Implementation and evaluation of a standardized nurse‐administered assessment of functional and psychosocial issues for patients in acute care

Peel, Nancye M. and Hornby-Turner, Yvonne C. and Osborne, Sonya R. ORCID: https://orcid.org/0000-0002-2826-0627 and Henderson, Amanda and Hubbard, Ruth E. and Gray, Leonard C. (2021) Implementation and evaluation of a standardized nurse‐administered assessment of functional and psychosocial issues for patients in acute care. Worldviews on Evidence-Based Nursing, 18 (3). pp. 161-169. ISSN 1545-102X


Abstract

Background
Increasingly, adults presenting to healthcare facilities have multiple morbidities that impact medical management and require initial and ongoing assessment. The interRAI Acute Care (AC), one of a suite of instruments used for integrated care, is a nurse-administered standardized assessment of functional and psychosocial domains that contribute to complexity of patients admitted to acute care.

Aim
This study aimed to implement and evaluate the interRAI AC assessment system using a multi-strategy approach based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.

Methods
This nurse-led quality improvement study was piloted in a 200-bed public hospital in Brisbane, Australia, over the period 2017 to 2018. The interRAI AC is a set of clinical observations of functional and psychosocial domains, supported by software to derive diagnostic and risk screeners, scales to measure and monitor severity, and alerts to assist in care planning. Empirical data, surveys, and qualitative feedback were used to measure process and impact outcomes using the RE-AIM evaluation framework (Reach, Efficacy, Adoption, Implementation, and Maintenance).

Results
In comparison to usual practice, the interRAI assessment system and supporting software was able to improve the integrity and compliance of nurse assessments, identifying key risk domains to facilitate management of care. Pre-implementation documentation (630 items in 45 patient admissions) had 39% missing data compared with 1% missing data during the interRAI implementation phase (9,030 items in 645 patient admissions). Qualitative feedback from nurses in relation to staff engagement and behavioral intention to use the new technology was mixed.

Linking Evidence to Action
Despite challenges to implementing a system-wide change, evaluation results demonstrated considerable efficiency gains in the nursing assessment system. For successful implementation of the interRAI AC, study findings suggest the need for interoperability with other information systems, access to training, and continued leadership support.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to Published version in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Date Deposited: 14 Jun 2021 01:31
Last Modified: 03 Aug 2021 05:29
Uncontrolled Keywords: implementation quality improvement nursing practice implementation, quality improvement, nursing practice, evaluation interRAI Acute Care assessment, PARIHS and RE-AIM frameworks, functional and psychosocial domains
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Fields of Research (2020): 42 HEALTH SCIENCES > 4203 Health services and systems > 420312 Implementation science and evaluation
42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care
Socio-Economic Objectives (2008): E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
Socio-Economic Objectives (2020): 20 HEALTH > 2003 Provision of health and support services > 200307 Nursing
Identification Number or DOI: https://doi.org/10.1111/wvn.12490
URI: http://eprints.usq.edu.au/id/eprint/42192

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