Table 1.
Overview of the nine components within the implementation guide
| Number | Content |
|---|---|
| Component 1 | Establishing the implementation project and preparing the environment |
| ▪ Informing the geriatric health care staff about the implementation project and the importance of change in care during the last days of life | |
| ▪ Executive endorsement: acquiring management approval for the trainings and audits ▪ Involvement of specialist palliative care services is recommended: at least one member of the Palliative Support Team of the hospital is member of the steering group | |
| ▪ Facilitators: a nurse and a physician of the geriatric ward | |
| ▪ Formation of steering group: at least four people from the geriatric ward (facilitators included) | |
| ▪ Intensive 2-day training of facilitators | |
| Component 2 | Preparing the documentation |
| ▪ Development of an information leaflet for family carers about the facilities in the geriatric hospital ward | |
| Component 3 | Baseline review |
| ▪ Analyzing end-of-life care data of deceased geriatric hospital patients using the patients’ medical files | |
| Component 4 | Training geriatric health care staff |
| ▪ Feedback of the results to the staff and focusing on improvement within the geriatric ward | |
| ▪ Facilitators and specialist palliative care colleagues train geriatric health care staff with the aid of a training package (i.e. hand-outs with information about the Care Guide for the Last Days of Life, a copy of the Care Guide for the Last Days of Life, a casus to discuss in group etc.) | |
| Component 5 | Care Guide use and intensive support |
| ▪ Care Guide use after sufficient training and education | |
| ▪ Intensive support and supervision by the steering group through repeated coaching, telephone and direct guidance, discussion of clinical cases and clinical audits | |
| Component 6 | Semi-intensive support |
| ▪ Semi-intensive support and supervision by the steering group through repeated coaching, telephone and direct guidance, discussion of clinical cases and clinical audits | |
| Component 7 | Evaluation |
| ▪ To organize a qualitative evaluation of the implementation: evaluating and discussing the performance and progress of each of the previous components | |
| ▪ The qualitative evaluation acknowledges areas where further support, education or training is needed | |
| Component 8 | Consolidation |
| ▪ To adopt a strategy to maintain/improve the implementation and sustainability of the Care Guide | |
| ▪ Support and supervision by the steering group through repeated coaching, telephone and direct guidance, discussion of clinical cases and clinical audits | |
| Component 9 | Ongoing education, training and support |
| ▪ Keeping up to date with developments in end-of-life care and a continuing education and evaluation within the hospital ward |