Implementing SAFE™ care: Evaluation of a geriatric model of care for real-world practice.

Systems Addressing Frail Elders (SAFETM) Care is a geriatric model of care that identifies high-risk hospitalized older adults, and provides targeted interprofessional interventions for risk factors associated with frailty. This post, mixed methods study sought to evaluate SAFETM Care implementation retrospectively at one public academic medical center and describe practical "real-world" considerations for implementation using the Consolidated Framework for Implementation Research (CFIR). In addition to barriers and facilitators, hidden characteristics to consider for implementation include initiating conditions, skills and experiences of implementers, interpersonal challenges, unique facilitators and barriers, surprising conditions, and threats to and requirements for sustainability. Implementation of SAFETM Care demonstrated effective adoption and implementation, but faced multiple threats that led to failed sustainability. The public sharing of these successes and failures will help implementers understand and make progress in adapting such important geriatric programs and quality improvement initiatives.

Effect of a preoperative instructional digital video disc on patient knowledge and preparedness for engaging in postoperative care activities.

This project determined the effects of developing and implementing a preoperative instructional digital video disc (DVD) on patients' level of knowledge, preparedness, and perceived ability to participate in postoperative care activities. Content areas that were incorporated into the preoperative instructional DVD included: pain management, surgical drainage, vital signs, incentive spirometry, cough and deep breathe, chest physiotherapy, anti-embolism stockings/sequential compression device, ambulation, diet/bowel activity/urine output, and discharge. A system was created to ensure that patients consistently received the preoperative instructional DVD prior to surgery. The instructional media product was found to be effective in increasing pre-operative knowledge and preparedness of patients and their families. Nurses reported higher levels of knowledge and engagement among patients and their families related to postoperative activities.