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Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, Dawe P, Doris F, Iles-Smith H, Kent M, Logan P, O'Connell A, Onysk J, Owens R, Quinn L, Rafferty AM, Romanczuk L, Russell AM, Shepherd M, Singh SJ, Sugg HVR, Coon JT, Tooze S, Warren FC, Whale B, Wootton S. Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial. J Adv Nurs 2024; 80:2137-2152. [PMID: 37986547 DOI: 10.1111/jan.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness. DESIGN Parallel two-arm, cluster-level randomized controlled trial. METHODS Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses. RESULTS We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. CONCLUSION We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. IMPACT Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care. REPORTING METHOD CONSORT and CONSERVE. PATIENT OR PUBLIC CONTRIBUTION Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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Affiliation(s)
- David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jess Bollen
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Jones
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Claire Hulme
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Heather Cook
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Siobhan Creanor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Phoebe Dawe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Faye Doris
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Merryn Kent
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Abby O'Connell
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jakub Onysk
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rosie Owens
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Lynne Quinn
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, Kings College University London, London, UK
| | | | | | - Maggie Shepherd
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Holly V R Sugg
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Susannah Tooze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bethany Whale
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Institute of Human Nutrition, University of Southampton, Southampton, UK
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Al Khan S, Rosinski K, Petraszko T, Dawe P, Hwang BW, Sham L, Hudoba M, Roland K, Shih AW. Reducing AB plasma utilisation through the AB plasma appropriateness index. Transfus Med 2019; 29:381-388. [PMID: 31576629 DOI: 10.1111/tme.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We hypothesised that there was inappropriate group AB plasma used in our hospital, identifiable by a novel key quality indicator (KQI) and mitigable through massive transfusion protocol (MTP) modification. BACKGROUND Group AB plasma is a scarce resource strained by increasing usage worldwide when used as universal donor plasma in non-group AB patients. To reduce inappropriate use and to promote benchmarking to the best practice, we developed the AB plasma appropriateness index (ABAI). ABAI is the ratio of AB plasma transfused to group AB or unknown blood group patients to all AB plasma utilised, where values closer to 1 are better. METHODS Data collected included AB plasma disposition by blood group, indications for transfusion, total blood utilisation, patient clinical characteristics and outcomes. ABAI during a 12-month period was retrospectively assessed, which led to implementation of pre-thawed group A plasma instead of group AB plasma for trauma patients starting in July 2017. RESULTS The ABAI retrospectively showed inappropriate use in non-group AB patients in our hospital, the majority used to avoid expiry after thaw. When comparing 1-year pre- and post-implementation periods, ABAI improved from 0·464 to 0·900 (P < 0·0001). After exclusion of therapeutic plasma exchange, ABAI still improved (0·486-0·720, P < 0·0001). No differences in the length of stay or mortality associated in 32 patients receiving group A plasma for emergency release were observed. CONCLUSION The ABAI is a novel KQI to indicate inappropriate AB plasma usage for quality improvement. This led to thawed A plasma use for MTPs, reducing inappropriate AB plasma usage.
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Affiliation(s)
- S Al Khan
- Blood Bank Services, Directorate General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - K Rosinski
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - T Petraszko
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - P Dawe
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - B W Hwang
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - L Sham
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - M Hudoba
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Roland
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A W Shih
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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