Table 10 Scenario illustrating influence of fidelity and feasibility on sustainability of a healthcare intervention

Study title

Factors affecting sustainability of a quality improvement policy on medications while fasting for surgery.

Background

Several adverse events associated with patients missing medications while fasting for surgery led to a quality improvement project that aimed to simplify and standardise oral restriction terminology and medication administration instructions to reduce confusion and unwanted practice variations when patients had oral intake restrictions such as fasting for surgery.

Method

A companion qualitative study to this quality improvement program was conducted after the roll out of the intervention: a new policy about medications and restrictions in oral intake.

Results

Before the quality improvement intervention, there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the rollout, there was improved clarity and decision support; but problems included lack of awareness about the policy, particularly due to staff movement and turnover; and individual interpretation and acceptance of the policy. Sustainability of the project appears dependent on continuing the role of a project officer combined with educators. These roles also appear important for scaling up the program within one hospital and essential for implementability elements of scaling up, acceptability, and fidelity in other hospitals.

Conclusion

Elements needed for greater sustainability included strategies and resources to 1) educate staff; 2) minimise variation, and optimise fidelity, in interpreting information; and 3) deal with continuous staff changes.

Relationship to implementability

1. Routinely conducting family meetings may not incur additional demands on health care utilisation.

2. The elements of implementability appeared to interact and cannot be viewed insolation.

3. Sustainability was heavily affected by staff changes and requires ongoing investment.

Reference

To, T‐P, Dunnachie, G, Brien, J‐a, Story, DA. Surgical nurses' perceptions and experiences of a medications and oral restrictions policy change: A focus group study. J Clin Nurs. 2019; 28: 3242– 3251.