Table 1 Steps taken to implement Richmond Agitation-Sedation Scale—palliative version (RASS-PAL) using a self-learning module

(1) Key stakeholders were identified and recruited, including local EPR colleagues to facilitate addition of the RASS-PAL tool to the EPR. Once approved by EPR regional partners, the ‘go live’ date for the online version of the RASS-PAL tool was set for June 2019, aligning with an extensive preplanned EPR update

(2) A PCU interprofessional core project group was formed, comprising NPL (KB) and PSN, physicians (n = 2) (SB and MD), pharmacist, social worker, spiritual care provider, and clinical manager. The core project group defined a project timeline. In-person group meetings were held every 2 weeks from December 2018 to April 2019

(3) The core project group completed collaborative fishbone diagrams for major barriers and facilitators to implementation of the RASS-PAL on the PCU

(4) The project lead (SB) and NPL developed a short online interactive SLM for all staff. Content consisted of a clinical case of a patient with refractory agitated delirium at the end of life receiving palliative sedation. In addition to describing the RASS-PAL tool, this SLM contrasted the RASS-PAL with the Nursing Delirium Screening Scale (Nu-DESC).¹¹ The SLM module ended with an interactive exercise and 4 mandatory post-module questions

(5) To assist implementation, a RASS-PAL point-of-care tool (as a double-sided ‘one-pager’ titled “Introducing the RASS-PAL”) for bedside nurses was developed by the NPL and a laminated copy was placed on every nurse mobile computer workstation (See Additional file 1).

(6) Laminated copies of the RASS-PAL tool and procedure were posted in all PCU-wings and the team rounds room as a reference document for all staff