Frailty care beyond the geriatric ward: A pre-implementation qualitative inquiry into anticipated barriers and facilitators to implementing a nurse-led frailty assessment and management programme in a hospital in Singapore

PURPOSE: Forging frailty-ready hospital systems is crucial given increasing number of frail older patients admitting across hospital services. Yet, systematic frailty identification and management remains lacking beyond specialist geriatric care. Hospital-wide approaches embedding frailty screening and coordinated management into routine care, supported by nurses and multidisciplinary teams, are needed. We developed an Inpatient Nursing Frailty Assessment program (INFA) that delivers nurse-led interventions for geriatric syndromes in mild-to-moderately frail older adults. Evaluating potential barriers and facilitators before implementation is critical for optimising actual implementation. This study identifies expected barriers and facilitators for INFA's adoptability, implementability, and sustainability. METHODS: Using an exploratory qualitative inquiry design guided by the updated Consolidated Framework for Implementation Research and its Outcomes Addendum, we engaged 25 healthcare providers through four focus groups and seven in-depth interviews: 10 nurses, five physicians, five allied health professionals, and five healthcare leadership staff. Data were analysed through deductive-inductive approach and framework analysis. RESULTS: Nine themes characterised factors shaping INFA's acceptability, appropriateness, and feasibility. Their inter-relationships informed adoptability, implementability, and sustainability. INFA's systematic approach for proactive, targeted multidisciplinary management led by nurses enhanced acceptability and adoptability. However, compatibility with existing workflows amid capability constraints, interprofessional power dynamics, and specialty-focused physician priorities, confront appropriateness and feasibility, complicating implementability. Ongoing training, monitoring, nurse recognition, and interprofessional communication structures were deemed essential for sustainability. CONCLUSION: Multi-level factors shape implementation complexity of nurse-led frailty management programs within hospitals. Eliciting anticipated contextual factors through multidisciplinary perspectives is critical for optimising implementation into clinical practice.