Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle

Authors: Siri Steinmo, Christopher Fuller, Sheldon P. Stone, Susan Michie

Published in: Implementation Science | Issue 1/2015

Login to get access

Abstract

Background

Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the ‘Sepsis Six’ evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27–47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to identify mechanisms of change. The aim of this study was to illustrate this process by using the Behaviour Change Wheel; Behaviour Change Technique (BCT) Taxonomy; Capability, Opportunity, Motivation model of behaviour; and Theoretical Domains Framework to characterise the content and theoretical mechanisms of action of an existing intervention to implement Sepsis Six.

Methods

Data came from documentary, interview and observational analyses of intervention delivery in several wards of a UK hospital. A broad description of the intervention was created using the Template for Intervention Description and Replication framework. Content was specified in terms of (i) component BCTs using the BCT Taxonomy and (ii) intervention functions using the Behaviour Change Wheel. Mechanisms of action were specified using the Capability, Opportunity, Motivation model and the Theoretical Domains Framework.

Results

The intervention consisted of 19 BCTs, with eight identified using all three data sources. The BCTs were delivered via seven functions of the Behaviour Change Wheel, with four (‘education’, ‘enablement’, ‘training’ and ‘environmental restructuring’) supported by the three data sources. The most frequent mechanisms of action were reflective motivation (especially ‘beliefs about consequences’ and ‘beliefs about capabilities’) and psychological capability (especially ‘knowledge’).

