Background: Early identification and proactive management of deterioration in aged care home residents can reduce avoidable transfers to hospitals. EDDIE+ was a randomised-controlled trial using a multi-centre stepped-wedge design implemented across 11 Queensland Residential Aged Care (RAC) homes operated by Bolton Clarke. The intervention had four components: education and training of nursing staff and personal care workers (PCWs), use of decision support tools, use of diagnostic medical equipment, and implementation facilitation and clinical systems support.
Change: The EDDIE+ program aimed to upskill and support nursing and care staff to identify and proactively manage residents in the early stages of deterioration. Each home received a bladder scanner and portable vital signs monitor. A Nurse Educator, employed by the study and external to the home, provided training on recognising deterioration, communicating deterioration, care pathways, and use of equipment. A dedicated in-home Clinical Facilitator promoted program engagement and provided follow-up training and support for staff in each facility.
Learnings: Initial training for nursing and care staff was well attended with over 90% of home staff trained in the early identification, communication and management of deterioration. Nursing staff were also trained in the use of a bladder scanner and vital signs monitor. A flexible, pragmatic approach with varied session times was needed to provide education whilst accommodating staff workload. An on-site Clinical Facilitator was employed one day a week to support implementation activities, including providing additional training sessions for staff to reinforce initial training. Challenges and learnings were numerous, with the impact of the COVID-19 pandemic and recent industry changes affecting the intervention. Maintaining a high proportion of staff who were educated in the EDDIE+ program proved difficult due to staff turnover. Having an on-site Clinical Facilitator to support the program long term was problematic for many homes. Where the role was maintained, quarantining time to undertake implementation activities was challenging, due to direct resident care remaining top priority. Where there was strong on-site facilitation, reinforcement of educational activities and intervention support occurred. Furloughing requirements of staff and infection control measures restricted movement between RAC home areas. Where equipment was used well, it gave nursing staff credibility and tangible clinical measurements to assist reporting deterioration signs when escalating to clinicians, such as General Practitioners. Clearly defined core and adaptable elements of the program allowed tailoring to each site, aiding responsiveness to some of the encountered challenges.