Background: Delirium is the most common hospital-acquired complication. It is distressing for patients and those who care for them, increases other hospital-acquired harms and length of stay, is the leading inpatient cause of aggression against nurses, increases post-hospital care needs, and increases future dementia risk. There is currently no disease treatment beyond reversing the underlying cause(s). Thirty years of research show that delirium prevention is highly effective yet it remains poorly implemented in practice. We previously developed and evaluated a novel and successful delirium prevention program Eat Walk Engage® which is explicitly underpinned by an implementation framework highlighting the central role of enabling facilitation. This paper describes our experience with state-wide program spread.
Change: From 2019-2022 we have implemented Eat Walk Engage® in 17 new hospitals throughout Queensland as part of the Queensland Frail Older Persons Program. We phased implementation to ensure we could provide adequate site support to clinical leads and training and support for facilitators. The multi-disciplinary state-wide program leadership team provides training and professional development (including online and face to face workshops) for facilitators and clinical assistants; provides clinical indicator site reporting and benchmarking; conducts annual site visits; supports a state-wide Consumer Response Team; supports communities of practice for clinical leads, program staff and clinicians; offers one-day multi-disciplinary clinician workshops focused on care of people with cognitive impairment; advises on environmental design; fosters collaborative research and quality improvement initiatives; and advocates with government and health services. We have had high program acceptability and adoption, with 90% uptake and sustainment across wards, and have demonstrated improved process measures in many sites. Significant contextual changes related to the COVID-19 pandemic and new funding reforms have been major challenges for progress.
Learnings: 1) Multidisciplinary change management takes time, skills and dedicated resources; 2) contexts vary between and within sites and over time, requiring continual tailoring of the interventions; 3) maintaining a facilitator workforce requires investment ; 4) local leadership is crucial, but leadership engagement and multidisciplinary governance is challenging; 5) availability of meaningful data for reflection, benchmarking and evaluation is critical for motivation and transparency; 6) networks create connection and learning; 7) a skilled and dedicated multidisciplinary leadership team has been fundamental to success.