DRAUP

De-implementation of Routine Chest Radiographs after Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol

The DRAUP deimplementation program was established after formative qualitative research and consists of seven strategies, each of which addresses one of three domains of behavior change: “capacity, opportunity, and motivation” theorized to drive behavior in a widely-used Behavior Change framework developed by Michie and colleagues.

We used qualitative methods to develop a general understanding of the barriers to de-implementation of CXR in the ED. Then, we developed a logic model from our qualitative work, demonstrating three principal themes (self-efficacy, perceived organizational norms, and inertia/habit) needed to influence provider behavior change using the theoretical model of COM-B. Finally, the Behavioral Change Wheel framework was used to select strategies which target 1) education and training, 2) facilitators, and 3) organizational buy-in (Figure 1).

Seven implementation strategies were developed and operationalized into the DRAUP program (De-Implementation of Routine CXR After Adoption of Ultrasound Guided Insertion and Confirmation of CVC Protocol). We initiated DRAUP in the ED in 2019 and have maintained 30-50% use of ultrasound in lieu of CXR for CVC confirmation.

DRAUP is now coming to the ICU where we hope to learn about adaptations needed to maintain similar or greater rates of deimplementation of CXR after ultrasound guided CVC confirmation!