There is a knowledge gap on implementing an Inpatient Nursing Frailty Assessment (INFA) programme whereby nurses identify geriatric syndromes in mild-to-moderately frail patients in non-geriatric wards and facilitate multidisciplinary management. We explored expected barriers and facilitators to adoption and implementation and developed implementation strategies pre-implementation. During pilot implementation, we assessed adoption, implementation, sustainability, and scalability. Qualitative inquiry was underpinned by the Consolidated Framework for Implementation Research. We engaged healthcare administrators and frontline providers (nurses, physicians, allied health professionals) through 11 focus group discussions (FGDs) and in-depth interviews (IDIs) pre-implementation, followed by nine FGDs and IDIs during implementation. We employed deductive-inductive analysis alongside table-based methods for synthesis. Before implementation, INFA’s systematic and proactive approach was expected to facilitate adoption and implementation. Expected barriers included competing priorities, capability gaps, and interprofessional communication challenges. During implementation, additional barriers were communication challenges with patients and caregivers affecting assessment accuracy, and perceived redundancies amid pre-existing specialty-specific care approaches. Facilitators to adoption and implementation included nurses’ pride in improving patient outcomes and compatibility with their workflows. Perceived enablers to sustainability were formal protocolisation, nurse compliance, and demonstration of outcomes. Scaling was expected to depend on strong buy-in and tailoring the care model for relevance to broader non-geriatric specialties. Implementation strategies developed at pre-implementation included capability building, communication platforms, and IT system integration. Emergent strategies uncovered during pilot to optimise adoption and implementation included quality monitoring, audit and feedback, and interactive problem-solving. This study offers translational insights into implementing hospital-based nurse-led frailty management programmes for older patients.

Authors:
Araviinthansai Subramaniam, Geriatric Education & Research Institute, Singapore
Mimaika Ginting, Geriatric Education & Research Institute, Singapore
Jia Ying Tang, Geriatric Education & Research Institute, Singapore
Celestine Lim, Tan Tock Seng Hospital, Singapore
Shi Yun Chua, Tan Tock Seng Hospital, Singapore
Woan Shin Tan, Geriatric Education & Research Institute, Singapore
Wee Shiong Lim, Tan Tock Seng Hospital, Singapore
Yew Yoong Ding, Geriatric Education & Research Institute, Singapore
Grace Sum, Geriatric Education & Research Institute, Singapore
Justin Chew, Tan Tock Seng Hospital, Singapore

About the Presenter(s)
Mr Araviinthansai Subramaniam is a Research Associate at the Geriatric Education & Research Institute in Singapore and is currently pursuing integrated care research through the implementation science lens.

Connect on Linkedin
https://sg.linkedin.com/in/araviinthansai-subramaniam

Connect on ResearchGate
https://www.researchgate.net/profile/Araviinthansai-Subramaniam

Additional website of interest
https://orcid.org/0009-0006-6330-4804

See this presentation on the full schedule – Wednesday Schedule

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