Implementing miniMAGIC in Brisbane (IMBed): An implementation study examining the impact on extravasations at the Queensland Children’s Hospital

The Michigan Appropriateness Guide for Intravenous Catheters in paediatrics (miniMAGIC) was developed by the international community using the RAND/UCLA method to provide international recommendations on IV device selection. ‘miniMAGIC’ considers the following factors when making a device selection: - infusate characteristics (i.e., peripheral vs non-peripherally compatible infusates); - treatment duration (i.e., less than 7 days, 8-14 days, 15-30 days, greater than 31 days); - age groups (i.e., neonates, infants, children and adolescents); - diagnostic groups (i.e., general hospitalised, critical care, cancer care, congenital cardiac conditions, and long term health conditions); and - insertion vessel and/or site (i.e. forearm, hand, foot, scalp, antecubital). Within Phase 1 of the implementation project, a panel of key stakeholders, representing all health disciplines and specialties involved in the selection, insertion and management of IV devices within Children’s Health Queensland (CHQ), will be convened. Within facilitated conversations, the panel will co-develop local resources to build on the primary miniMAGIC recommendations, including identification of commonly used medications (including their local administration policies, e.g., diluent, final concentration, 24-hour continuous vs intermittent continuous vs bolus), and mapping their appropriateness across peripheral, and central IV device. Secondly, the panel will assist with the development and mapping of miniMAGIC implementation strategies across the key COM-B domains. This will include specific strategies related to the COM-B framework, such as education and training (capability), electronic medical records and mHealth applications (opportunity), and case study-based coaching (motivation). Together, and within the COM-B framework the panel will develop strategies (e.g., weekly didactic training facilitated by clinical managers, imbedding miniMAGIC recommendation into electronic medical records) for employing miniMAGIC in routine clinical practice. The extent and nature of IMBed panel membership will be defined a priori with clear expectations regarding meeting schedules, and feedback on resource development. Meetings (~4) will be convened using a combination of teleconference, Microsoft Teams and face-to-face appointments. The panel meetings will be facilitated by CI Gibson and Ullman, using an ongoing iterative process of review and discussion to achieve the study objectives. The IMBed panel will develop a plan for procedures and activities to ensure implementation. As a baseline this will include case-study based information sessions during routine education events (e.g., registrar training, nurse annual competency) and mentorship-based education by clinical champions across health disciplines. Phase 1 will occur approximately 4 weeks prior to Phase 2. During the intervention (Phase 2; delivered via stepped wedge clustering), all divisions will start the trial in the control phase for two months, with baseline measures taken. Following this, one cluster / division will randomly (computer generated) step-up to implementation every month for up to 5 months. During the intervention phase, all eligible patients will receive the intervention as many times as clinically relevant. Sustainability will be measured at one and six months post full implementation. Each month (and time point), a random sample of 25 peripheral IV devices will be selected and assessed for appropriateness at each timepoint. During implementation, Research Nurses (ReNs) will work with investigators, local educators, and clinical managers to review practice procedures and intervention fidelity, with the tailored Michigan Appropriateness Guide to Intravenous Cannulation for paediatrics (miniMAGIC) delivered to the local setting. Intervention fidelity will be recorded in patient medical records, with a random sample of peripheral IVs (n = 25) per cluster at each timepoint assessed to monitor treatment adherence. The mode of delivery will be developed by the key stakeholder panel, following the COM-B framework for implementation. This implementation theory considers three sources of behaviour: Capability (psychological and/or physical), Opportunity (social and/or physical), and Motivation (autonomic and/or reflexive) – COM-B. These interact to influence and are influenced by behaviour. A range of physical implementation materials will be used, as designed by the IMBed panel. This may include posters in clinical areas, lanyard summaries (for clinical staff), the miniMAGIC mHealth app (https://play.google.com/store/apps/details?id=au.edu.griffith.minimagic&hl=en_AU&gl=US / https://apps.apple.com/us/app/minimagic/id1523408770) and prompts within electronic medical records and email summaries.