Table 2 Final intervention details

PCW introductory education

Within first 4 weeks^a of intervention introduction phase

• Introductory video – What is EDDIE + ?

• PowerPoint slides covering:

– What to look for – signs and symptoms of early deterioration (eight areas)

– What to say (communication with nursing staff) via communication tools CUS & Stop and Watch

• Workbook

• EDDIE + pen and chocolate

Nurse educator presents key information in a blended learning style with question-and-answer  (1 h session)

Face-to-face or online option – conducted in groups

Each participant received once

• Attendance records

• Presenter feedback form

• Self-efficacy questionnaire^b

Nurse introductory education

Within first 4 weeks^a of intervention introduction phase

• Introductory video – What is EDDIE + ?

• PowerPoint slides covering:

– Eight areas of clinical deterioration – RACR – Recognise, Assess, Care, Report (see other section for more detail)

– Communication to GPs and other clinical services e.g. ISBAR tool

– Communication with personal care workers covering the CUS & Stop and Watch tools they will use for reporting, and expectation for closing the feedback loop with PCWs

• Workbook

• EDDIE + pen and chocolate

Nurse educator presents key information in a blended learning style with question-and-answer  (1h 15min session)

Face-to-face or online option – conducted in groups

Each participant received once

• Attendance records

• Presenter feedback form

• Self-efficacy questionnaire^b

Equipment training

Within first 4 weeks^a of intervention introduction phase

• Each site was provided with two pieces of equipment—(1) Bladder scanner; and (2) Vital signs monitor with blood pressure, pulse oximetry, and 3 lead ECG; with alarms, automated observation cycling (e.g. every 15 min), and print-out options

• 2–3 PowerPoint slides on interpretation of results and management of clinical findings

• Phantom bladder, distilled water, ECG gel

• ANNIE demonstration mannequin, ECG dots, vital signs monitor observation print-out strip

• Workbook and competency quiz (in addition to hands-on assessment)

• Instructional videos available to staff for revision

• Quick reference guides attached to each piece of equipment for future referral

Nurse educator presents 2–3 slides, conducts a hands-on demonstration with both pieces of equipment, including use of phantom bladder. A hands-on competency assessment, as well as short quiz is completed by nursing staff (45 min session in total for both pieces of equipment)

EDDIE + Clinical facilitator in each site provides additional support or revision training for nursing staff in using equipment as needed

• Attendance records

Bladder Scanner

From start of intervention introduction phase to end of intervention exposure phase (available for use once trained)

• 1 × bladder scanner per site

• Consumables e.g. ultrasound gel

Provided to each site at the beginning of the intervention introduction phase (with consumables provided throughout)

Nursing staff to use with residents as needed throughout the intervention introduction and exposure phases (once training complete and assessed as competent)

• Fortnightly CF check-in form

Vital signs monitor

From start of intervention introduction phase to end of intervention exposure phase (available for use once trained)

• 1 × vital signs monitor per site

• Consumables e.g. ECG dots and paper

Provided to each site at the beginning of the intervention introduction phase (with consumables provided throughout)

Nursing staff to use with residents as needed throughout the intervention introduction and exposure phases (once training complete and assessed as competent)

• Fortnightly CF check-in form

Decision Support tool

Within first 4 weeks^a of intervention introduction phase

• Retractable badge holder with key decision support/ information attached (2 double sided cards for nurses, 2 double-sized cards for PCW)

• Laminated copies of key assessment tools that are kept in each nurses’ station

Provided during introductory education session for PCWs and Nurses. Staff to wear throughout trial (to end of intervention exposure phase)

• Fortnightly CF check-in form

Individual RAC home context assessment (baseline)

Initial site visit 3–4 weeks prior to intervention introduction phase

• Individual RAC home context assessment based on the i-PARIHS framework

Implementation Facilitator

1 h session (usually F2F) with local Residential Manager, Clinical Manager and Clinical Facilitator

• Individual RAC home context assessment

• Field Notes

Clinical Facilitator induction training and materials

Initial site visit 3–4 weeks prior to intervention introduction phase

• Clinical facilitator guide (printed and electronic versions)

• USB and printed versions of all project materials including:

– Promotional posters

– Data collection tools such as check-in form, training logs

– Training materials

– Engagement letter/information for key stakeholders

• Laptop bag with additional tools for the facilitator e.g. diary, notepad, pens, BlueTak

2–3 h session with EDDIE + Clinical Facilitator at each site, Nurse Educator and Intervention Facilitator

Face-to-face or online option

• Field notes

Onsite EDDIE + Clinical Facilitator

From initial site visit (3–4 weeks prior to intervention introduction phase) through to end of intervention exposure phase

• Each site had 0.2FTE nursing position paid for by the study

Clinical facilitator to:

• Support implementation of the EDDIE + program, including training and mentoring activities, maintaining nursing and care staff and RAC home engagement

• Support and monitor nursing and care staff use of the EDDIE + processes, equipment, and decision support tools in the home

• Speak with the Nurse Educator or Implementation Facilitator fortnightly to maintain RAC home engagement, monitor implementation processes and address issues as required

• Documentation and record keeping of, staff training, consumable usage and equipment maintenance using the template/s provided

• Liaison with study team to provide data

• Work with the Nurse Educator to identify and engage with clinical support channels as required, including engagement with GP practices, nurse practitioners

• Assist with resident and family/ advocate/ representative engagement with the EDDIE + program

• Advocate for and champion the EDDIE + Project in the RAC home to all nursing and care staff, residents and families

• Work with the Nurse Educator to identify local and individual learning needs

• Undertake extension scenarios with staff (see detail below)

• Assist with the local orientation of all new staff to EDDIE + 

• Fortnightly CF check-in form

Extension scenarios

Throughout the implementation exposure phase

• Clinical and communication scenarios with 2–3 questions per scenario– available electronically on a tablet and hard copy with a verbal discussion of the questions

• Android tablet with data (included videos and scenarios)

Clinical facilitator in each site undertakes scenario discussion on a semi-regular basis with nurses and PCW (5min to 30min sessions during shift “on the floor”)

• Fortnightly CF check-in form

Mentoring and support for Clinical Facilitators

From initial site visit (3–4 weeks prior to intervention introduction phase) through to end of intervention exposure

• Fortnightly check-in meetings between Clinical Facilitator and EDDIE + Nurse Educator (or EDDIE + Facilitator)

• Availability of coaching on teaching techniques

• Availability of list of contact information for RAC home clinical nurse advisors

Nurse Educator and Implementation Facilitator regularly engaged with each EDDIE + Clinical Facilitator by email and phone, and any activities as required

EDDIE + Clinical Facilitators were encouraged to access internal BC supports such as SCNAs and other Clinical Facilitators at participating sites

• Individual RAC home context assessment

• Fortnightly CF check-in form

• Field Notes