Table 2.
Project timeline for adaptation, implementation, and evaluation of the interprofessional modular delirium clinical practice guideline
| DATE | DETAILS |
|---|---|
| Initial steps: | |
| Autumn 2013 | Established initial core guideline group (physician, pharmacist, PSN and RN) – regular meetings; grant submission |
| February 2014 | With PSN (APN position remained vacant), proceed with launch of ‘Starter Kit’ as mini opportunistic ‘lunch and learn’ sessions to nursing in the PCU break room during their lunch breaks |
| March 2014 – November 2014 | Significant PCU staff changes across the PCU team (nursing, PSN, allied health, unit CM) necessitating stop of ‘Starter Kit’ launch in March; PCU and other institution-wide training priorities |
| December 2014 – February 2015 | Develop clinical cases for Nu-DESC module with two experienced PCU RNs; draft non-pharmacological content with experienced PCU RPN; meetings with physicians and pharmacist regarding pharmacological management; change of unit CM |
| January – April 2015 | Hospital EPR rollout |
| April – June 2015 | APN position filled (make tentative plan to launch guideline rollout in July 2015); increased clinical workload on PCU due to increase in number of daily admissions to improve hospital patient flow |
| June – August 2015 | Family delirium information booklet drafted by summer undergraduate medical student: feedback from IP team in focus groups/ interviews |
| September 2015 | New APN (tentative plan to launch guideline rollout in November 2015); PCU and other institution-wide training priorities postpone guideline rollout |
| October 2015 – March 2016 | Clinical lead continues to develop and refine module content |
| April 2016 | APN leaves; Part-time physiotherapist and rehabilitation assistant reassigned to other units |
| June 2016 | New NPL (replacing APN position): initially as 2-month interim position with remit and protected time to focus solely on the delirium CPG project – assists with completion of e-Learning modules |
| October 2016 | Competing institution-wide education projects – guideline implementation deferred |
| Full CPG implementation: | |
| December 1, 2016 | Interprofessional presenter roll-out meeting; All members of GAG given silver-coloured school star badges to be worn on work lanyards so clearly identifiable for the rest of the PCU team |
| December 5 –15, 2016 | Implementation of multiple small group mandatory introductory IP ‘Starter Kit’ sessions over 2 weeks (facilitated by interprofessional presenters from the GAG) in the unit dedicated team rounds room with ‘Evaluation and monitoring’ session component for nursing (facilitated by NPL/PSN); separate ‘Starter Kit’ session held for physicians and medical learners for ease of coordination |
| December 2016 |
Launch of 1st 3 e-Learning online modules: - Delirium screening (review of Nu-DESC tool) – nurses only - Non-pharmacological strategies – all staff - Communication tips with delirious patients – all staff |
| December 2016 | Launch of patient and family delirium information leaflet |
| January 2017 | Further ‘Starter Kit’ sessions for nurses and volunteers |
| June 2017 | Pharmacological module and ‘prescribing framework’ finalised |
| September 5, 2017 | Launch of Pharmacological e-Learning online module – physicians, nurses, pharmacist |
| September 5, 2017 | Launch of ‘Big Picture’ summary (point-of-care tool) |
| September 5, 2017 | Launch of guideline algorithm |
| September 5, 2017 | Unit celebration event (with CPG colour-coded icing on the celebration cake) on PCU to showcase the work of the GAG. Attended by hospital CEO, senior management, PCU volunteers, staff from across the organisation, and representatives from hospital communications department |
| December 2017 | Deadline for completion of Pharmacological module |
| Evaluation: | |
| February – April 2018 | Pre-CPG patient chart audit of 20 patients admitted in June – December 2015 |
| May 2018 | Initial IP team SurveyMonkey® evaluation emails sent out |
| August 2018 | Close of SurveyMonkey® |
| September 2018 – January 2019 | Focus groups/ interviews |
| October – November 2018 | Post-CPG patient chart audit of 20 patients admitted in January – March 2018 |
Abbreviations: APN Advanced practice nurse, CEO Chief executive officer, CM Clinical manager, CPG Clinical practice guideline, EPR Electronic patient record, GAG Guideline adaptation group, IP Interprofessional, NPL nursing practice leader, Nu-DESC Nursing Delirium Screening Scale [32], PCU Palliative care unit, PSN Practice support nurse, RN Registered nurse, RPN Registered practical nurse