144 Chapter 6 The developed CREATE-tool is a logical first step towards the implementation of CRE. However, this approach is new and needs to be studied. The aim of the current study is to explore the feasibility of applying the CREATE-tool in a clinical setting by investigating the following research questions: 1) does the CREATE-tool identify areas for improvement for wards regarding CRE, and 2) how do the users evaluate the process of application of the CREATE-tool? Method Study design This is an observational study. In the development of the CREATE-tool the results of previous studies concerning CRE were integrated. (7-10) Setting and participants Professionals of five wards of two geriatric rehabilitation providers in the Netherlands participated in this study. On each ward the team manager used purposive sampling to select 10 professionals from various disciplines to participate in this study in order to represent the interdisciplinary team. Study protocol After the development of the CREATE-tool, the protocol for this study consists of three phases: 1) rating phase, 2) team discussion phase, and 3) reporting phase. Development of the CREATE-tool The previous study on CRE resulted in a conceptualization of CRE in 5 clusters with a total of 70 statements. (7) The number of statements per cluster varied between 4 and 20. These statements were used to develop the CREATE-tool, and a short description was made for each statement. Each statement could be rated according to the Plan, Do, Check, Act (PDCA) methodology, in order to assess the current situation on the ward. (14-16) Also, a short description was made for all PDCA elements (Appendix 1). The PDCA rating was chosen because it represents the four steps for improvement. The four rating categories are meaningful and dynamic and facilitate a discussion about the context instead of the rating.
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