136 Chapter 5 Dose of the implementation strategies During the pilot, thirteen ERIC implementation strategies were employed, resulting in the following activities: 4 local implementation team meetings, 35 daily joint sessions, 15 informal visits, and 10 educational sessions. Implementing these strategies on the wards required approximately 1,455 minutes in total. By counting session participants (rather than unique individuals), a cumulative attendance of 270 nurses was recorded. Among the strategies, attending all daily joint sessions proved the most challenging to implement consistently, with a few instances where no project team members present. One-hundred-and-two unique users (73%; 102/140) accessed DRAAI’s stand-alone web page, collectively using the report 599 times. A key implementation strategy was to purposefully reexamine the implementation to enhance the feasibility and fidelity of DRAAI’s predictions by addressing practical issues. For example, the project team developed standardized content for discussion during the daily joint stand-ups. However, in practice, the initial sessions focused more on the development, risk predictors, and reliability of DRAAI. This shift occurred partly due to nurses’ questions and the need to build trust in the tool. Discussing specific cases with at-risk predictions helped nurses better understand why a patient was classified as at-risk for PU. By the second week, the focus shifted to correctly following up on risk predictions. This included selecting appropriate PU preventive measures, evaluating their effectiveness, and performing regular skin observations. Another key implementation strategy involved providing local technical assistance. During the pilot, nurses required guidance on adding the web page to their favorites or creating a desktop shortcut, as it was accessed via a stand-alone web application. Additionally, other important implementation strategies were organizing clinician implementation team meetings and conducting educational meetings. All the strategies and their operationalization are described in Supplemental file 1. Adaptations of DRAAI’s The refinement of DRAAI during the pilot involved five updates to the dashboard visualization and prediction model. The first update was necessary after the very first day, following feedback that the status of nursing care plans was not adequately displayed. This issue was addressed before the next day, fostering trust among nurses. The second update added an information page to the dashboard, detailing all predictors used by the model and the direction of their effects. For example, ‘advanced age increases predicted risk’.
RkJQdWJsaXNoZXIy MTk4NDMw