Reach
delirium, pain
SAID
A proportion of ward staff at all sites engaged with PERFECT-ER to some degree. Many staff at Ward C were largely unaware of the study and when asked about changes due to the intervention their typical response was:Nurse Practitioner: I wouldn’t have thought, not through PERFECT-ER no, I wouldn’t think so no.Senior Nurse: Or if it is through PERFECT-ER no-one has told us it has come from that. (Focus Group, Ward C)Nevertheless, PERFECT-ER elements implemented for the study were now part of their usual daily practice and valued.Nurse Practitioner: …all the tools that we are bringing in are certainly useful to help appropriately nurse the patients that we actually do have (Focus Group, Ward C)This suggests that implementation of PERFECT-ER elements did not rely on the engagement of all ward staff with the process.In wards C and E several staff members said they would have liked more information about the intervention and an active role with implementation.Physiotherapist: Just to know more about it [PERFECT-ER] really… So, we could get more involved basically. (Focus Group, Ward E)This suggests optimal reach was not always achieved. Nevertheless, across wards elements of PERFECT-ER were viewed as having improved staff awareness, particularly of pain and delirium.Occupational Therapist: I suppose it [PERFECT-ER] has highlighted it [pain] individually to me to be more aware and do something about it. (Focus Group, Ward C)Interviews with relatives and patients suggested they did not notice an enhanced care experience. They expressed mixed experiences of care generally, but no-one noted PERFECT-ER specifically in their interview.By and large as I say it was a good experience umm I’d, I had done it before… I think it was better than it was 4 years ago. (Relative, Ward C)We felt like we were being a negative complaining family in a way because things just weren’t going right. (Relative, Ward A)Indicators of implementation may have reflected changes in documentary practices, and not changes in ethos or clinical practice as staff noted modifications to standardise recording and assessment practices.I don’t think it changed my practice… it helped standardise those that perhaps wouldn’t routinely do the same thing, but for those that were doing it, it allowed us to be clearly documented (PL, Ward E)