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

Peel, Nancye M., Hornby-Turner, Yvonne C., Osborne, Sonya R, Henderson, Amanda, 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.

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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.

Item ID: 69301
Item Type: Article (Research - C1)
ISSN: 1741-6787
Keywords: implementation, quality improvement, nursing practice, evaluation, interRAI Acute Care assessment, PARIHS and RE-AIM frameworks, functional and psychosocial domains
Copyright Information: © 2021 Sigma Theta Tau International
Funders: Metro South Study, Education, Research Trust Account (SERTA), Australian Centre for Health Services Innovation (AusHSI)
Projects and Grants: SERTA Grant Number: 222-15/16, AusHSI Grant Number: IG000810
Date Deposited: 07 Sep 2021 04:23
FoR Codes: 42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care @ 50%
42 HEALTH SCIENCES > 4205 Nursing > 420502 Aged care nursing @ 50%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200304 Inpatient hospital care @ 100%
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