Implementing an intervention to enhance care delivery and consistency for people with hip fracture and cognitive impairment in acute hospital wards: a mixed methods process evaluation of a randomised controlled feasibility trial (PERFECTED)

Backhouse, Tamara ORCID: https://orcid.org/0000-0001-8194-4174, Fox, Chris, Hammond, Simon P ORCID: https://orcid.org/0000-0002-0473-3610, Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911, McDermott-Thompson, Vicki, Penhale, Bridget ORCID: https://orcid.org/0000-0002-8487-0606 and Cross, Jane ORCID: https://orcid.org/0000-0002-7003-1916 (2023) Implementing an intervention to enhance care delivery and consistency for people with hip fracture and cognitive impairment in acute hospital wards: a mixed methods process evaluation of a randomised controlled feasibility trial (PERFECTED). BMJ Open, 13 (2). ISSN 2044-6055

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Abstract

Objectives: To determine how, and under what circumstances, the PERFECT-ER intervention was implemented in five acute hospital wards and impacted on staff practices and perceptions. Design: Mixed methods process evaluation (undertaken between 2016 and 2018). Setting: Five acute hospital wards across three different UK regions. Participants: Patients (n=3) admitted to acute wards with hip fracture and cognitive impairment, their relatives (n=29) and hospital staff (n=63). Interventions: PERFECT-ER, a multicomponent intervention designed to enhance the recovery of patients with hip fracture and cognitive impairment was implemented for 18 months. PERFECT-ER was implemented at ward level ensuring that multiple new and existing practices were undertaken consistently, on the assumption that collectively, small individual advances would improve care delivery for patients. Primary and secondary outcome measures: Implementation of the PERFECT-ER intervention examined through regular intervention scores, service improvement staff reports and action plans, and semi-structured interviews and focus groups. Results: The process evaluation identified points of implementation vulnerability and strength. All wards implemented some elements of PERFECT-ER. Implementation was fragile when ward pressures were high and when ward staff perceived the relative priority of intervention practices to be low. Adaptations to the implementation process may have reduced whole-ward staff engagement with implementation. However, strategical enlistment of senior ward influencers (such as ward managers, orthogeriatricians) combined with service improvement lead in-ward peer pressure tactics facilitated implementation processes. Conclusions: Our study suggests that implementation was expediated when senior staff were on board as opinion leaders and formally appointed internal implementation leaders exerted their power. Within hierarchical settings such as acute wards, key individuals appeared to influence implementation through endorsement and sometimes enforcement. This indicates that whole-ward interventions may not always require cognitive engagement from all ward staff to implement changes. Future ward-level implementation studies could consider how best to engage staff and most importantly, which staff to best target. Trial registration number ISRCTN99336264.

Item Type: Article
Uncontrolled Keywords: delirium & cognitive disorders,dementia,orthopaedic & trauma surgery,medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Social Sciences > School of Education and Lifelong Learning
Faculty of Social Sciences > School of Psychology
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Faculty of Social Sciences > Research Centres > Centre for Research on Children and Families
Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Faculty of Social Sciences > Research Groups > Cognition, Action and Perception
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 07 Feb 2023 12:30
Last Modified: 19 Oct 2023 03:32
URI: https://ueaeprints.uea.ac.uk/id/eprint/91061
DOI: 10.1136/bmjopen-2022-064482

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