Abstract

BackgroundThe Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications.Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging.MethodsTwenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support.Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care.During the implementation intervention, all events are recorded, and the facilitators keep diaries.Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation.Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes.DiscussionThe OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

Highlights

  • The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications

  • The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular

  • It may progress the understanding of implementation leadership by dyads of facilitators and first-line managers

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Summary

Methods

Aims The OPTION trial will evaluate the effects and outcomes of an implementation strategy for evidence-based practice by means of clinical practice guidelines for postoperative bladder distension and urinary retention. 2. To provide an implementation support programme for the local facilitator teams, including managers, for 12 months to the sites randomised to the intervention (WP2). Participants Patients Patients undergoing hip surgery in any of the orthopaedic units (whether control or intervention groups) during the project’s three data collection points will be informed about and asked to participate in the study at baseline and follow-ups I and II. Quantitative data regarding urinary retention will be collected from patient records, including bladder monitoring, voiding and healthcare interventions, by means of a structured template [12, 22] at baseline, post completion of the study intervention, and an additional, 1-year follow-up. All data will be considered in the final mixed methods [49], embedding the process evaluation [50]

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