has proved challenging. There remains little understanding of the barriers to reliable implementation of bundle components. We examined frontline clinical practice in implementing the Sepsis Six. METHODS:We conducted an ethnographic study in six hospitals participating in the Scottish Patient Safety Programme Sepsis collaborative. We conducted around 300 h of non-participant observation in emergency departments, acute medical receiving units and medical and surgical wards. We interviewed a purposive sample of 43 members of hospital staff. Data were analysed using a constant comparative approach. RESULTS:Implementation strategies to promote reliable use of the Sepsis Six primarily focused on education, engaging and motivating staff, and providing prompts for behaviour, along with efforts to ensure that equipment required was readily available. Although these strategies were successful in raising staff awareness of sepsis and engagement with implementation, our study identified that completing the bundle within an hour was not straightforward. Our emergent theory suggested that rather than being an apparently simple sequence of six steps, the Sepsis Six actually involved a complex trajectory comprising multiple interdependent tasks that required prioritisation and scheduling, and which was prone to problems of coordination and operational failures. Interventions that involved allocating specific roles and responsibilities for completing the Sepsis Six in ways that reduced the need for coordination and task switching, and the use of process mapping to identify system failures along the trajectory, could help mitigate against some of these problems. CONCLUSIONS:Implementation efforts that focus on individual behaviour change to improve uptake of the Sepsis Six should be supplemented by an understanding of the bundle as a complex trajectory of work in which improving reliability requires attention to coordination of workflow, as well as addressing the mundane problems of interruptions and operational failures that obstruct task completion.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Tarrant C,O'Donnell B,Martin G,Bion J,Hunter A,Rooney KDdoi
10.1186/s13012-016-0518-zsubject
Has Abstractpub_date
2016-11-16 00:00:00pages
149issue
1issn
1748-5908pii
10.1186/s13012-016-0518-zjournal_volume
11pub_type
杂志文章,多中心研究abstract:BACKGROUND:Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case ...
journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
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abstract:BACKGROUND:Health practice guidelines (HPGs) are important tools for the translation of evidence into practice. Reporting Items for Practice Guidelines in HealThcare (RIGHT) checklist provides guidance on reporting health practice guidelines (HPGs). We assessed the reporting completeness and quality of a set of nationa...
journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
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