Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

5.2 - Developing resources to support evidence-based practice

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The majority of training and educational resources were targeted at staff working directly with residents. In general, these built on existing resources, or else were based on a particular philosophy, in particular person-centred care. The resources were mainly educational training packages and CDs, designed to be used during the course of the EBPRAC project, as well as to serve as a resource for facilities once the project ended. One exception was the training resource developed by the nutrition and hydration project, which was produced as an outcome of that project.

A number of projects also targeted activities to families and carers who were the audience for a number of promotional resources, such as posters and leaflets, particularly evident in Round 1 projects. In addition, one of the behaviour management projects in Round 2 explicitly targeted families and carers of people with behaviours of concern and sought to introduce support groups within the facilities, with varying degrees of success. It was anticipated that the support groups could provide a venue for education and training, but predominantly would provide opportunities for mutual support with other families, and for families to contribute to the overall care of their family member’s behaviours of concern.

The majority of projects used existing assessment tools, with a number of these being modified to suit the context of residential aged care. The pain management project simplified the Resident's Verbal Brief Pain Inventory and developed a PRN sticker with a pain scale for pre- and post-assessment of analgesia. Similarly, the falls prevention project developed a survey to scope evidence-based practice within a facility based on the falls prevention guidelines, and the oral health project developed a pocket guide to undertaking oral health assessments. The three palliative care projects all refined tools, resources and clinical pathways which had been developed for use in acute and sub-acute palliative care, to be more relevant and user-friendly for staff in aged care. All three behaviour management projects used an existing purpose designed tool to evaluate the residential aged care environment – the Environmental Assessment Tool – with adaptations in particular projects.

Some projects were underpinned by particular approach to change management and developed resources to support its implementation and sustainability. One of the behaviour management projects used the Translating Evidence into Aged care Methods (TEAM) approach, which is a modified participatory action research method, and the falls prevention project developed guidelines for implementing action research. The Hammond Care behaviour management project included a distinct mentoring and guided reflective practice element in its training, the critical elements of which were articulated in its final report alongside potential funding models to enable its sustainability and broader application.

The section in the final report from each project about ‘new resources developed’ yielded a range of information, from details of major resources developed for use elsewhere to other, more minor, resources developed specifically for project use. Table 19 summaries the major resources developed by each project. In addition, each project developed various handouts, newsletters, flyers, brochures, presentations, assessment tools and audit tools, all designed specifically for their project and not necessarily intended for use elsewhere. Details of these resources have not been included in the table.

Table 19 Summary of resources to support evidence-based practice

Project title	Resources developed
NARI pain	A range of educational materials and a Principles of pain management and assessment workbook, one for nurses and one for personal carers. A tool for ascertaining the level of compliance of a facility against standards for the provision of best practice pain management.
UN nutrition	Tool Kit for Best Practice Nutrition and Hydration in Aged Care.
NARI falls	A web-based guide to implementing falls prevention interventions - Working together to prevent falls in residential aged care: resource package.
SA dental	Three educational resource portfolios, one for general practitioners and registered nurses; one for facilitators and one for facility staff.
DATIS meds	A complete set of resources for each of the three educational modules used in the project.
QUT wounds	RACF Wound Management Education and Self-evaluation Resource Package.
PW inf control	An Infection Control Collaborative Program Handbook developed at the beginning of the project.
MGPN pall care	Developing new resources was not a focus of this project.
NEVDGP pall care	Audit tools for self-assessment of use of end-of-life care pathway. Two education modules designed for delivery using academic detailing, for use with three audiences – general practitioners, nurses and personal carers.
UQ pall care	Palliative Approach Toolkit which includes three modules, one for managers; one on the key processes in a palliative approach and one on five domains of clinical care, supported by three self-directed learning packages and other educational material.
UTS behav	EN-ABLE Toolkit which includes comprehensive material on the EN-ABLE model, including CDs which provide electronic versions of presentations and tools.
HC behav	The project assembled a toolkit which includes information about environmental auditing, staff training, mentoring, family support and evaluation of outcomes.
MU behav	Two interactive e-learning CDs for provision of in-house education by facilities, supported by various documents, including a well-being checklist and policy audit tool.

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5.2.1 Generalisability of the resources produced by the projects

The resources produced by the EBPRAC projects generally fall into one of four groups:

1. Resources that are already available on the Internet for use by anyone e.g. the Principles of pain management and assessment workbook and Working together to prevent falls in residential aged care: resource package.
2. Resources developed for use as ‘stand alone’ entities, either whole ‘packages’ of resources or components of resource packages: the Tool Kit for Best Practice Nutrition and Hydration in Aged Care, the brochures and tip sheets from the wound management project, and the resources developed by the Monash University behaviour management project. These resources can be taken up and used by anyone.
3. Resources that, based on advice from the authors, should preferably be used by someone if they have some expertise in the area or the ability to access appropriate expertise e.g. the evidence summaries produced by the wound management project, the environmental audit tool used in the behaviour management projects, and the material on mentoring and establishment of family groups developed by the Hammond Care behaviour management project.
4. Resources that are designed for a specific purpose and should only be used for that purpose. Examples include the educational resources produced by the two projects that used academic detailing and the EN-ABLE Toolkit which has been designed for use as an integrated package.

Further details of the resources summarised in Table 19 and comments about the generalisability of those resources are included in Appendix 17.

The material from the oral health project in Round 1 formed the foundation for the national training package implemented as part of the Oral and Dental Health Care Plan for residential aged care and is by far the best example to date of resources from the EBPRAC program being generalised across residential aged care.

The tool developed as part of the pain management project to assess compliance with best practice pain management could be used by facilities but it is quite a complex task to undertake as the tool stands at present, requiring a good knowledge of evidence-based pain management. The tool is not currently available on the Internet as the other resources developed by this project are but it could be simplified for widespread use. However, this would require further work. The simplified tool could be used to assess quality of care and identify areas for improvement.

The team from the University of Queensland palliative care project recommend that the toolkit they developed (the Palliative Approach Toolkit) should be reviewed and updated every five years which is a sensible recommendation but one which would require ongoing investment of resources. No resources comparable to the Toolkit were developed by either of the other two palliative care projects. Given the ubiquitous nature of palliative care in residential aged care and the existence of the Guidelines for a palliative approach in residential aged care it is recommended that the guidelines (which are due for review) and the Toolkit are made widely available ‘in tandem’ within residential aged care. It is important that the updated guidelines and the Toolkit are compatible.

At the workshop involving the three palliative care projects that took place in Melbourne in July 2010 concern was raised about the capability within residential aged care to access and use web-based resources. Although this is a legitimate concern the sheer volume of resources produced by the EBPRAC program makes it almost inevitable that the most viable option for making those resources widely available is via the Internet – the cost of producing and distributing paper versions would be prohibitive.
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