Education and Implementation Co-Design Approaches for READI-SET-GO using CFIR Framework

Video Health & Life Sciences 2025 Graduate Exhibition

Presentation by Zahra Karimi

Exhibition Number 516

Abstract

Background: Delirium in hospitalized older adults often results in adverse outcomes, including falls, unnecessary use of antipsychotics, and misdiagnosis as the progression of Alzheimer's disease or Alzheimer's disease-related dementias, ultimately leading to irreversible cognitive decline and/or death. Early detection is a crucial step in managing delirium in the clinical setting. A study of barriers and facilitators by Eagle and colleagues utilizing qualitative interviews identified implementation barriers of lack of clinical prioritization and competing demands, time, comfort in using the CAM, lack of knowledge, and hospital leadership and culture. We describe preliminary education and implementation approaches for delirium screening and management by integrating the Ultra-Brief Confusion Assessment Method (UB-CAM) into the electronic health record (EHR). Method: This study is a stepped-wedge design, in which the UB-CAM screening is launched in a new unit every 6 months over a 42-month period at 3 hospitals. The implementation strategies were guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and consolidated framework for advancing implementation science (CFIR). Our strategies included: (1) app-based adaptive screening integrated into EHR; (2) stakeholder engagement; (3) education (in person and online) with co-design by nursing, physician and pharmacy staff, and hands on practice with cases studies and feedback on performance; and (4) organizational factors including culture, leadership style, champion engagement, and the alignment of ongoing training with existing practices and workflows. Result: During the first intervention block, 100% education compliance with a 65% participation rate in person and 35% on the online course was achieved. We will describe champion selection, use of feedback report data with clinical staff, the approach to the co-design of clinical strategies, engagement of leadership and alignment with organizational priorities. We will describe preliminary engagement and adherence to the screening tool. Discussion: Thus far, co-designed education and implementation has fostered engagement and compliance with the UB-CAM integration into EHR. Compared to previous nursing education, hybrid and technology-based approaches, including innovative videos formats, have optimized training effectiveness. Additionally, diverse implementation approaches including organizational factors, leadership engagement and feedback have supported continuous monitoring of UB-CAM adoption. Future research should evaluate the impact of these co-design approaches on the sustainability of clinical interventions. Keywords: Delirium, Older Adult, Alzheimer’s disease and Alzheimer’s disease related dementias, Ultra-brief Confusion Assessment Method, implementation study

Importance

Thus far, co-designed education and implementation has fostered engagement and compliance with the UB-CAM integration into EHR. Compared to previous nursing education, hybrid and technology-based approaches, including innovative videos formats, have optimized training effectiveness. Additionally, diverse implementation approaches including organizational factors, leadership engagement and feedback have supported continuous monitoring of UB-CAM adoption. Future research should evaluate the impact of these co-design approaches on the sustainability of clinical interventions.