Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study [version 1; peer review: 1 approved]
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Date
2022-01-11
Authors
Naughton, Corina
Cummins, Helen
de Foubert, Marguerite
Barry, Francis
McCullagh, Ruth
Wills, Teresa
Skelton, Dawn A.
Dahly, Darren
Palmer, Brendan
Murphy, Aileen
Journal Title
Journal ISSN
Volume Title
Publisher
Health Research Board
Published Version
Abstract
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.
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Keywords
Nurses , Multidisciplinary , Older people , Nutrition , Mobilisation , Cognitive engagement , Fundamental care , Hospital associated decline , Functional decline , Implementation science , Behaviour change theory
Citation
Naughton, C., Cummins, H., de Foubert, M., Barry, F., McCullagh, R., Wills, T., Skelton, D. A., Dahly, D., Palmer, B., Murphy, A., McHugh, S., O'Mahony, D., Tedesco, S. and O'Sullivan, B. (2022) 'Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study [version 1; peer review: 1 approved]', HRB Open Research 2022, 5:3, pp. 1-19. doi: 10.12688/hrbopenres.13473.1
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Copyright
© 2022, Naughton, C. et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.