SuDDICU Project - Crit Care Symposium · SuDDICU Project SuDDICU Project Launch June 7th 2010 ....
Transcript of SuDDICU Project - Crit Care Symposium · SuDDICU Project SuDDICU Project Launch June 7th 2010 ....
HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The author accepts full responsibility for this talk.
Health Services Research Unit University of Aberdeen
SuDDICU Project
SuDDICU Project Launch
June 7th 2010
Health Services Research Unit
What ‘s the SuDDICU project again?
Brief overview
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Background
• The Problem: • Hospital Acquired Infections
(HAIs) are major clinical problem.
• HAIs have severe consequences in ICU patients.
• The Procedure: • Selective Decontamination of the
Digestive (SDD) tract is used to prevent HAIs and mortality.
• SDD is the application of topical non-absorbable antibiotics to the throat and stomach and a short course of intravenous antibiotics.
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Background
• The Evidence: • Effectiveness: Meta-analyses show that SDD is effective in
reducing HAIs and, in some cases, mortality.
• Implementation: Despite favourable evidence, SDD is not used frequently – 10-15 ICUs in the UK.
• Potential Issues: • SDD too complex
• behavioural problem
• SDD evidence inadequate • e.g. not generalisable, gaps in intervention designs
• SDD counterintuitive • fear of multi-resistant organisms
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Research Questions
1. What are the clinical and behavioural components of SDD?
2. How has SDD been implemented and delivered into practice?
3. What are stakeholders’ views on consequences of SDD?
4. What are stakeholders’ views on barriers to implementing SDD?
5. What are stakeholders’ views on validity & adequacy of evidence?
6. What are the current SDD practices and intentions of intensivists & microbiologists?
7. If there are uncertainties in the evidence base, what trial design(s) and interventions would be preferred to address these?
8. What are the likely challenges in a large multi-national RCT of SDD?
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September 2011 – November 2011
Complete by August 2010
SuDDICU Overview
CASE STUDIES OF UNITS DELIVERING SDD
DELPHI STUDY OF KEY STAKEHOLDERS’ SDD BELIEFS
NATIONWIDE SURVEY OF CURRENT SDD PRACTICE AND BELIEFS
SEMI-STRUCTURED INTERVIEWS WITH INTENSIVE CARE TRIALISTS STAGE 4
STAGE 3
STAGE 2
STAGE 1
1. What are the clinical and behavioural components of SDD?
2. How has SDD been implemented and delivered into practice?
3. What are stakeholders’ views on consequences of SDD?
4. What are stakeholders’ views on barriers to implementing SDD?
5. What are stakeholders’ views on validity & adequacy of evidence?
6. What are the current SDD practices and intentions of intensivists & microbiologists?
7. If there are uncertainties in the evidence base, what trial design(s) and interventions would be preferred to address these?
8. What are the likely challenges in a large multi-national RCT of SDD?
June 2010 - August 2011
April 2011 – September 2011
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Stage 1: Case Studies
• Design: Observational and interview study
• Procedures: • Observation of SDD delivery
• Interviews with stakeholders
• Sample: • Clinical lead
• Microbiologist
• Pharmacist
• ICU nurse
• Outcomes: • Behavioural observation,
• Interview responses,
• SDD relevant materials and documents
2 ICUs currently delivering SDD
involved in SDD implementation and/or delivery
Target n = 2 each
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Stage 1: Case Studies
• Analysis:
• Behavioural Analysis of Complex Clinical Procedure
Person 1 Person 2 Person 3 Person 4
Time 1 Action 1
Time 2 Action 2, 3, 4
Time 3 Action 5, 6, 7
Time 4 Action 8 Action 9, 10 Action 11
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Stage 1: Case Studies
• Analysis:
• Behavioural Analysis of Complex Clinical Procedure
Doctor Pharmacist ICU nurse Microbiologist
SDD decision Selects patient
Pre delivery Orders and prepares
antibiotics
SDD delivery Pick up drugs,
administer SDD
Post delivery Monitoring of
antibiotics stocks
Disposes of
leftovers
Monitor ICU
environment
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Delphi
• Goals of the Delphi interview:
• Access diverse (rather than representative) expert opinions/beliefs on SDD
• Develop a questionnaire that includes the key issues and opinions to be able to assess representative in the next stage of the project (i.e. Stage 3: Nationwide Questionnaire Study).
• Tap into relevant theoretical domains for three specific behaviours:
1. Providing SDD
2. Participating in an effectiveness trial
3. Participating in an implementation trial
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Theory
Skills
Social/Role Identity
Beliefs about capabilities
Environmental context and resources
Behavioural regulation
Emotion Social
influences
Memory, attention and
decision processes
Motivation and goals
Beliefs about consequences
Knowledge
Michie et al., 2005
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Stage 2: Delphi Survey
• Design: • 4 Delphi ‘rounds’
• Procedures: 1. Semi-structured one-to-one telephone interviews
2. Feedback on interviews via email questionnaire
3. Feedback and revisions via email questionnaire
4. International feedback and revisions via email questionnaire
• Sample: • Clinical lead
• Microbiologist
• Pharmacist
• ICU nurse
stakeholders involved in SDD implementation and/or delivery
Target n = 10 each
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Stage 3: Nationwide Survey
• Design:
• Nationwide survey (based on responses from Delphi)
• Sample: • Clinical leads (n~2000)
• Microbiologists (n~180)
• Procedures: • One large-scale postal questionnaire
• Analysis: • descriptive statistical methods
• statistical prediction techniques
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Stage 4: Trialists interviews
• Design:
• Semi-structured interviews
• Sample:
• International trialists (published authors of large randomised trials in critical care, target n = 10)
• Procedures: • One-to-one telephone administered interview
• Analysis: • Transcripts analysed using content analysis
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What ‘s the funding situation?
Funding update
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SuDDICU International
SuDDICU protocol adopted in 3 countries:
1. UK
2. Canada
3. Australia/New Zealand
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Team
The
Geoff Bellingan University College London, UK
Marion Campbell University of Aberdeen, UK
Brian Cuthbertson Sunnybrook Health Sciences Centre, Canada
Stephan Dombrowski University of Aberdeen, UK
Martin Eccles Newcastle University, UK
Jill Francis University of Aberdeen, UK
Marie Johnston University of Aberdeen, UK
Graeme MacLennan University of Aberdeen, UK
Craig Ramsey University of Aberdeen, UK
Louise Rose University of Toronto, Canada
Kathy Rowan Intensive Care National Audit & Research Centre, UK
Ian Seppelt University of Sydney, Australia
Rob Shulman University College Hospital, UK
Peter Wilson University College Hospital, UK
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Any questions?
Additional feedback, thoughts, or comments please email Stephan: [email protected]
Thank you