Quasi-experimental study on the effectiveness and impact of implementing nurse-led 'therapeutic optimisation' (THEO)...

Higher staffing levels, particularly with experienced registered nurses, are associated with improved patient safety and fewer adverse events, as skilled nurses can quickly identify potential risks and implement strategies to mitigate them, creating a safer environment for patients. This study will investigate the effectiveness and impact of implementing therapeutic optimisation (THEO) intervention, a complex intervention aimed at enhancing nursing care by increasing experienced registered nurse staffing and facilitating practice development (PD) activities for all staff.

A multicentre quasi-experimental (before and after) study with an embedded convergent mixed methods process evaluation in older persons' wards across two National Health Service (NHS) Trusts in England. Four work packages are proposed. Work Package 1 will use participatory action research to implement the THEO intervention, including an enhanced staffing model and PD activities, involving seven iterative participatory data collection exercises with staff, patients and their personal consultees, as appropriate. Work Package 2 will extract and aggregate anonymised administrative data (patient and staff related) from 1 January 2015 to 30 days after the 12-month intervention period. Work Package 3 will use qualitative interviews to explore the experiences of patients with and without mental capacity (with their personal consultees) and staff regarding the THEO intervention. Work Package 4 is a mixed methods process evaluation to assess implementation and contextual factors impacting the effectiveness of the THEO intervention, collecting both quantitative (survey) and qualitative (guided discussions and workshops) data.

The UK Health Research Authority provided governance and ethical approval (Integrated Research Application System, IRAS ID: 334473). Dissemination will be with key stakeholders (including patient and public representatives), conference presentations and publications in peer-reviewed high-impact journals.