Australian Residential Aged Care Facilities Research Articles

Surveillance of Antimicrobial Use in Long-Term Care Facilities: An Antimicrobial Mapping Survey

ObjectivesTo explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. DesignVoluntary, online cross-sectional survey. Setting and ParticipantsThe survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. MethodsThe survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. ResultsOf the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Conclusions and ImplicationsAntimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.

Diabetes in residential aged care: Pharmacological management and concordance with clinical guidelines.

Existing studies have highlighted suboptimal diabetes management in residential aged care facilities (RACFs). However, understanding of diabetes management in Australian metropolitan RACFs has been limited. This retrospective cohort study aimed to explore the pharmacological management of diabetes in 25 RACFs in Sydney Australia and assess concordance with clinical practice guidelines (CPGs). Data from 231 permanent RACF residents aged ≥65 years and over with type 2 diabetes mellitus over the period from 1 July 2016 to 31 December 2019 were used. Concordance was measured by assessing the medications and medical history data for each individual resident for concordance with evidence-based CPGs. Multivariable logistic regression was used to estimate the effect of resident characteristics on concordance with CPGs. Of the 231 residents with diabetes, 87 (38%) were not taking any antidiabetic medication. Pharmacological management inconsistent with CPG recommendations was observed for 73 (32%) residents, with the most common reason for non-concordance being the use of medications with significant adverse effects in older adults (47, 2%). Residents with hypertension or other heart diseases in addition to their diabetes had greater odds of their diabetes management being non-concordant with CPGs (OR = 2.84 95% CI = 1.54, 5.3 and OR = 2.64, 95% CI = 1.07, 6.41, respectively). Pharmacological diabetes management in metropolitan Australian RACFs is suboptimal, with a high prevalence of inconsistency with CPGs (32%) observed. Additionally, having hypertension or heart diseases significantly increased the possibility of non-concordance among diabetic RACF residents. Further investigation into the underlying relationships with comorbidities is required to develop better strategies.

Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study.

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

Australian Residential Aged Care Facilities Managers’ and Nurses’ Experiences In Implementing Telehealth and Social Connection During COVID-19

Introduction: Residential aged care facility (RACF) residents are highly vulnerable to severe infection and death from COVID-19. During the pandemic, telehealth (telephone and video) provided a mechanism to deliver for health care and social support. We examined logistical factors associated with telehealth, reasons for its use and barriers associated with the choice of telehealth. Methods: A mixed method exploratory study. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using a hybrid framework approach; deductive analysis followed by inductive analysis for sub-themes. Results: Participants (n=19) reported an increase in telehealth use during COVID-19. Organisations bought new equipment, predominately tablets; half had internet connectivity difficulties; nurses used personal devices to overcome connectivity issues or inadequate devices and 74% used three or more platforms/software. Few residents had personal digital devices or could connect with family and friends alone. Five key sub-themes emerged from qualitative data. 1. Needing and persisting with telehealth. RACFs had limited video telehealth use before COVID-19. 2. Being dependent on health providers offering telehealth services. Telehealth was used for a broad range of services. However, many health providers did not offer telehealth consultations. 3 Residents living with dementia. Telehealth was suitable for residents with dementia, depending on the disease stage and clinical need. 4. Challenges with implementing telehealth consultations. Most challenges pertained to workflows. 5. Suitability of videoconferencing for social connection. Staff supported residents with video calls which were highly valued. Conclusion: To capitalise on and sustain telehealth activity in RACFs, further guidance and support to overcome operational barriers are required.

Comparison of polypharmacy and potentially inappropriate medication use in older adults with and without dementia receiving residential medication management reviews.

Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR. A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD-10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia. Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p < .001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22-1.41, p < .001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73-2.04, p < .001). In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia.

Simplifying medication regimens for residents of aged care facilities: Pharmacist and physician use of a structured five-step medication simplification tool

