243 - Barriers and Facilitators to Implementing a Pediatric Patient Acuity Tool at a Tertiary Pediatric Health Centre

Poster Number: 243
Publication Number: 243.2239

Background: Nursing staffing shortages and increasing patient acuity continuously challenge health systems, leading to chronic burnout and impacting job retention. Nursing workload measurement tools are used to create safe patient assignments based on individual patient and family care needs; however, the majority of traditional workload measurement tools are designed for adult care. Pediatric nursing care has unique workload requirements that often are not included in adult based tools.

Objective: This study aimed to identify the potential barriers and facilitators to implementing a patient acuity tool into nursing practice throughout four pediatric inpatient units at a tertiary pediatric health centre.

Design/Methods: A qualitative descriptive design was used to conduct semi-structured interviews and focus groups, guided by the Consolidated Framework for Implementation Research (CFIR). The study took place in a pediatric health centre in Nova Scotia and focused on four pediatric in-patient units: i) Pediatric Medical Unit, ii) Medical, Surgical, Neurosciences Unit, iii) Hematology/Oncology Unit, and iv) Pediatric Intensive Care Unit. Participants were recruited through stratified purposive sampling, and interviews and focus groups took place virtually through Microsoft Teams, or in-person on the unit, depending on participants’ preference. Interviews were audio-recorded, transcribed verbatim, and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using inductive thematic analysis, then further examined using deductive content analysis, guided by the CFIR.

Results: A total of 14 staff nurses, 3 clinical leaders, and 1 clinical manager participated. We identified a range of barriers and facilitators related to the implementation of a patient acuity tool, including: i) Flexibility of the tool to support care needs; ii) Importance of data to facilitate decision-making, iii) Patient acuity differences within and between inpatient units; iv) Integration of a tool into workflow, and v) The potential for missing information on the tool.

Conclusion(s): Guided by CFIR framework, we identified interconnected barriers and facilitators related to the innovation, individuals, and inner setting influencing the implementation of a pediatric patient acuity tool. These findings will be used to inform the design of implementation strategies to support the adoption and sustainability of a patient acuity tool at the tertiary pediatric health centre.