Implementation of an intervention for the assessment, diagnosis, and management of urinary incontinence and lower urinary tract symptoms on wards that admit adult patients.

Our practice-change package is designed to support clinicians and health services to deliver guideline-recommended UI and LUTS care. It consists of our 3-part SCAMP intervention that we developed as part of a stroke rehabilitation quality improvement project in 2009-10, and revised in 2018 with experts from stroke, continence, rehabilitation and urology to ensure they met current best-evidence UI and LUTS care for the majority of adult inpatient populations. It will be implemented using evidence-based implementation strategies. SCAMP Intervention a. the 4-page Structured Urinary Continence Assessment and Management Plan decision support tool b. the associated Clinical Practice Guideline c. Eight online education modules (content covers normal bladder function, why continence is an issue after stroke, and six common inpatient UI and LUTS types, hosted on https://informme.org.au/learning-modules/Continence%20Modules ) and a local module (PowerPoint slides with voice over) on how to use the SCAMP decision support tool. The frequency and duration of these modules was not prescribed. it depended on the local site plan and based on local ward processes for clinician education. Attendance numbers at face-to-face sessions was recorded. Implementation strategies -Build a coalition: A coalition has been built that includes 15 wards across 12 hospitals, peak government and non-government bodies, and multiple universities. -Work with educational institutions: Coalition members include institutions that provide tertiary and/or professional development education to the target groups. -Develop academic partnerships, use data experts: Coalition members include academics from multiple institutions with expertise in implementation science, statistics, health economics, and data management. - Centralise technical assistance- Sites will be supported by a centralised research team who will provide the evidence-based intervention (SCAMP); develop implementation resources in consultation with the team (including education materials, Implementation Training Workshops for site leaders); and evaluation resources (data collection tools, data storage, data analysis, reporting. -Access new funding: Sites will be supported to conduct the audits with small grants secured by the research team. -Identify and prepare champions- Each site will have a local project lead and site champions who will drive the project locally. Leads will be senior clinicians, managers or educators who have influence over local practice and will identify local champions. -Recruit, designate, and train for leadership: at least one leaders/ champion from each site will attend two one-day training workshops which will include: an overview what is implementation research, strategies for implementing and sustaining evidence based practice, overcoming barriers, generating sponsorship, communication, and using mixed methods for evaluation. The first workshop will be held in the month following the pre-implementation data collection period. The second workshop will be held in the first month of the implementation period. -Create a learning collaborative: A learning collaborative will be developed where sites learn from and share with each other to improve implementation. -Develop resource sharing agreements: Sites will share any implementation resources they develop with other members of the collaborative. This will be facilitated by a shared cloud based repository. -Organise clinician implementation team meetings, provide ongoing consultation: Project team members from each site will meet at two implementation workshops plus monthly teleconferences for education, consultation, and collaboration. -Identify barriers and facilitators: Local sites will use the Behaviour Identification and Mitigation tool to develop a local implementation plan. -Tailor strategies ,promote adaptability to meet local needs: Local implementation plans will tailor the implementation strategy and adapt the intervention to suit local needs. -Distribute educational materials: Local sites will facilitate staff undertaking the education modules that inform the SCAMP decision support tool. -Conduct educational meetings- Site leads/ champions will conduct local education meetings to educate staff. -Change record systems: The SCAMP decision support tool will be implemented at all sites. Paper or electronic versions will be used based on local needs. -Audit and provide feedback: audit data will discussed at project team meetings and fed back to each site (localised presentation) to be disseminated using local processes. -Remind clinicians: A poster display of different continence types and possible management solutions will be made available to all sites. Reminders will also include at safety huddles, local posters, spot audits to identify areas for improvement then clinicians reminded by lead/ champion Process evaluation Measures will be collected to assess the process and fidelity of the implementation of the intervention. Spot check audits will be conducted to identify any issues with completing the SCAMP decision support tool. We will also record: attendance for ward education sessions and the project team implementation workshops (2 one-day workshops with a least one representative from each ward); the monthly project team meetings; the number and availability of identified champions throughout; the number and types of resources generated and reminder activities conducted; the number of audit and feedback sessions conducted; and any local changes made to the SCAMP intervention. The selection of implementation strategies at each site will be based on local barrier assessment. The implementation period will be 6 months in duration.