BackgroundPharmacist-led medication regimen simplification using a structured approach can reduce unnecessary medication regimen complexity in residential aged care facilities (RACFs), but no studies have investigated simplification by different health professionals, nor the extent to which simplification is recommended during comprehensive medication reviews. ObjectivesTo compare medication regimen simplification opportunities identified by pharmacists, general medical practitioners (GPs), and geriatricians and to determine if pharmacists identified simplification opportunities during routinely conducted comprehensive medication reviews in RACFs for these same residents. MethodsThree pharmacists, three GPs and three geriatricians independently applied the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) to medication data for 83 residents taking medications at least twice daily. Interrater agreement was calculated using Fleiss's kappa. Pharmacist medication review reports for the same 83 residents were then examined to identify if the pharmacists conducting these reviews had recommended any of the simplification strategies. ResultsOverall, 77 residents (92.8 %) taking medications at least twice daily could have their medication regimen simplified by at least one health professional. Pharmacists independently simplified 53.0–77.1 % of medication regimens (Κ = 0.60, 95%CI 0.46–0.75, indicating substantial agreement), while GPs simplified 74.7–89.2 % (Κ = 0.44, 95%CI 0.24–0.64, moderate agreement) and geriatricians simplified 41.0–66.3 % (Κ = 0.30, 95%CI 0.16–0.44, fair agreement). No simplification recommendations were included in the reports previously prepared by pharmacists as part of the comprehensive medication reviews undertaken for these residents. ConclusionPharmacists, GPs, and geriatricians can all identify medication regimen simplification opportunities, although these opportunities differ within and between professional groups. Although opportunities to simplify medication regimens during comprehensive medication reviews exist, simplification is not currently routinely recommended by pharmacists performing these reviews in Australian RACFs.

Exploring occupational therapy practice in Australian residential aged care facilities: A cross-sectional survey.

Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.

National Trends in Antidepressant Use in Australian Residential Aged Care Facilities (2006–2019)

ObjectivesAntipsychotics have been the focus of reforms for improving the appropriateness of psychotropic medicine use in residential aged care facilities (RACFs). Comprehensive evaluation of antidepressant use in RACFs is required to inform policy and practice initiatives targeting psychotropic medicines. This study examined national trends in antidepressant use among older people living in RACFs from 2006 to 2019. DesignNational repeated cross-sectional study. Setting and ParticipantsIndividuals aged 65 to 105 years who were permanent, long-term (≥100 days) residents of Australian RACFs between January 2006 and December 2019 were included. MethodsAnnual age- and sex-adjusted antidepressant prevalence rates and defined daily doses (DDDs) supplied per 1000 resident-days from 2006 to 2019 were determined. Age- and sex-adjusted prevalence rate ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson and negative binomial regression models. ResultsA total of 779,659 residents of 3371 RACFs were included (786,227,380 resident-days). Overall, antidepressant use increased from 46.1% (95% CI, 45.9–46.4) in 2006 to 58.5% (95% CI, 58.3–58.8) of residents in 2019 (aRR, 1.02; 95% CI, 1.02–1.02). Mirtazapine use increased from 8.4% (95% CI, 8.2–8.5) to 20.9% (95% CI, 20.7–21.1) from 2006 to 2019 (aRR, 1.07; 95% CI, 1.07–1.07). Antidepressant use increased from 350.3 (95% CI, 347.6–353.1) to 506.0 (95% CI, 502.8–509.3) DDDs/1000 resident-days (aRR, 1.03; 95% CI, 1.03–1.03), with mirtazapine utilization increasing by 6% annually (aRR, 1.06; 95% CI, 1.06–1.06). Conclusions and ImplicationsThis nationwide study identified a substantial increase in antidepressant use among residents of Australian RACFs, largely driven by mirtazapine. With nearly 3 in every 5 residents treated with an antidepressant in 2019, findings highlight potential off-label use and suggest that interventions to optimize care are urgently needed.

Extracting Symptoms of Agitation in Dementia from Free-Text Nursing Notes Using Advanced Natural Language Processing.

Nursing staff record observations about older people under their care in free-text nursing notes. These notes contain older people's care needs, disease symptoms, frequency of symptom occurrence, nursing actions, etc. Therefore, it is vital to develop a technique to uncover important data from these notes. This study developed and evaluated a deep learning and transfer learning-based named entity recognition (NER) model for extracting symptoms of agitation in dementia from the nursing notes. We employed a Clinical BioBERT model for word embedding. Then we applied bidirectional long-short-term memory (BiLSTM) and conditional random field (CRF) models for NER on nursing notes from Australian residential aged care facilities. The proposed NER model achieves satisfactory performance in extracting symptoms of agitation in dementia with a 75% F1 score and 78% accuracy. We will further develop machine learning models to recommend the optimal nursing actions to manage agitation.

Who speaks my language? Linguistic diversity among people living in Australian residential aged care facilities.

