Transforming nursing assessment in acute hospitals: A cluster randomised controlled trial of Evidence-based Nursing CORE assessment (the ENCORE trial)

The ENCORE intervention is a complex systems intervention. Each intervention ward will adopt the following core components of the intervention: Proactive surveillance: A structured Core Plus nursing surveillance model for recognition of early changes in patient status on general wards. *Core assessment comprises standardised minimum assessment activities that are common across all clinical areas. The Plus specialty assessment parameters are customised minimum assessment activities relevant to the ward specialty areas. *The Core Plus model is designed for collection and synthesis of patient data to inform further symptom directed assessment and/or ongoing care decisions. ENCORE informs nursing care planning and multidisciplinary team communication. Systems re-design: Facilitated ward-level practice change to embed the Core Plus model and optimise early intervention for preventable deterioration. *Nurses will conduct Core Plus assessment of patients in their allocation at the beginning of each shift. *The patient’s primary nurse reviews patient status and goals of care during multidisciplinary team ward rounds. Our partner investigators are committed to support ward-level negotiated and tailored strategies to enable and sustain this practice change and embed the ENCORE intervention in ward routine. In re-focusing nursing assessment practices from minimal vital signs recording to purposeful assessment, the ENCORE intervention will strengthen nurse surveillance to ensure adequate and ongoing monitoring of acute care patients’ health status. This practice model will optimise nurses’ capacity to detect and act on emerging indicators of a change in patient status, enabling early intervention for preventable deterioration and adverse events. A 6-month implementation period for intervention wards will support staff engagement and participation in developing context-specific solutions for practice change: *Implementation will adopt an external-internal model of facilitation. Expert external facilitators (research team) will work with internal facilitators (ENCORE leads) on each intervention ward to embed practice change. Each intervention ward will contribute ENCORE leads (clinical nurses) for 6 months as internal facilitators responsible for their ward’s implementation plan, supported by the project coordinator/research team. *Ward staff (targeting >80% of permanent registered nurses in each ward) will attend face-to-face, group-based introductory (1 x 4 hours) and development (1 x 2 hours) ENCORE workshops over the first month of implementation, facilitated by the project coordinator/research team. Workshops are designed to be collaborative and participatory in customising the Core Plus assessment model and developing local strategies for ward-level practice change. *Clinical reminders and ENCORE intervention resources will be provided on each intervention ward (i.e. a video demonstrating the core components of the intervention, posters, lanyard-sized cards, Core Plus assessment bedside guidelines, professional stethoscopes for nurses). Sponsorship for the study was sought from the Executive Directors of Nursing and Chief Executive Officers of each hospital prior to the funding application. A prospective process evaluation will examine implementation outcomes of the ENCORE intervention including uptake, fidelity, acceptability and sustainability. This will be achieved using surveys, focus group and individual interviews of clinical staff participants conducted by a member of the research team.