CogChamps – a model of implementing evidence-based care in hospitals: study protocol

Abstract

BackgroundDelirium and dementia (cognitive impairment; CI), are common in older hospital patients, and both are associated with serious adverse outcomes. Despite delirium often being preventable, it is frequently not recognized in hospital settings, which may be because hospital nurses have not received adequate education or training in recognizing or caring for those with CI. However, the most effective way of increasing nurses’ awareness about delirium and dementia, and initiating regular patient screening and monitoring to guide best practices for these patients in hospital settings is not known. Hence this current project, conducted in 2015–2017, aims to redress this situation by implementing a multi-component non-pharmacological evidence-based intervention for patients with CI, through educating and mentoring hospital nurses to change their practice.MethodsThe development of the practice change component is informed by recent findings from implementation science that focuses on facilitation as the active ingredient in knowledge uptake and utilization. This component focuses on educating and empowering experienced nurses to become Cognition Champions (CogChamps) across six wards in a large Australian tertiary referral hospital. The CogChamps will, in turn, educate other nursing team members to more effectively care for patients with CI. The hospital leadership team are supportive of the project and are directly involved in selecting the CogChamps. CogChamps will be provided with comprehensive education in evidence-based delirium assessment, prevention and management, and practice change management skills. They will receive continuing support from research and education staff about raising awareness, upskilling other staff in delirium assessment and in the adoption of best practices for preventing and managing delirium. Both qualitative and quantitative data are being collected at multiple time-points to evaluate process, impact and outcome, and to provide clarity regarding the most effective aspects of the intervention.DiscussionThis paper describes the study protocol for the implementation of multi-component evidence-based non-pharmacological practices designed to improve the care of older hospital patients with CI. Findings will inform subsequent initiatives directed towards enhancing the capacity of the nursing workforce to implement best practices for providing high quality care for this growing patient population throughout their acute care hospital stay.

CogChamps: impact of a project to educate nurses about delirium and improve the quality of care for hospitalized patients with cognitive impairment

“…but which declined to 76% at follow-up. While at a ward level there was variation in how much change occurred (see [ 12 ]), the data did not demonstrate any differences associated to whether the ward was medical or surgical. While wards varied in some of the resources they adopted, these were not liked to any significant changes or variation between wards.…”

“…The methods have been comprehensively described in the protocol paper [ 12 ], and hence are only briefly outlined here. Registered Nurses (RNs) with two or more years’ clinical experience were invited to become Cognition Champions (CogChamps) if they demonstrated (a) a specific interest in dementia and delirium, or alternatively, (b) displayed suitable leadership skills.…”

“…Patients were excluded only if they were likely to be absent from the ward for much of the day (e.g. if a procedure had been scheduled), or if there were more than eight eligible patients on any one day, in which case a randomization procedure was used (see [ 12 ] for details).…”

“…Accordingly, we developed an interventional protocol that upskilled RN champions to improve the capacity of an acute-care nursing workforce to recognize patients with CI and provide high quality care. The intervention (described in full elsewhere [ 12 ]), adopted a “distributed leadership” approach to improving clinical practice in which self-nominated Cognition Champions (CogChamps) facilitated the collective social education of ward staff. The CogChamps were provided in-depth education on evidence-based assessment and multi-factorial management approaches to caring for cognitively impaired patients in hospital and were encouraged to develop “Action Plans for Practice Change” pertinent to their individual ward settings.…”

Consolidated framework for advancing implementation science for the implementation process and adherence assessment of a non‐pharmacological delirium prevention program

“…Available evidence for the use of IS in the prevention of delirium is based on the use of several elements and theoretical frameworks but not in the comprehensive use of them. This is how Mudge A, et al used the iPARISH framework for a protocol of prevention of geriatric syndromes in the hospitalized elderly or the COGCHAMPS initiative that performs a series of interventions to deal with hospitalized patients with cognitive deficits 36,37 . The use of the CFIR framework enables a relatively detailed understanding of the strengths and weaknesses of the implementation of a non‐pharmacological delirium prevention program aiming at improving its reach to older hospitalized persons.…”