ANNP and Principal Teaching Fellow
University of Southampton and UHS NHS Foundation Trust, UK

Vicky works as a Principal Teaching Fellow on the MSc Advanced Clinical Practice (Neonatal) programme, as well as working clinically as an Advanced Neonatal Nurse Practitioner at University Hospital Southampton NHS Foundation Trust.  She designs and delivers teaching relating to evidence-based practice and research methods, neonatal pathophysiology, independent prescribing and advanced clinical practice.

Keen to improve the quality of neonatal care, she is currently undertaking her PhD researching the implementation of complex interventions, in order to understand how to effectively embed and sustain new processes in clinical practice.  She is interested in the translation of evidence into practice and behavioural change.

She has presented and published the preliminary stages of her PhD work at several international conferences and has recently won an award for the Best Paper by a Clinical Academic at the Medical and Health Research Conference (May 2019, Southampton). She was honoured to be an invited speaker at the international 99NICU conference in April 2019 where she presented some preliminary research findings. She has been a peer-reviewer for several international journals, including Archives of Disease in Childhood and the International Journal of Nursing Studies.

She has also worked as a volunteer for the Newborns’ Vietnam educational programme and is involved with the web-based 99NICU educational forum.

She has received funding from the Royal College of Nursing Professional Bursary Award for her PhD studies.

Talk Summary

Investigating the implementation of a care bundle to reduce central line-associated bloodstream infections in the neonatal unit.

There is now a plethora of evidence from quasi-experimental studies suggesting care bundles, defined as an intervention with multiple interacting components, can significantly reduce the rate of neonatal central line-associated bloodstream infections (CLABSIs) by up to 60% (Payne et al 2017). However, there is heterogeneity across these studies in terms of the individual elements implemented and the magnitude of effect. Within multi-centre studies, some individual neonatal units were unable to sustain reductions in CLABSI rates whilst other neonatal units actually increased their CLABSI rates after the introduction of a care bundle. This supports the findings of previous research which suggests that the site of care remains an independent risk factor for neonatal CLABSIs despite adjusting for differences in case mix (Chein et al 2002). It has been suggested that studying the practice patterns of individual neonatal units may be helpful in understanding this variation. Whilst the implementation of care bundles to reduce CLABSIs has been studied in adult intensive care and emergency departments, no studies have investigated how these care bundles are implemented in the neonatal setting.

It is often unclear if it is the intervention, the implementation, or both that have had the observed effect and it is well-known that sustaining such effects over time can be a major challenge.  Evaluating how these complex interventions are implemented can not only help to explain the success, or not, of an intervention, but can also help to identify what factors are important for the sustainability of new practices.

This session will present the results of a mixed-methods study investigating the implementation of a care bundle on a tertiary neonatal unit. It will explore the factors that may promote or inhibit the embedding of new practices, and provide recommendations for effectively embedding and sustaining new processes in clinical practice.