Over 50% of HSE hospital bed-days are used by patients aged >65 years. This patient group experience high rates of hospital-associated decline (HAD). Reduced mobility and suboptimum nutrient lead to muscle weakness, delayed recovery, HAD, frailty and prolonged stay. Yet, these modifiable factors are frequently overlooked activities during hospitalisation.
Aim
This is a prospective cohort implementation study of a multicomponent Frailty Care Bundle (FCB) targeting early mobilisation, nutrition and patient/family partnership working in acute care wards. The intervention combines international and local evidence on interventions to reduce HAD and promote patient functional activity. Our study involves nursing staff (nurses & health care assistants), the multidisciplinary team and patients/families.
The implementation strategy utilises a multicomponent Practice Facilitation model (education, coaching, mentoring) to embed FCB principles into ward culture. The strategy will be underpinned by the COM-B (Capability, Opportunity, Motivation) behaviour change model and the Promoting Action on Research Implementation in Health Services (i-PARiH) to address multi-level cultural, organisational, team and patient barriers.
Design
A multisite study with a pre-post evaluation, based in three acute care hospitals and six wards (two per site). Sample size include staff (n=200) and patients (n=180).
Data collection will use mixed-methods guided by COM-B/i-PARiH to construct a pre-post situational analysis to determine implementation feasibility and tailoring. Primary outcomes will be patient functional activity (mobilisation measured using accelerometer) and staff uptake of the FCB (observation of practice). Secondary outcomes include knowledge and attitudes, length of hospital stay, functional activity at 1-month follow-up. Quantitative data (survey, observation, accelerometer step-count) will be combined with qualitative interviews on the implementation process.
Impact
This is a high-value low-cost intervention. Our partners, the SSWHG and the Office Nursing and Midwifery Service Director, will accelerate knowledge translation of the study outputs into local and national nursing practice and health policy.
