Development of a grant application to estimate the safety, effectiveness and cost-effectiveness of implementing routine dysphagia screening on care of the older persons wards.

Development work questions Which individuals are required to optimise our research team, patient and public involvement and form an expert advisory group? What are the barriers and enablers associated with dysphagia screening on care of the older person wards?

What are the core outcome measures required to capture the effectiveness of a dysphagia screening service for older people?

Background Dysphagia, believed to be present in up to half of older persons in hospital, is strongly associated with aspiration pneumonia, one of the most common causes of death in geriatric conditions.

Patients with dysphagia are three times more likely to be at risk of medication administration errors whilst hospitalised.

Dysphagia is not currently routinely screened for on care of the older persons wards and therefore an opportunity to improve patient safety and outcomes is being missed. Evidence suggests that routine dysphagia screening can enhance older person outcomes.

Aims and objectives To develop a program grant application to test our hypothesis that routine nurse screening for dysphagia on care of older person wards will improve patient outcomes, we need to: Identify individuals required to optimise research team effectiveness Identify the barriers and enablers to its routine implementation Describe the core outcome measures that should be used and tested within our future feasibility study Development work plan Ethical approval will be obtained.

The project will follow recommendations for ensuring cultural competence, be delivered in a Covid safe manner and as such will have a minimal carbon footprint.

Phase 1 Research team enhancement Within this phase we will optimise the strength of our team of co-applicants, develop an eight member culturally diverse PPI advisory group (PAG) and an expert advisory group configured to maximise future impact.

Phase 2 Systematic review with narrative synthesis Following Cochrane guidance and underpinned by the Theoretical Domains Framework, we will perform a systematic review to identify the reported barriers and enablers to nurse-initiated screening for dysphagia in hospital. Outputs will be assigned to TDF domains which will be used to inform evidence-based behaviour change techniques.

This will inform this element of the final intervention.

Phase 3 Core outcome set development Using previously created related core outcome sets plus an early draft of a logic model with additional process and behavioural outcomes, we will create a list of possible outcome options for inclusion.

These will be reviewed by stakeholders and experts through two Delphi rounds, with final consensus regarding inclusion made via a panel meeting using Nominal Group Technique.

Phase 4 Dissemination and grant application preparation We will publish papers from phases 2 & 3 and present findings at national conferences to discuss findings with the nursing profession and commissioners.

The final research team will discuss and agree the optimal design for the proposed definitive trial and create an NIHR Program Grant for Applied Research application. Anticipated impact Our new COS will be recorded on an international research database. Information regarding service specification will be of use to service developers and similar research groups.