Refinement of training
delirium, cardiac, urinary tract infections, adult learning and communication lens, constipation, dehydration, dyspnoea
DEHYDRATION
The educational component of the pilot intervention targeted both nursing staff (RNs and ENs) and PCWs. Results from the environmental scan demonstrated a gap in training and resource material specifically for PCWs. Thus, it was agreed by the IWG that a specific set of training materials was needed for PCWs to better match their role and needs. Two distinct sets of training materials were then developed (by the study team led by the nurse educator), to better align with each professional group’s needs. The training content refinement process included a literature search; a review of the Aged Care standards and Queensland Health policies; a review of the aged care provider’s training modules, policies, and procedures; observation of current training sessions and online modules to become familiar with the online learning platform currently in use; and consultation with key personnel at the aged care provider.There were eight areas of deterioration identified as commonly leading to potentially avoidable hospitalisations in the pilot evaluation (delirium, constipation, dehydration, dyspnoea, cardiac, urinary tract infections, falls and palliative care), and it was agreed to continue with these as the focus areas of the education and training component and decision support tools in the larger trial.In addition, a barrier cited in previous research was the communication barrier between PCWs and nursing staff when reporting deterioration [Introduction of the two communication tools, “Stop and Watch” and “CUS” for PCWs to report deterioration to nursing staff. Implementation of the “Stop and Watch” communication tool was planned for 2021 by the aged care provider, aligning with licensing requirements. This tool uses the phrase “Stop and Watch” to draw attention to key aspects of deterioration. The “CUS” communication tool uses the phrases “I am Concerned…”, “I am Uncomfortable”, and “This is a Serious/Safety issue” to focus the nurses’ attention [Expectation for nursing staff to ‘close the loop’ by providing feedback to PCWs on the actions taken by the clinical team after deterioration had been reported.Wearable reference cards with communication tool wording provided to PCWs in response to initial feedback that identified a need to provide point-of-care reference materials to aid PCWs and nursing staff in their communication.Nursing staff provided with notepads branded with communication and feedback loop reminders.Communication-specific scenarios developed to support staff reinforcement of reporting and feedback practices.These additional communication-specific tools were assessed to be in line with the mechanisms of change that were in the original program logic. Further, the educational content was reviewed with an adult learning and communication lens to maximise knowledge transfer and information retention by both clinical and non-clinical recipients, and to support virtual or hybrid delivery during COVID-19. Enhancements included:Introductory 1-2min video for all staff on the purpose of EDDIE + Development of a four-step process of Recognition, Assessments, Care, and Referral/Review (RACR) to structure the information in small, repeated sections within each of the eight areas of deteriorationRepeated visual cues with coloured hexagon icons for each of the eight areas of deterioration for both PCW and nursing staffUse of non-clinical language with PCWs focusing on symptom recognition and other signs of deteriorationClinical scenarios for use by the local EDDIE + Clinical Facilitator in each site to support ongoing detection of deterioration throughout the trial phase (as a form of reinforcement of learnings)A specific procedure for the administration of subcutaneous fluid was incorporated into training after the RAC home provider identified the requirement to re-introduce the procedure in preparation for possible changes to hospital practices during COVID-19 outbreaks.