Optimising outcomes for frail hospitalised older adults – nurse led volunteer support and pain assessment interventions: A cluster randomised control trial

This study will utilise a cluster randomised control trial to evaluate the effectiveness of nurse led volunteer support interventions and technology driven pain assessment (PainChek Universal®) compared with standard care, on changes in frailty and specific clinical outcomes of older adults during hospitalisation, at discharge and at 30 days after discharge. A stakeholder evaluation (stakeholders include patient-participants, family, staff and volunteers) and cost effectiveness analysis will also be conducted. Potential participants will be screened for frailty using the modified-Reported Edmonton Frail Scale (mod-REFS) and demographic and clinical information will be collected from their patient file. Patients meeting the frailty criteria (mod-REFS score of 8 or greater) will be invited to participate in the intervention study. All participants will be assessed on admission and discharge by the project nurse using the InterRAI Acute Care assessment battery. All participants will have their level of pain, scale used, whether assessment was at rest or on movement, and any action taken in response (e.g., medication, repositioning, heat pack) recorded for all pain assessments as part of usual care while in hospital. This information will be recorded by ward staff. For groups receiving PainChek Universal® this information will be recorded in the app. For the other groups, this information will be recorded on the Pain Record Sheet which will be kept in the patient’s room. There will be three intervention groups: 1) Standard care plus nurse led volunteer support For participants allocated nurse led volunteer support, the project nurse will develop an individual volunteer support care plan in consultation with the patient and ward staff to provide up to two one-hour session with a volunteer per weekday for the duration of their hospitalisation. Volunteer support may include: Orientation - Volunteers will utilise strategies aimed at time, place, and situation to reorient patients if required. This may include orienting patients to the ward areas by taking them for a walk showing the layout of the ward; using a room calendar and or clock to orientate to date and time; and discussing about being in hospital as part of situational reorientation. Cognitive Stimulation - Volunteers will engage in activities with patients to support cognition. This may include reading newspapers, discussing current events, or discussing areas of interest. Mobility support - Volunteers will utilise strategies to promote physical activity such as accompanying patients on walks around the ward or encouraging them in their bed or chair exercises. Nutrition - Volunteers will use strategies to improving patients’ nutrition such as assisting patients with cutting food and positioning utensils and drinks, so they are accessible and also encourage the patient to eat and drink. Sensory Support - Volunteers will provide sensory support for patients’ vision and hearing such as checking if patients require glasses and hearing aids and if they are accessible and in place. Volunteer support provided to the participant will be recorded by the volunteers on the Volunteer Support Care Plan Record. 2) Standard care plus technology driven pain assessment (PainChek Universal®) During their hospital stay participants in this group will have any pain assessments conducted as part of usual care and any actions taken in response recorded for this project in the PainChek Universal® application by ward staff. For participants unable to report pain (e.g., due to cognitive impairment), the application based-tool utilises the in-built cameras and processors of smart devices to assess the presence of pain associated facial muscle movements (action units) using a 3-second video analysis of the individual’s face. The application then guides the assessor through checklists of pain behaviours, which include items related to changes in vocalisations, movement, and behaviours enacted by individuals during the experience of pain. The total of these behaviours informs the pain intensity according to the following categories: no pain (0-6), mild (7-11), moderate (12-15) and severe (greater than or equal to 16). For participants able to verbally report pain, their standard pain assessments (e.g., numerical ratings) will be recorded in PainChek Universal®. All pain assessments will be recorded in the PainChek Universal application and stored in a repository within the PainChek Universal® secure cloud database. 3) Standard care plus nurse led volunteer support and technology driven pain assessment (PainChek Universal®) Participants in this group will receive both nurse led volunteer support (as described for intervention 1) and technology driven pain assessment (as described for intervention 2)