Participatory development and implementation of a dementia care pathway with intervention bundles in acute care during the coronavirus pandemic: A process evaluation study

Abstract

Aims: To explore the implementation of a dementia care pathway in an acute care setting.

Background: Dementia care in acute settings is often constrained by contextual factors. We developed an evidence-based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care.

Design: Process evaluation using quantitative and qualitative methods.

Methods: Pre-implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence-based dementia care. Post-implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR).

Reporting guideline: Standards for Reporting Qualitative Research Checklist.

Results: Pre-implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence-based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational- and process-related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines.

Conclusions: Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process.

Relevance to clinical practice: Our study provides important learning around improving care for persons with dementia and their families in hospitals.

Patient or public contribution: A family caregiver was involved in the development of the education and training programme.

Keywords: Alzheimer's disease; acute care; care bundles; care pathway; dementia; evidence-based care; family members; implementation; mild cognitive impairment; older persons.