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Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention

Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention
Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention
Background: low grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice 
Methods: this implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the "implementation outcome variables" proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified. 
Results: 155 nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25-80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (<27kg for men and <16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions.
Conclusions: training a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions' motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay.
1471-2318
1-14
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Patel, Harnish P.
e1c0826f-d14e-49f3-8049-5b945d185523
Baxter, Mark
3415aa9a-8eb0-454e-9b7a-dadb1ce4e5c6
Sayer, Avan A.
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Patel, Harnish P.
e1c0826f-d14e-49f3-8049-5b945d185523
Baxter, Mark
3415aa9a-8eb0-454e-9b7a-dadb1ce4e5c6
Sayer, Avan A.
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Roberts, Helen C.
5ea688b1-ef7a-4173-9da0-26290e18f253

Ibrahim, Kinda, May, Carl R., Patel, Harnish P., Baxter, Mark, Sayer, Avan A. and Roberts, Helen C. (2018) Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention. BMC Geriatrics, 18, 1-14, [79]. (doi:10.1186/s12877-018-0768-5).

Record type: Article

Abstract

Background: low grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice 
Methods: this implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the "implementation outcome variables" proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified. 
Results: 155 nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25-80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (<27kg for men and <16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions.
Conclusions: training a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions' motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay.

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Implementation of Grip strength final version 12-03-2018
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More information

Accepted/In Press date: 13 March 2018
e-pub ahead of print date: 22 March 2018
Published date: 22 March 2018

Identifiers

Local EPrints ID: 418886
URI: http://eprints.soton.ac.uk/id/eprint/418886
ISSN: 1471-2318
PURE UUID: 7ab8cfa3-f821-4909-89c9-ebe298512cc3
ORCID for Kinda Ibrahim: ORCID iD orcid.org/0000-0001-5709-3867
ORCID for Carl R. May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Helen C. Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 23 Mar 2018 17:30
Last modified: 07 Oct 2020 04:45

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Contributors

Author: Kinda Ibrahim ORCID iD
Author: Carl R. May ORCID iD
Author: Harnish P. Patel
Author: Mark Baxter
Author: Avan A. Sayer

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