Evaluating the impact of a falls prevention community of practice in a residential aged care setting: A realist approach
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© 2018 The Author(s). Background: Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice. Methods: A convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.). Results: Staff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management. Conclusions: Interdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.
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Investigating the impact of a falls prevention community of practice in a residential aged-care setting: A mixed methods study protocolFrancis-Coad, J.; Etherton-Beer, C.; Bulsara, C.; Nobre, D.; Hill, Anne-Marie (2015)© 2015 John Wiley & Sons Ltd. Aim: The aim of this study was to facilitate the implementation and operation of a falls prevention Community of Practice in a residential aged-care organization and evaluate its effect on ...
A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilitiesHaralambous, B.; Haines, T.; Hill, Keith; Moore, K.; Nitz, J.; Robinson, A. (2010)Background. Falls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for ...
Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: A clinical auditFrancis-Coad, J.; Etherton-Beer, C.; Bulsara, C.; Nobre, D.; Hill, Anne-Marie (2017)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 ...