Co-designing Implementation Strategies for the Use of Negative Pressure Wound Therapy for Acute Paediatric Burns in Australia

Maleea Holbert¹, Bronwyn Griffin^1,2, Kristen Storey^1,2, Jed Duff³, Fiona Wood^4,5, Roy Kimble^2,6, Andrew Holland^7,8, Warwick Teague^9,10,11,12, Dianne Crellin^9,10,13, Cody Frear^2,6, Natalie Philips², Yvonne Singer¹⁴, Leila Cuttle^No, Alexandra De Young², Dimitrios Vagenas¹⁵, Steven McPhail¹⁶, Pauline Calleja¹⁷,
¹Menzies Health Institute Queensland, Griffith University, Nathan Campus, Queensland, Australia
²Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
³Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
⁴Perth Children’s Hospital, Nedlands, Western Australia, Australia
⁵Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
⁶Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
⁷The Burns Unit, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
⁸Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
⁹Surgical Research, Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
¹⁰Burns Service, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
¹¹Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
¹²School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
¹³Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
¹⁴Victorian Adult Burn Service, Alfred Hospital, Melbourne, Victoria, Australia
¹⁵School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
¹⁶Faculty of Health, School of Public health and Social Science, Queensland University of Technology , Brisbane, Queensland, Australia
¹⁷School of Nursing, Midwifery & Social Sciences, Central Queensland University, Cairns, Queensland, Australia

Abstract

Background
Paediatric burn injuries pose a major clinical problem worldwide and result in significant morbidity. Early application of negative pressure wound therapy (NPWT) has been shown to significantly improve time to re-epithelialisation in paediatric burn patients. This adjunctive treatment has not yet been reliably or consistently adopted.

Methods
This investigation used a qualitative research design to identify and explore barriers to the implementation of NPWT in acute paediatric burn care. An online co-design questionnaire was developed and disseminated to healthcare professionals within Australia’s four major paediatric hospitals. Deductive coding based on the Consolidated Framework for Implementation Research (CFIR) was used to evaluate free-text data on barriers and enablers to NPWT implementation gathered from the questionnaire. Specific barrier data were mapped to relevant implementation strategies using the Expert Recommendations for Implementing Change (ERIC) matching tool. Semi-structured interviews were then conducted with senior clinicians at the four participating hospitals. Interviews aimed to determine clinicians’ level of agreement and consensus with the identified NPWT implementation barriers, and further develop implementation strategies tailored to local needs. Moreover, these interviews aimed to establish and gain consensus on patient eligibility and exclusion criteria for NPWT.

Results
A total of N = 67 health care professionals participated in the questionnaire, and semi-structured interviews were conducted with N = 10 senior clinicians. This investigation identified eight implementation barriers covering five domains and co-designed targeted strategies to address the identified barriers. Barriers included a lack of available resources, limited access to knowledge and information, individual stage of change, limited knowledge and beliefs about the intervention, lack of external policy and incentives, intervention complexity, and planning.

Conclusion
In order to implement NPWT into clinical practice for the acute treatment of paediatric burn injuries – additional resources, education, training, and updates to policies and guidelines are required.

Biography

Dr Maleea Holbert is a Clinical Research Coordinator with the School of Nursing and Midwifery at Griffith University and Queensland Children’s Hospital. She completed her PhD through the Centre for Children’s Burns and Trauma Research and Faculty of Medicine at The University of Queensland and has been involved in pediatric burn research since 2017.