Authors: Melissa Roberts 1,2,3, Liz Dalla Santa 1, Praneeta Ranchod 1, Rose Goonan 1, Dr Julie Lustig 8, Dr Abby Foster3,4,5, Dr Sarah Milne2,5,6,7

Affiliations:

1. Transition Care Program, Monash Health, Melbourne

2. Physiotherapy Department, Monash Health, Melbourne

3. Allied Health Workforce, Innovation, Strategy, Education and Research (WISER) Unit, Monash Health, Melbourne

4. School of Allied Health, Human Services & Sport, La Trobe University, Melbourne

5. School of Primary & Allied Health Care, Monash University, Melbourne

6. Bruce Lefroy Centre for Genetic Health Research, Murdoch Children’s Research Institute, Melbourne

7. Department of Paediatrics, The University of Melbourne, Melbourne

8. Aged and Rehabilitation Division., Monash Health, Melbourne

Background & Objective:

Older people with delirium and/or dementia are at a significantly increased risk of preventable adverse outcomes and complications in hospital. Harm could be minimised if delirium and/or dementia is identified early, and risks mitigated. Non-pharmacological approaches for behavioral and psychological symptoms of dementia and delirium (BPSD) management are evidence-based, non-invasive treatment options that do not use medication to manage symptoms. This study explored the tailored implementation of evidence-based BPSD management strategies in a multi-site bed-based Transition Care Program (BB-TBP), within a residential care setting.

Method:

A sequential mixed method approach. Data collection methods included focus groups and interviews; and pre- and post-implementation surveys, evaluation of adverse events, and audit of tool use. A theoretically informed co-production approach was used to design implementation. Quantitative data were analysed using descriptive statistics.

Results:

Pre-implementation measures directly informed the design of a tailored implementation strategy, co-designed with employees, to support the use of evidence-based BPSD strategies. An iterative process was required to address ongoing barriers to implementation. Perceived barriers pre-implementation included lack of staffing resources, and existing policies and procedures. Post-implementation, staff survey findings demonstrated a shift to more enablers and fewer barriers across the Theoretical Domains Framework. Completion rates for delirium screening and a person-centred care tool increased by 77% and 82% respectively.

Discussion and Conclusion:

The findings of this study highlight the need for a pragmatic, iterative approach to implementation in complex clinical settings, including the need for flexibility in response to external factors such as the COVID-19 pandemic and staffing resource limitations. Prioritising stakeholder engagement and cyclic inclusion of stakeholder feedback assisted with a sense of agency that supported adoption of proposed evidence-based strategies. Utilising structured theoretical frameworks to support change can guide implementation.