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

Abstract

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.

Evaluation of care staff knowledge, confidence, motivation and opportunity for preventing falls in residential aged care settings: A cross‐sectional survey

“…Technology development in the RAC sector is looking to provide low‐cost, asynchronous training options such as e‐learning accessed online, which will require staff to have computer literacy skills (Hanssen, Norheim, & Hanson, ). However, previous studies amongst nurses and allied health staff have identified that a technology usability gap exists (Francis‐Coad et al, ). Explanations for the usability gap may be linked to the age bracket of staff employed in RAC as predominantly 40–60 years meaning their exposure to technology is more limited (Hanssen et al, ).…”

“…This study reports on one aspect of a large mixed methods fall prevention project conducted in an Australian RAC organisation (Francis‐Coad, Etherton‐Beer, Bulsara, Nobre, & Hill, ). Briefly, the project evaluated how a group of interdisciplinary RAC staff with a common interest in falls prevention (community of practice) identified gaps in fall prevention practice (Francis‐Coad, Etherton‐Beer, Bulsara, Nobre, & Hill, ), prioritised goals collaboratively and implemented selected falls prevention strategies across the RAC organisation (Francis‐Coad, Etherton‐Beer, Bulsara, Blackburn, Chivers, & Hill, ). One of the identified gaps in practice was the lack of evidence‐based falls prevention education provided for care staff and unknown understanding of their fall prevention knowledge and education preferences.…”

“…Care provision included complex care for cognitive impairments, rehabilitation, palliation and respite. Findings from facility falls prevention activity audits (Francis‐Coad et al, , Etherton‐Beer, Bulsara, Nobre, & Hill, ) reported all care staff new to the RAC organisation received 2‐day mandatory orientation training. This included 4 hr of general manual handling skills and occupational health and safety processes.…”

Evaluating the impact of operating a falls prevention Community of Practice on falls in a residential aged care setting

“…During period three the CoP met via web-based discussion forums supported by face to face meetings to plan and conduct a falls prevention audit identifying gaps in practice. 20 In periods four, five and six the CoP developed and implemented falls prevention activities, where the CoP determined the timing and type of interventions that occurred (Table 1).…”

“…A falls prevention CoP was established, piloted and then operationalized across the RAC organization. 20 The falls prevention CoP was considered an intervention at organization level as it acted across all 13 RAC sites. Findings from the pilot study facilitated CoP operationalization and activity across the sites.…”