Barriers and Co-Designed Strategies for the Implementation of Negative Pressure Wound Therapy in Acute Paediatric Burn Care in Australia: A Mixed Method Study
Authors: Holbert Maleea D , Duff Jed , Wood Fiona , Holland Andrew , Teague Warwick , Frear Cody , Crellin Dianne , Phillips Natalie , Storey Kristen , Martin Lisa , Singer Yvonne , Cuttle Leila , Vagenas Dimitrios , McPhail Steven , Calleja Pauline , De Young Alexandra , Kimble Roy , Griffin Bronwyn 
Published: November 2023

Background
Paediatric burn injuries pose a major clinical problem worldwide and result in significant morbidity. Early adjunctive application of negative pressure wound therapy (NPWT) significantly improves time to healing by re-epithelialisation in children with burns. This treatment strategy has not been consistently adopted as part of acute paediatric burn care.
Methods
This investigation used a sequential mixed methods design to identify and explore barriers to the implementation of adjunctive NPWT in acute paediatric burn care. An online questionnaire was developed and disseminated to healthcare professionals within four major paediatric hospitals in Australia, each with a dedicated burns service. Specific barrier data were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were then conducted with senior clinicians across the four participating hospitals to tailor implementation strategies to local contexts. A stakeholder consensus meeting was then conducted to consolidate implementation strategies and local processes.
Results
A total of 63 healthcare professionals participated in the online questionnaire, and semi-structured interviews were conducted with nine senior burn clinicians. Two interviews were also conducted with parents and caregivers of paediatric burn patients who had received adjunctive NPWT as part of their acute burn treatment within the last 12-months. This investigation identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address these identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change (which describes clinicians’ readiness or enthusiasm to change practice), patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies and incentives, intervention complexity, and poor planning of the intervention implementation.
Conclusion
There are multiple and inter-related contextual characteristics that influence the uptake of adjunctive NPWT into acute paediatric burn settings in Australia. Results from this investigation will be used within a multi-state stepped-wedge cluster randomised controlled trial. In order to implement adjunctive NPWT into clinical practice for the acute treatment of paediatric burn injuries, additional resources, education, training, and updates to policies and guidelines are required. It is anticipated that adjunctive NPWT, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
Trial Registration
This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR) on the 1st of February 2022 – registration number ACTRN12622000166774.