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Table 2 Project timeline for adaptation, implementation, and evaluation of the interprofessional modular delirium clinical practice guideline

From: Adaptation, implementation, and mixed methods evaluation of an interprofessional modular clinical practice guideline for delirium management on an inpatient palliative care unit

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

  1. 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