Table 2 Modifications to intervention based on themes and corresponding TDF domains identified in interviews
Theme | TDF Domains | Modification | BCTs delivered |
|---|---|---|---|
New intervention component 1: partnership agreement | |||
Empowerment and support, working together | Belief about capabilities, social/pro role and identity, behavioural regulation, social influences | A collaborative partnership agreement between the intervention facilitator and clinical leads of the area is developed. This includes: | Behavioural contracta |
Working together | Social influences, social professional role and identity | Details of when education and feedback sessions will be delivered and who will attend is decided by ward and facilitator collaboratively | Commitment,a self-monitoring |
Empowerment and support, working together | Belief about capabilities, social/pro role and identity, behavioural regulation, social influences | Two sepsis champions (1 doctor/1 nurse) nominated and supported | Social support (unspecified) |
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Commitment to Sepsis Six includes recognition of role model status and staff support | Identification of self as role-model,a social support (unspecified) |
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Agreement that signatories will emphasise full group engagement with Sepsis Six | Commitment, behavioural contract |
Empowerment and support, working together | Belief about capabilities, social/pro role and identity, behavioural regulation, social influences | Agreement that signatories will emphasise that challenging others is encouraged | Commitment, behavioural contract |
Working together | Social influences, social professional role and identity | Agreement that staff attendance at training and feedback sessions will be recorded | Commitment, self-monitoring |
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Agreement on iterative nature of the document—all parties are involved it its creation and amendments | Commitment |
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Plan for collecting and sharing implementation data including details of who is responsible how it will be shared/displayed | Commitment, action planninga |
Working together | Social influences, social/pro role and identity | Agreement that information shared at group feedback sessions will be cascaded down to all staff (those not able to attend feedback sessions) | Commitment |
New intervention component 2: Hospital at Night Co-ordinator education | |||
Staffing levels | Environmental context and resources | Hospital at Night Co-ordinators receive sepsis education session including: | |
Risks and benefits | Beliefs about consequences | Statement about the severity/health consequences of sepsis to patient | Information about health consequences |
Risks and benefits | Beliefs about consequences | Statement about urgency: the consequences of not implementing within one hour | Information about health consequences |
Risks and benefits | Beliefs about consequences | Statement about the importance of finding an on call doctor to attend triggering patients | Information about health consequences |
Knowing what to do and why | Knowledge, social/pro role and identity | Statement of sepsis triggers | Instruction on how to perform a behaviour |
Staffing levels | Environmental context and resources | “Sepsis bags” are made available in the PARRT office | Adding objects to environment |
Working together | Social influences, social/pro role and identity | Instruction on how to perform a sepsis call to doctor | Instruction on how to perform a behaviour |
Knowing what to do and why | Knowledge, social/pro role and identity | Statement about importance of using the six steps together as a bundle | Information about health consequences |
Knowing what to do and why, risks and benefits | Knowledge, social/pro role and identity, beliefs about consequences | At least two “FAQs” are addressed, e.g. appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle | Instruction on how to perform a behaviour, information about health consequences |
Modifications to existing staff education component | |||
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Statement that staff have authority to commence Sepsis Six using clinical discretion | Social support (unspecified) |
Empowerment and support | Belief about capabilities, social/professional role and identity, behavioural regulation, social influences | Statement that full ward/department commitment is expected | Information about social consequencesa |
Empowerment and support, working together | Belief about capabilities, social/pro role and identity, behavioural regulation, social influences | Statement that challenging others should be un-personal and should be normalised | Generalisation of behavioura |
Risks and benefits | Beliefs about consequences | Evidence of patient outcomes presented quantitatively in at least two formats | Information about health consequences |
Knowing what to do and why, working together | Knowledge, social/pro role and identity, social influences | Instruction on how to perform a sepsis call to doctor or Hospital at Night Co-ordinator | Instruction on how to perform a behaviour |
Knowing what to do and why | Knowledge, social/pro role and identity | Statement about importance of implementing the six steps together as a bundle | Information about health consequences |
Knowing what to do and why, risks and benefits | Knowledge, social/pro role and identity, beliefs about consequences | At least two “FAQs” are addressed, e.g. appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle | Instruction on how to perform a behaviour, information about health consequences |
Modifications to documents and materials component | |||
Staffing levels | Environmental context and resources | Sepsis bags made available to Hospital at Night Co-ordinators | Prompts/cues |
Knowing what to do and why, risks and benefits | Knowledge, social/pro role and identity, beliefs about consequences | “FAQ” information sheet addresses: appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle | Instruction on how to perform a behaviour |