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

Key Messages

Up to Publications

prev pageprev page| TOC |next page

The EBPRAC program represents the most comprehensive, coordinated, approach to implementing evidence-based practice in residential aged care undertaken in Australia, involving 13 projects working with facilities in 108 locations across six states. Previous work has been limited, generally undertaken on a small scale and within short timeframes.

Changes to the care received by residents as a result of the EBPRAC program were diverse. There were lots of small changes by many individuals, reflecting the capacity for small-scale change within residential aged care and the nature of evidence, which is never ‘fixed’ or certain. Overall, it was difficult to gauge the extent to which changes were implemented.

Improvements in resident outcomes were mixed. The best improvements for residents resulted from behaviour management and prevention strategies. About one third of intended outcomes for residents were achieved which, in part, is a reflection of how challenging it can be to measure outcomes.

About 7,000 people received some form of training during the program, resulting in improvements in awareness, confidence, knowledge and skills.

Impacts on facilities included improvements to the physical environment, better access to equipment and outside services, and improvements in key processes and systems of care.

Significant resources were developed in the form of training materials, tool kits and evidence summaries. It is important that these resources are made available throughout residential aged care in a way that does not add to the fragmented nature of resources already available.

The program objectives were ambitious; four of the seven objectives were met, one was partially met and two not met. This is a good result, given that it is too early to fully assess the extent to which some objectives were met.

A wide range of strategies were employed to implement evidence-based practice but with some common elements – a strong focus on education (primarily 1:1 or small-group and interactive), use of local facilitators, feedback of data to staff and provision of resources.

The results indicate that there are no ‘magic bullets’ for successful implementation, which is consistent with current knowledge about how to implement evidence-based practice. All projects adopted a multi-faceted approach to change, which is recognised as more effective than reliance on single strategies.

Residents had little influence on the design and implementation of each project. The focus was more on keeping residents informed rather than seeking their opinion about what should happen.

A very positive consequence of the program is that it has helped to bridge the ‘evidence gap’ by bringing researchers and practitioners together.

There were no adverse unintended consequences. Some variations to project scope and the pace of project implementation resulted in minor delays.

The major issue for the EBPRAC program is how to build on the lessons learnt and instil evidence-based practice throughout residential aged care. This should include consideration of issues such as linking evidence-based practice to existing systems of funding, accreditation, education and quality improvement. What is required is a more strategic approach that supports the ongoing development and implementation of evidence, at the same time as providing a receptive context for implementation to take place.

Feedback from those attending the EBPRAC workshops was very positive, indicating that workshop aims were met, that the workshops were a worthwhile use of time and an effective way of promoting networking and collaboration.

The lessons learnt during the EBPRAC program about how to implement evidence-based practice can be summarised in a series of ‘principles of practice change’:

• Leadership - without someone to lead change it is probably not worth starting. One person might be able to start the change but it takes more than one leader to keep going. Leadership does not have to come from managers but if that is the case it is important that managers support the change.
• Staff motivation - the motivation of individuals working in residential aged care is one of the ‘keys’ to successful implementation.
• Change advocates - involving the people who will be affected by any change is important. Strong advocates for change may come from staff who would not normally be considered change agents.
• Evidence - simply having ‘evidence’ is not sufficient. Staff will want to know whether the proposed changes ‘make sense’ and will work i.e. provide benefits for themselves, their colleagues or residents.
• Education - education is necessary but not sufficient to change the practices of those providing care to residents. Education needs to be done in tandem with other strategies and tailored to the knowledge, skills and literacy levels of staff. A ‘one size fits all’ approach to education is likely to be ineffective.
• Communication - informal communication such as conversations and impromptu meetings can be just as important as more formal means of communication.
• Capacity to change - the capacity to implement evidence-based practice in residential aged care is limited, resulting in change that is likely to take place ‘step by step’ and in small doses rather than change on a more radical scale.
• Planning - some form of plan for implementing evidence-based practice is generally a good idea, but there is a need for flexibility to cope with unpredictable events that can upset those plans.
• Resources - resources are required, usually in the form of resources to provide education or to ‘free up’ at least some staff time to support change.

prev pageprev page| TOC |next page