Australia's migration programs mean that an increasing number of people living in residential aged care (RAC) were born in a non-main English-speaking country (NMESC) and have a preferred language other than English (LOTE). This study describes the number of such residents in aged care facilities in Australia and discusses the implications for their care. This study presents a secondary analysis of the Australian Institute of Health and Welfare (AIHW) National Aged Care Data Clearinghouse 2020-2021 to examine the country of birth and preferred language of people living in RAC in each state and territory and the number of residents who are lone speakers of their language in their facility. Less than half (45 per cent) of the residents born in a NMESC had a preferred LOTE. Of those, 50 per cent spoke Italian, Greek or Cantonese. At least 60 other preferred languages were recorded, the majority with very few speakers. Australia-wide, more than one in five residents with a preferred top 20 LOTE are the lone speaker of their language in their facility. The proportion of lone speakers is highest in Tasmania, the ACT and Queensland. Understanding the extent of language diversity, location and linguistic isolation of people living in RAC is essential for planning to ensure residents with a preferred LOTE receive high-quality, individualised care. There is a need for consistent and timely data collection about the diversity of aged care residents and workers in this sector.

A Five-Step Workflow to Manually Annotate Unstructured Data into Training Dataset for Natural Language Processing.

Natural Language Processing (NLP) is a powerful technique for extracting valuable information from unstructured electronic health records (EHRs). However, a prerequisite for NLP is the availability of high-quality annotated datasets. To date, there is a lack of effective methods to guide the research effort of manually annotating unstructured datasets, which can hinder NLP performance. Therefore, this study develops a five-step workflow for manually annotating unstructured datasets, including (1) annotator training and familiarising with the text corpus, (2) vocabulary identification, (3) annotation schema development, (4) annotation execution, and (5) result validation. This framework was then applied to annotate agitation symptoms from the unstructured EHRs of 40 Australian residential aged care facilities. The annotated corpus achieved an accuracy rate of 96%. This suggests that our proposed annotation workflow can be used in manual data processing to develop annotated training corpus for developing NLP algorithms.

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.

Acupressure Intervention Program for Older Adults in Australian Residential Aged Care Facilities: A Qualitative Evaluation.

The current study explored participants' experiences and perceptions of receiving acupressure within an Australian aged care context. Participants were older adults living in three residential aged care facilities who had received an acupressure intervention. Data were collected using semi-structured interviews and analyzed using a thematic approach. Twelve participants (10 females and two males) were interviewed. Four major themes emerged: Having Better Sleep, Feeling Calm and Relaxed, Promoting Well-Being and Functional Status, and Acceptability of Acupressure. Participants' perception of the acupressure was positive, as participants found acupressure to be beneficial for the improvement of sleep, mood, and general well-being. Participants' overall perception supports the acceptability of acupressure and suggests acupressure may be beneficial for improving sleep, relaxation, and well-being in older adults. [Journal of Gerontological Nursing, 50(1), 30-36.].

Food, nutrition and the dining experience in aged care settings: Findings of a nationwide survey.

Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.

Excess mortality in residents of aged care facilities during COVID-19 in Australia, 2019-22.

To date, the excess mortality experienced by residential aged care facility (RACF) residents related to COVID-19 has not been estimated in Australia. This study examined (i) the historical mortality trends (2008-09 to 2021-22) and (ii) the excess mortality (2019-20 to 2021-22) of Australian RACF residents. A retrospective population-based study was conducted using the Australian Institute of Health and Welfare's GEN website data (publicly available aged care services information). Non-Aboriginal, older (≥65 years old) RACF residents between 2008-09 and 2021-22 were evaluated. The observed mortality rate was estimated from RACF exits compared with the RACF cohort yearly. Direct standardization was employed to estimate age-standardized mortality rates and 95% CIs. Excess mortality and 95% prediction intervals (PIs) for 2019-20 to 2021-22 were estimated using four negative binomial (NB) and NB generalized additive models and compared. The age-standardized mortality rate in 2018-19 was 23 061/100 000 residents (95% CI, 22 711-23 412). This rate remained similar in 2019-20 (23 023/100 000; 95% CI, 22 674-23 372), decreased in 2020-21 (22 559/100 000; 95% CI, 22 210-22 909) and increased in 2021-22 (24 885/100 000; 95% CI, 24 543-25 227). The mortality rate increase between 2020-21 and 2021-22 was observed in all age and sex groups. All models yielded excess mortality in 2021-22. Using the best-performing model (NB), the excess mortality for 2019-20 was -160 (95% PI, -418 to 98), -958 (95% PI, -1279 to -637) for 2020-21 and 4896 (95% PI, 4503-5288) for 2021-22. In 2021-22, RACF residents, who represented <1% of the population, experienced 21% of the Australian national excess mortality (4896/22886). As Australia adjusts to COVID-19, RACF residents remain a population vulnerable to COVID-19.

Afterhours telehealth in Australian residential aged care facilities: a mixed methods evaluation

BackgroundThe aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs.MethodsUsing the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents.ResultsMost calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications.ConclusionsThe afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.

