This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
Background During hospitalisation older adults are at greater risk of hospital associated decline (HAD), attributed to hospital processes that fail to prioritise fundamental care related to mobility, nutrition and cognitive health. The study aims to enable the nursing and multidisciplinary team to prioritise early mobilisation, optimise nutrition and cognitive engagement in patients aged 60 years and older. Methods Four wards were recruited, two orthopaedic trauma and two orthopaedic rehabilitation. Following situational analysis on each ward, we used behaviour change theory COM-B (capability, opportunity motivation) to align the intervention components to barriers. These included inter-professional communication (mobility board with patient goals, nurse & physiotherapy huddles, daily mobility record); staff knowledge (education, coaching, posters); nutrition opportunities (assisted mealtimes, MUST tool, enhanced snack rounds) and cognition (patient information leaflet, distraction activity resources). Data collection included observational audits of mobility measuring: % mean time walking, % patients sitting out of bed, % patients walked at last once, and nutrition: % of meals half or less eaten at baseline and 12-week follow-up. Each ward was observed from 8am to 5pm. Results In total mobility audit data was collected on 124 patients (pre =63, post 61), mean age 78 years (SD13.8) and 63% female. Mean data across the four wards are presented. There were small positive changes in two mobility indicators: patients sitting out of bed (pre 69% vs post 76%); % patients walked at least once (pre 53% vs post 62%); there was no change in mean % time spent walking (pre 9% vs post 8%). Nutrition indicator: % meals <half eaten (pre 57.6% vs post 53%). Conclusion The FCB showed some promising trends in prioritising mobilisation and nutrition. Implementation relies on ward manager leadership, nursing team cohesion, and active role modelling from the MDT. Sustainability is likely to require ongoing facilitation resource.
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