Conclusions

The intervention consisted of a wide range of BCTs targeting a wide range of mechanisms of action. This study demonstrates the utility of the Behaviour Change Wheel, the BCT Taxonomy and the Theoretical Domains Framework, tools recognised for providing guidance for intervention design, for characterising an existing intervention to implement evidence-based care.
Appendix
Available only for authorised users
Literature
1.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53.CrossRefPubMed
2.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–96.CrossRefPubMed
3.
Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. Data Brief no. 62. Hyatsville, MD: National Center for Health Statistics; 2011.
4.
Bakker J, De Munck P, Rommes H. Cost of severe sepsis in a multidisciplinary intensive care unit. Crit Care. 1998;26:A131.CrossRef
5.
Robson WP, Daniels R. The Sepsis Six: helping patients to survive sepsis. Br J Nurs. 2008;17:16–21.CrossRefPubMed
6.
Daniels R, Nutbeam T, McNamara G, Galvin C. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011;28:507–12.CrossRefPubMed
7.
Health Service Ombudsman for England. Time to act - severe sepsis: rapid diagnosis and treatment saves lives. London: Parliamentary and Health Service Ombusdman; 2013.
8.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2012;41(2):580–637.CrossRef
9.
Daniels R. Key recommendations for sepsis briefing. Sutton Coldfield: UK Sepsis Trust; 2013.
10.
CEM clinical audits 2011–2012: severe sepsis and septic shock. London: College of Emergency Medicine; 2012.
11.
Cronshaw HL, Daniels R, Bleetman A, Joynes E, Sheils M. Impact of the Surviving Sepsis Campaign on the recognition and management of severe sepsis in the emergency department: are we failing? Emerg Med J. 2011;28:670–5.CrossRefPubMed
12.
Fretheim A, Schunemann H, Oxman A. Improving the use of research evidence in guideline development: 15. Disseminating and implementing guidelines. Health Res Policy Sys. 2006;4(1):27.CrossRef
13.
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362:1225.CrossRefPubMed
14.
Davies P, Walker A, Grimshaw J. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010;5:14.CrossRefPubMedPubMedCentral
15.
The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG). Designing theoretically-informed implementation interventions. Implement Sci. 2006;1:4.CrossRef
16.
Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009;4:40.CrossRefPubMedPubMedCentral
17.
18.
19.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedPubMedCentral
20.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral
21.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.CrossRefPubMed
22.
Michie S, van Stralen MM, West R. The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.CrossRefPubMedPubMedCentral
23.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRefPubMedPubMedCentral
24.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The Behavior Change Technique Taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed
25.
Bussieres AE, Patey AM, Francis JJ, Sales AE, Jeremy GM, Team CPP. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework. Implement Sci. 2012;7:82.CrossRefPubMedPubMedCentral
26.
Curran JA, Brehaut J, Patey A, Osmond M, Stiell I, Grimshaw J, et al. Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation. Implement Sci. 2013;8(1):25.CrossRefPubMedPubMedCentral
27.
Patey AM, Islam R, Francis JJ, Bryson GL, Grimshaw JM, Canada PPT. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests. Implement Sci. 2012;7:52.CrossRefPubMedPubMedCentral
28.
Duncan EM et al. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implement Sci. 2012;7:86.CrossRefPubMedPubMedCentral
29.
Islam R, Tinmouth A, Francis J, Brehaut J, Born J, Stockton C, et al. A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the theoretical domains framework. Implement Sci. 2012;7:93.CrossRefPubMedPubMedCentral
30.
Fuller C, Besser S, Savage J, McAteer J, Stone S, Michie S. Application of a theoretical framework for behavior change to hospital workers’ real-time explanations for noncompliance with hand hygiene guidelines. Am J Infect Control. 2014;42(2):106–10. doi:10.​1016/​j.​ajic.​2013.​07.​019.CrossRefPubMed
31.
Boscart VM, Fernie GR, Lee JH, Jaglal SB. Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention. Implement Sci. 2012;7:77.CrossRefPubMedPubMedCentral
32.
Laba TL, Bleasel J, Brien JA, Cass A, Howard K, Peiris D, et al. Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: a systematic review. Int J Cardiol. 2013;167(6):2430–40.CrossRefPubMed
33.
Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27(3):379–87.CrossRefPubMed
34.
Fleming A, Bradley C, Cullinan S, Byrne S. Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation. BMJ Open. 2014;4(11):e006442.CrossRefPubMedPubMedCentral
35.
Squires JE, Grimshaw JM, Taljaard M, Linklater S, Chasse M, Shemie SD, et al. Design, implementation, and evaluation of a knowledge translation intervention to increase organ donation after cardiocirculatory death in Canada: a study protocol. Implement Sci. 2014;9:80.CrossRefPubMedPubMedCentral
36.
Michie S, Atkins L, West R. The Behaviour Change Wheel: a guide to designing interventions. London: Silverback; 2014.
37.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008;57(4):660–80.CrossRef
38.
Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2015;20(1):130–50.CrossRefPubMed
39.
Voils C, King H, Maciejewski M, Allen K, Yancy Jr W, Shaffer J. Approaches for informing optimal dose of behavioral interventions. Ann Behav Med. 2014;48(3):392–401.CrossRefPubMedPubMedCentral
40.
Adams A, Soumerai S, Lomas J, Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999;11(3):187–92.CrossRefPubMed
41.
Jenner EA, Fletcher BC, Watson P, Jones FA, Miller L, Scott GM. Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals. J Hosp Infect. 2006;63(4):418–22.CrossRefPubMed
42.
Kelly M, Morgan A, Ellis S, Younger T, Huntley J, Swann C. Evidence based public health: a review of the experience of the National Institute of Health and Clinical Excellence (NICE) of developing public health guidance in England. Soc Sci Med (1982). 2010;71(6):1056–62.CrossRef
43.
Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;10:Cd008165.PubMed
44.
Michie S, Johnston M, Rothman A, Kelly M, de Bruin M. Developing methodology for designing and evaluating theory-based complex interventions: an ontology for linking behaviour change techniques to theory. Med Res Counc. 2014.
Metadata
Title
Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle
Authors
Siri Steinmo
Christopher Fuller
Sheldon P. Stone
Susan Michie
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-015-0300-7

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Research

Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support

Study protocol

Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol

Systematic review

A systematic review of real-world diabetes prevention programs: learnings from the last 15 years

Research

The evolution of social networks through the implementation of evidence-informed decision-making interventions: a longitudinal analysis of three public health units in Canada

DEBATE

Computer-supported feedback message tailoring: theory-informed adaptation of clinical audit and feedback for learning and behavior change

Systematic review

Trends in guideline implementation: a scoping systematic review