Identifying barriers and enablers to participation in infection surveillance in Australian residential aged care facilities

BackgroundInfection surveillance is a vital part of infection prevention and control activities for the aged care sector. In Australia there are two currently available infection and antimicrobial use surveillance programs for residential aged care facilities. These programs are not mandated nor available to all facilities. Development of a new surveillance program will provide standardised surveillance for all facilities in Australia.MethodsThis study aimed to assess barriers and enablers to participation in the two existing infection and antimicrobial use surveillance programs, to improve development and implementation of a new program. A mixed-methods study was performed. Aged Care staff involved in infection surveillance were invited to participate in focus groups and complete an online survey comprising 17 items. Interviews were transcribed and analysed using the COM-B framework.ResultsTwenty-nine staff took part in the focus groups and two hundred took part in the survey. Barriers to participating in aged care infection surveillance programs were the time needed to collect and enter data, competing priority tasks, limited understanding of surveillance from some staff, difficulty engaging clinicians, and staff fatigue after the COVID-19 pandemic. Factors that enabled participation were previous experience with surveillance, and sharing responsibilities, educational materials and using data for benchmarking and to improve practice.ConclusionStreamlined and simple data entry methods will reduce the burden of surveillance on staff. Education materials will be vital for the implementation of a new surveillance program. These materials must be tailored to different aged care workers, specific to the aged care context and provide guidance on how to use surveillance results to improve practice.

Assessing implementation fidelity of an on-site pharmacist intervention within Australian residential aged care facilities: A mixed methods study

BackgroundAn on-site pharmacist (OSP) intervention was implemented which sought to improve medication management within residential aged care facilities (RACFs) in the Australian Capital Territory, Australia. The objectives of this mixed methods study were to evaluate the implementation fidelity of the OSP intervention and to determine the moderating factors which influenced delivery of this intervention.MethodsThis convergent parallel mixed methods study was underpinned by Hasson’s conceptual framework for implementation fidelity. Implementation fidelity for seven intervention RACFs was quantitatively assessed using three quantitative data sets: (1) range of OSP intervention activities delivered; (2) random sample of 10% of medication reviews assessed for quality; (3) proportion of residents who received at least one medication review. Semi-structured interviews (n = 14) with managers and OSPs across the intervention RACFs were conducted to identify moderating factors which may have influenced OSP intervention delivery.ResultsThe OSP intervention was generally delivered as intended with overall medium levels of implementation fidelity. This delivery was supported by a range of facilitation strategies with most participants perceiving that the intervention was delivered to a high standard. RACF managers and OSPs were mostly well engaged and responsive. A number of potential barriers (including the part-time OSP role, COVID-19 pandemic, RACFs spread out over a large area with significant distance between resident dwellings) and facilitators (including the pharmacist support meetings, OSPs who took time to establish relationships, RACF managers who actively supported OSPs and worked with them) for OSP intervention delivery were identified which have potential implications for the roll out of OSPs within Australian RACFs.ConclusionIn this study, the implementation fidelity of OSP intervention delivery was assessed with overall medium levels of fidelity found across the intervention RACFs. This suggested that the OSP intervention can generally be delivered as intended in real world RACFs. OSP intervention delivery was influenced by a range of moderating factors, some of which posed barriers and others which facilitated the OSP intervention being delivered as intended.

Embedded on-site aged care pharmacists in Australia: Insights from early adopters of a new workforce model.

To explore the roles of early adopters of Australia's embedded on-site pharmacist model in supporting quality use of medications in residential aged care facilities (RACFs). Qualitative semistructured interviews were conducted with 15 pharmacists working as embedded on-site pharmacists, or beyond the scope of traditional consultant pharmacist roles in Australian RACFs. Interviews were audio-recorded, transcribed and thematically analysed independently by two investigators using an inductive approach. Deductive analysis was also undertaken using a knowledge broker framework: knowledge manager, linkage agent and capacity builder. Dominant themes were roles and benefits of embedded pharmacists, factors associated with success and challenges. Roles and benefits included (1) resident-level interventions and an enhanced ability to provide collaborative outcome-focussed resident-centred care, including timely input and follow-up, and improved relationships with residents, family and interdisciplinary team; and (2) system-level interventions such as contributing to clinical governance and quality improvement. Factors associated with success included personal capabilities and approach of the pharmacist, and organisational culture and sector-wide support. Challenges included pharmacist workforce shortages, perceived lack of pharmacist readiness and difficulty determining an appropriate service model. Deductive coding demonstrated roles of embedded pharmacists were consistent with all three activities of a knowledge broker. This study highlights the resident- and system-level roles and benefits of embedded on-site pharmacists, and provides a framework for defining this emerging workforce model in Australian RACFs.