Evaluating the impact of a falls prevention community of practice in a residential aged care organisation

Falls in the residential aged care (RAC) sector are a global concern with humanitarian and economic consequences. Reducing falls using a multifactorial approach involving multidisciplinary staff is recommended, but it is not clear how RAC organisations in Australia can achieve this in a resource constrained environment. One potential solution is to develop a sustainable means of addressing falls prevention from within an organisation, creating a forum for staff to share ideas, expertise and achieve goals in a community of practice (CoP). The purpose of this research was to evaluate the impact of a falls prevention CoP on falls outcomes in a RAC setting. A mixed methods design framed by a realist approach was undertaken, to better understand how CoP interventions were influenced by current conditions (contexts) in triggering (mechanisms) the observed outcomes. Diverse data sources including surveys, electronic CoP discussion transcripts, semi-structured interviews and organisational falls data were used to triangulate findings. The CoP was mapped across three phases. Phase 1 described how the CoP was developed, then evaluated its establishment and operation across 13 geographically diverse RAC sites. In Phase 2 the CoP identified gaps in falls prevention practice using evidence-based audit and feedback, determining the areas for priority intervention. Phase 3 comprehensively evaluated the impact of CoP activity at three levels; member, site and organisation. Overall the CoP had a positive impact; members gained new peer connections and falls prevention knowledge, the proportion of residents supplemented with vitamin D improved significantly and a falls prevention policy and risk assessment tool were developed and implemented across the organisation. Management recognition and support were key mechanisms in achieving successful outcomes. Falls rates pre CoP were 10.1/1000 occupied bed days (OBD) compared with 10.9 /1000 OBD post CoP operation [coefficient 0.7, 95% CI (-33.5, 34.9) p = .967]. This was potentially confounded by an increased use of beds for short stay transition care services and identified differences in defining falls between sites. A downward trend in the rate of injurious falls resulting in fractures was observed (pre CoP 0.2/1000 OBD compared with 0.1/1000 OBD post CoP; [coefficient -0.3, 95% CI (-1.1, 0.4) p = .423]. As the prioritised CoP interventions required design and development, implementation only occurred towards the end of the research period meaning the intervention effect on falls outcomes may require longer term follow up. The CoP remains operational and is ideally positioned to continue to lead evidence-based falls prevention practice change as determined by its membership

Undergraduate reflective journaling in work integrated learning: Is it relevant to professional practice?

This paper presents the research findings from a study reviewing graduates’ opinions on completing online reflective journaling tasks during work integrated learning as an undergraduate. The study was divided into two parts with an initial focus group conducted with six physiotherapy graduates seven months following graduation. Findings from the focus group guided the development of a questionnaire sent to graduates nine months after course completion. Results from both the focus group and questionnaire (n = 25) highlighted the benefits of online, structured, assessed reflective writing tasks. Graduates provided specific examples of their personal and professional development and perceived benefits from undertaking reflective journaling during work integrated learning. These findings may have application across a wide variety of tertiary courses of study with work integrated learning incorporated into curriculum

Can a web-based community of practice be established and operated to lead falls prevention activity in residential care?

The aims of this study were to evaluate establishing and operating a web-based community of practice (CoP) to lead falls prevention in a residential aged care (RAC) setting. A mixed methods evaluation was conducted in two phases using a survey and transcripts from interactive electronic sources. Nurses and allied health staff (n = 20) with an interest in falls prevention representing 13 sites of an RAC organization participated. In Phase 1, the CoP was developed, and the establishment of its structure and composition was evaluated using determinants of success reported in the literature. In Phase 2, all participants interacted using the web, but frequency of engagement by any participant was low. Participatory barriers, including competing demands from other tasks and low levels of knowledge about information communication technology (ICT) applications, were identified by CoP members. A web-based CoP can be established and operated across multiple RAC sites if RAC management support dedicated time for web-based participation and staff are given web-based training

The effect of complex falls prevention interventions on falls in residential aged care settings: A systematic review protocol

The objective of this review is to synthesize the best available evidence on the effectiveness of complex falls prevention interventions on fall reductions in the residential aged care population, implemented at two or more of the following levels: organization, facility or resident. Specifically the review question is: What is the effect of complex falls prevention interventions on falls in residential aged care settings

Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting

Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents\u27 risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls

Designing and evaluating falls prevention education with residents and staff in aged care homes: A feasibility study

Purpose: The purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling. Design/methodology/approach: A two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries. Findings: A poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as “If I feel unwell, I\u27ll ring the bell” and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents\u27 exposure and engagement with the programme were identified, along with recommendations to improve feasibility. Practical implications: When developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions. Originality/value: The use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference

Evaluating the impact of operating a falls prevention community of practice on falls in a residential aged care setting

