Tools and Tips for Implementation
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Tools and Tips for Implementation
This page provides resources to support the implementation of the recommendations in the COSA Cancer-related Malnutrition and Sarcopenia Position Statement.
Putting all the position statement recommendations into practice is a complex process. It requires engagement and support from within your organisation, and a coordinated effort from the multidisciplinary team to develop a local action plan. In most cases this is a multi-year process. An important starting point is to understand what is happening in your workplace now and what needs to change.
Develop your local action plan
1.
Identify focus for improvement
- Use the audit tool or self-assessment checklist to identify areas for improvement.
2.
Build internal support
- Use the ‘Why should we care about cancer-related malnutrition and sarcopenia’ slide deck to support engagement with key stakeholders.
3.
Build your team
- Identify key stakeholders from the multidisciplinary and leadership teams.
- Refer to the How to Build Your Implementation Team checklist.
4.
Prepare for practice change
- Decide which screening tools and diagnostic criteria your workplace will use.
- Select the AACTT framework relevant to your clinical setting to help define what needs to change.
- Develop a local pathway of care using the generic pathway template.
- Understand local barriers and enablers, workforce capacity and workflows.
5.
Support your team
- Define the roles and responsibilities of your team.
- Use the How-to-Guides, instructional videos and treatment resources to upskill your team.
6.
Make the change
- Start small by making change in one clinical setting or with one patient group. This can help build your confidence to tackle subsequent changes in different clinical settings or with other patient groups.
7.
Monitor and evaluate progress
- Plan for data collection using the example clinical indicators.
- Embed changes within a regular quality cycle using relevant tools/frameworks eg PDSA or IHI improvement methodology.
Adherence audit tool
This audit tool can be used to assess your workplace’s adherence to the position statement recommendations. Under the ‘recommendation clarified’ column the inpatient setting has been used as an example. The Actor, Context, and Target can be tailored to each clinical setting (ie day therapy unit / radiotherapy outpatients) at your organisation using the example AACTT frameworks included in the toolkit. Time should be determined with consideration given to best practice and local resourcing.
Cancer-related malnutrition and sarcopenia self-assessment checklist
This checklist can be used to assess your individual clinical practice against the recommendations in the position statement.
Cancer-related malnutrition and sarcopenia self-assessment checklist
Why is it important to address cancer-related malnutrition and sarcopenia?
This slide deck can be used to support engagement of key stakeholders in your workplace.
Why is it important to address cancer-related malnutrition and sarcopenia?
How to build your implementation team
This checklist can be used to guide the formation of a local implementation team.
AACTT frameworks
The Action, Actor, Context, Target, Time (AACTT) framework is a behaviour specification framework (Presseau et al, 2019). It has been used to specify the behaviour of individuals relating to screening, assessment, treatment and multidisciplinary care of malnutrition and sarcopenia in a number of clinical settings. These are examples only and recommended timeframes should be adapted to the target population and the local context in which they are being applied.
AACTT framework inpatients
AACTT framework day therapy units
AACTT framework radiotherapy outpatients
AACTT framework rural/community
AACTT framework primary care
Generic pathway
A generic pathway that can be tailored to each specific context has been developed and is available for download. Use the example AACTT frameworks to tailor the pathway to your local context. A worked example can be found below.
Generic pathway (editable version)
Generic pathway (worked example)
Checklist to identify and address barriers to implementation
This checklist can be used to support the identification of common barriers and enablers to the implementation of position statement recommendations.
Checklist to identify and address barriers to implementation
Example clinical indicators
Clinical indicators (or key performance indicators) should be used after you have tailored the pathway to your local context, as a way of monitoring compliance to the care pathway.
There are a number of implementation theories, models and frameworks that can guide and support your implementation journey. The following diagram adapted from Nilsen (2015), provides an overview of the theoretical approaches used in implementation science.
Theoretical approaches used in implementation science
Describing or guiding the process of translating research into practice
Understanding or explaining what influences implementation outcomes
Exemplars of evidence-based care in practice
The following case studies have been developed as exemplars of evidence-based care in practice. It is hoped they will help to support the implementation of the position statement recommendations into practice.
Raising awareness of malnutrition and sarcopenia in your organisation
Advocating with the MDT for a business case to establish a new clinical service
Pre-operative nutrition care in patients undergoing oral cavity surgery
Integrating a co-located exercise clinic into oncology care