Facilitation model changes
The local home-based Clinical Facilitator was noted to be a vital element of the implementation process in the pilot. In line with the i-PARIHS framework, it was agreed that this role was an essential component of EDDIE + . Appropriate resourcing was also considered important to enable the local EDDIE + Clinical Facilitator to enact the role, particularly given the organisational and broader context of aged care. Consequently, funding was provided for a 0.2 full time equivalent (FTE) EDDIE + Clinical Facilitator per site during the study (facilitator role not funded in the pilot).To accommodate shift requirements and individual RAC home demands, the option of sharing of the EDDIE + Clinical Facilitator role between more than one nurse was included. It was also agreed that the local EDDIE + Clinical Facilitator would benefit from additional support and mentoring from a more experienced facilitator, which aligns with the i-PARIHS framework and the idea of different levels of facilitation. As such, external facilitation via the study implementation facilitator and nurse educator roles (both from the university-based study team) would support implementation across the sites, which was not part of the original pilot.Communication with residents, families, general practitioners, and other stakeholders was highlighted in the pilot evaluation to be a vital element needed to create the type of buy-in that supports successful implementation. However, direct interaction with residents and their families for study purposes was limited by the aged care provider, due to the increased sensitives and pressures in the aged care sector, and sustained COVID-19 pandemic priorities. Further, unlike the active engagement of general practitioners and local hospitals in the pilot studies this engagement was minimal during the trial phase.