Reconstructing successes and failures in implementing multidisciplinary delivery of expert consultation for restrictive measures

Introduction: A trial to implement a new mode of delivery of MultiDisciplinary Expert Team (MDET) consultation to reduce restrictive measures (RM) was conducted. MDET includes consultation, registration and monitoring of RM, and team and individual level interventions. Accelerated reduction of RM was observed in units randomised to receive MDET. This study seeks to reconstruct successes and failures of the approach by comparing units differing in the rate of RM reduction. The used frameworks were derived from emerging models for effective implementation from Cochrane Effective Practice and Organisation of Care (EPOC) and Normalisation Process Theory (NPT).

Methods: Process notes and MDET plans for 21 units and residents were used for content analyses by encoding on mentioning EPOC interventions and NPT constructs. This information is associated with the degree of elimination of RM (111 RM, 40%).

Results: Results show a distribution of implementation methods across units with least to most success concerning the reduction of RM.

Implications: The relevance of findings will be discussed for deliver the MDET model within and across settings. EPOC and NPT are useful for understanding implementation as a social process.