(1217) Identifying Implementation Strategies to Bridge the Evidence-Based Practice Gap in ARDS Care

Introduction: Low Tidal Volume Ventilation, PEEP optimization and prone position ventilation are underutilized evidence-based practices (EBPs) of ARDS care. Our MICU implemented a respiratory failure protocol to guide sequential application of these EBPs. We performed a qualitative assessment of caregiver perceptions of barriers and facilitators to protocol use and implementation strategies used to support the protocol. We hypothesized additional strategies are needed for effective protocol implementation.

Methods: Semi-structured interviews of 24 caregivers were conducted. Constant comparative methods were used to develop a codebook of emerging themes. Barriers and facilitators were mapped to the Consolidated Framework for Implementation Research (CFIR) and strategies to Expert Recommendations for Implementing Change (ERIC) implementation strategies. Thematic analysis and the CFIR-ERIC Implementation Strategy Matching Tool were applied to define the current state and identify gaps and opportunities in implementation strategies selection.

Results: 13 attendings, 2 trainees, 3 APPs, 4 RTs and 2 RNs participated. Barriers were mapped to 23 CFIR constructs. Caregivers identified use of 20 strategies (7 perceived effective, 13 used but needing improvement) and 10 strategies were reported as notably absent. Of the 24 ERIC strategies strongly recommended by the CFIR-ERIC Matching Tool, caregivers noted 3 were used ineffectively and 6 were notably absent from implementation. Caregivers and CFIR-ERIC Matching Tool identified key strategies essential for sustained, effective implementation of protocolized respiratory failure care: a formal implementation plan, development of a quality monitoring system and tailoring of strategies over time based on implementation outcomes and caregiver feedback. These strategies were underutilized throughout our protocol implementation.

Conclusions: Protocolized respiratory failure care requires deliberate use of implementation strategies that match local contextual barriers. We identified essential strategies for effective protocol implementation including a formal implementation plan, a dedicated quality monitoring process and iterative modification of support strategies. Use of targeted implementation strategies may serve as an avenue to close the ARDS EBP gap.