Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach

Jacqueline Francis-Coad,Anne-Marie Hill,Nicole Blackburn,Paola Chivers,Caroline Bulsara,Christopher Etherton-Beer

doi:10.1186/s12913-017-2790-2

Abstract

BackgroundFalls 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.MethodsA 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.).ResultsStaff 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.ConclusionsInterdisciplinary 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.

Highlights

Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture
RAC facility level Measurement of the impact of the community of practice (CoP) at facility level prioritised improving the proportion of residents supplemented with vitamin D and development of falls prevention education
Facility visiting GPs who related to RAC staff ( CoP members and Nurse Practitioners) as credible peers and advocated for the recommended evidence significantly improved their proportion of residents supplemented with vitamin D

Summary

Introduction

Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. A CoP was established to bring together RAC staff with an interest and goal in preventing falls with the intention of offering a social learning opportunity [19] and robustly evaluating its feasibility to facilitate translation of the current evidence using both objective outcomes and observed changes in health behaviour [24, 25]. The CoP was viewed as a complex intervention at the organisational level that could have differing impact across RAC facilities and the individual staff participating as members, dependent upon leadership, culture and staff behaviours [25,26,27] Evaluation using this realist approach could identify how the CoP influenced the observed outcomes in different contexts of its membership, the RAC facility and RAC organisation [26, 28, 29]

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