Background/Purpose: Falls are a leading adverse event in residential aged care (RAC) settings with prevention a global aim. The purpose of this study was to determine whether operating a falls prevention community of practice (CoP) delivering evidence-based prevention interventions could change the rate of falls and injurious falls in a RAC setting. Methods: A prospective quasi-experimental pre/post design was conducted. Participants were 13 RAC sites (779 beds) of a single RAC organization, with 20 multidisciplinary staff volunteering as CoP members. Results: Falls rates pre CoP were 10.1/1,000 occupied bed days (OBD) compared with 10.9 /1,000 OBD post CoP operation [coefficient 0.7, 95% CI -33.5, 34.9 (p=0.967)]. This was confounded by identified differences and changes in defining falls between sites. The rate of injurious falls resulting in fractures pre CoP was 0.2/1,000 OBD compared with 0.1/1,000 OBD post CoP; [coefficient -0.3, 95% CI -1.1, 0.4 (p=0.423)]. Conclusion: A falls prevention CoP operating for 18 months was unable to reduce falls rates in that time frame but there was a trend to a reduction in falls resulting in fracture. Additional time for implementation and evaluation of falls prevention interventions will be required in complex settings, such as RAC organizations, in the absence of additional funding. Valid comparisons of falls rates and injurious falls rates within the RAC population require the adoption of standardized definitions to improve reporting reliability

Evaluation of older people\u27s knowledge, awareness, motivation and perceptions about falls and falls prevention in residential aged care homes: A tale of two cities

Falls prevention strategies can only be effective in reducing falls amongst older people if they are adopted and enacted in their daily lives. There is limited evidence identifying what older people in residential aged care (RAC) homes understand about falls and falls prevention, or what may limit or enable their adoption of strategies. This study was conducted in two countries and explored older people’s knowledge and awareness of falls and their preferences, opportunities and motivation to undertake falls prevention strategies. A cross-sectional survey was administered to participants (N = 70) aged 65 years and over, living in six RAC homes in Perth, Australia and six RAC homes in Swansea, Wales, United Kingdom. Participants had limited knowledge about intrinsic falls risk factors and strategies to address these and frequently expressed self-blame regarding falling. Almost all (N = 67, 95.7%) participants felt highly motivated to maintain their current functional mobility and independence in everyday tasks. Key preferences for receiving falls prevention messages favoured a positive approach promoting wellness and independence (N = 41, 58.6%) via pictorial posters or brochures (N = 37, 52.9%) and small group discussions preferably with demonstrations (N = 18, 25.7%). Findings from this study may assist organisations and staff to more effectively engage with older people living in RAC about falls prevention and design targeted resources to address the motivations and preferences of this population

Designing and evaluating falls prevention education with residents and staff in aged care homes: a feasibility study

Purpose The purpose of this study was to co-design a falls prevention education programme with aged care home residents and staff and evaluate its feasibility. The intention of providing the education programme was to assist residents to stay safe and mobile whilst reducing their risk of falling. Design/methodology/approach A two-phase mixed methods participatory design using a resident (n = 6) and care staff (n = 5) consumer engagement panel, pre- and post-programme resident (n = 35) survey and semi-structured care staff interviews (n = 8) was undertaken in two countries. Findings A poster, brochure, video and staff education guide featuring 12 safety messages depicting fall prevention behaviours were co-designed. Residents, supported by staff, perceived the falls prevention education programme as enjoyable and informative, but there were no significant differences in capability, opportunity or motivation. However, several residents were observed enacting fall prevention behaviours such as “If I feel unwell, I'll ring the bell” and waiting for staff assistance. Challenges to programme demand, acceptability and implementation which may have impacted residents' exposure and engagement with the programme were identified, along with recommendations to improve feasibility. Practical implications When developing falls prevention education programmes partnering with residents and staff, providing choices to meet personal and aesthetic preferences along with frequent, shorter duration learning opportunities are important for translating education messages into actions. Originality/value The use of bespoke resources, novel rhymes, positive messages emphasising safety and co-designing with residents themselves was a welcomed point of programme difference

Partnering with patients to design a prehabilitation program for optimizing the patient experience through general surgery

The objective of this study was to explore patients’ experiences when preparing for and undergoing general surgery at a large tertiary hospital. Findings aimed to inform the development of a prehabilitation program to empower patients to optimize their recovery and enhance their experience of general surgery. A qualitative exploratory research approach was utilized. Patients (\u3e18 years) attending for elective general surgery between May and July 2018 were invited to participate. Four focus groups (n=18) and an interview were conducted to reach saturation. Deductive content analysis was used to map responses against theoretical determinants of health behavior change. Patients described their overall experience of general surgery as positive but provided key insights about the surgical journey that impacted their capability, opportunity and motivation to optimally engage and address their recovery. Interaction and information from health professionals, understanding expectations, timely access to treatment and support of family members greatly enhanced their experience. Lack of personalized exercise and nutrition prescriptions, access to shared patient experiences of the surgical journey and not being asked about personal goals were key inhibitors. Patients also expressed feelings of frustration and anxiety regarding hospital procedures, including repetitive gathering of information and poor communication across departments. Patients’ experiences of the surgical journey identified gaps that impacted their capability, opportunity and motivation to effectively prepare and rehabilitate, that could be addressed by a multimodal prehabilitation program. Intervention options at patient and policy level were identified for trial to enhance the patient experience of general surgery. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens