CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

After hospitalization, 1.5 million older adults each year receive post-acute care in skilled nursing facilities (SNF). Transitional care services, designed to prepare older SNF patients (and their family caregivers) for their transitions from a SNF to home, have rarely been studied. Thus, we conducted a longitudinal, multiple case study of transitional care provided in an SNF to explore the care processes and staff interaction strategies that SNF staff members used to optimize delivery of on transitional care. Using qualitative data from 89 interviews, 118 field observations, and 70 chart or document reviews, we observed that transitional care services were not solely formalized processes, but rather were embedded in the interactions among older adult patients, their family caregivers and members of interdisciplinary care teams. We found, moreover, that staff member interactions with patients and family caregivers increased the capacity of patient care teams for optimizing patient-centered care, information exchange, and coordination of transitional care.

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“…Connections, e.g., be approachable, pitch in, seek assistance, reciprocate, show appreciation, give respect, say thank you, coach/mentor 35 …”

Section: Tablementioning

confidence: 99%

“…Information exchange, e.g., listen, give and share information, receive information, explain, and verify the meaning of information 35 …”

Section: Tablementioning

confidence: 99%

Staff Interaction Strategies That Optimize Delivery of Transitional Care in a Skilled Nursing Facility

Toles

Barroso

Colón‐Emeric

et al. 2012

Family &Amp; Community Health

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“…Interactive, authentic education tailored to staff sub groups and accessible to all is recommended. 24,25 Both our results demonstrate that the process of evidence translation to practice was not complete.…”

Section: Discussionmentioning

confidence: 78%

Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Francis‐Coad

Etherton‐Beer

Bulsara

et al. 2017

Aust. Health Review

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Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice. What is known about the topic? Audit and feedback is an effective way of measuring clinical quality and safety. CoPs have been established in healthcare using workplace staff to address clinical problems but little is known about their ability to audit and influence practice change. What does this paper add? This study contributes to the body of knowledge on CoPs in healthcare by evaluating the performance of one in the domain of falls prevention audit action. What are the implications for practitioners? A CoP is an effective model to engage staff in the clinical audit process. Clinical audits can raise staff awareness of gaps in practice and motivate staff to plan and action change as recommended in best practice guidelines.

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“…Data quality was regularly assessed with a second data collection on a random 5% of resident records; inter-rater agreement exceeded 90% for all measures. 17 …”

Section: Methodsmentioning

confidence: 99%

Chronic kidney disease and recurrent falls in nursing home residents: A retrospective cohort study

et al. 2015

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This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH residents had CKD. In adjusted analyses, the incidence of recurrent falls was similar in those with and without CKD [fall rate ratio (FRR) 1.00, 95% confidence interval (CI) 0.97-1.02]. Orthostatic hypotension (FRR 1.52, 95% CI 1.12-2.05), history of falls during the prior six month period (FRR 1.25, 95% CI 1.05-1.49), cane or walker use (FRR 1.64, 95% CI 1.16-2.33), and ambulatory dysfunction (FRR 1.47, 95% CI 1.23-1.75) were independently associated with increased fall rate. CKD was not an important predictor of falls in this cohort of nursing home residents with prior falls. Instead, traditional fall risk factors were much more strongly associated with recurrent falls.

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CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

Cited by 40 publications

References 82 publications

Staff Interaction Strategies That Optimize Delivery of Transitional Care in a Skilled Nursing Facility

Staff Interaction Strategies That Optimize Delivery of Transitional Care in a Skilled Nursing Facility

Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Chronic kidney disease and recurrent falls in nursing home residents: A retrospective cohort study

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