Case study of the PRoWL project: a whole-system implementation project involving nursing and dietetic lead facilitators

This case study presents a project conducted within a large tertiary hospital in Australia which aimed to improve the care and outcomes for older adults at risk of malnutrition. As with many such projects there was a dual purpose of improving practice but also adding to the science of knowledge translation. We used a staggered approach known as the stepped wedge design which allowed the project to be rolled out to a large number of wards as a staged process. This assisted with the logistical and practical issues that are encountered with such a large study (Hussey and Hughes, 2007). Four teams each with the responsibility of managing six to seven wards were established. We provide an overview of the project including the impetus to conduct the study and a detailed description of the study design and facilitation strategies. We include a description of the interventions that were used and evaluation of both processes and outcomes. The chapter concludes with a discussion of the lessons learnt, particularly with regard to the stepped wedge design and the advantages of working with experienced local facilitators.