scholarly journals Process evaluation for the Care Homes Independent Pharmacist Prescriber Study (CHIPPS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda Birt ◽  
Lindsay Dalgarno ◽  
David J Wright ◽  
Mohammed Alharthi ◽  
Jackie Inch ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Care Homes ◽  
Structured Interviews ◽  
Medicines Management ◽  
Care Home Staff ◽  
Care Plans

Abstract Background Medicines management in care homes requires significant improvement. CHIPPS was a cluster randomised controlled trial to determine the effectiveness of integrating pharmacist independent prescribers into care homes to assume central responsibility for medicines management. This paper reports the parallel mixed-methods process evaluation. Method Intervention arm consisted of 25 triads: Care homes (staff and up to 24 residents), General Practitioner (GP) and Pharmacist Independent Prescriber (PIP). Data sources were pharmaceutical care plans (PCPs), pharmacist activity logs, online questionnaires and semi-structured interviews. Quantitative data were analysed descriptively. Qualitative data were analysed thematically. Results were mapped to the process evaluation objectives following the Medical Research Council framework. Results PCPs and activity logs were available from 22 PIPs. Questionnaires were returned by 16 PIPs, eight GPs, and two care home managers. Interviews were completed with 14 PIPs, eight GPs, nine care home managers, six care home staff, and one resident. All stakeholders reported some benefits from PIPs having responsibility for medicine management and identified no safety concerns. PIPs reported an increase in their knowledge and identified the value of having time to engage with care home staff and residents during reviews. The research paperwork was identified as least useful by many PIPs. PIPs conducted medication reviews on residents, recording 566 clinical interventions, many involving deprescribing; 93.8% of changes were sustained at 6 months. For 284 (50.2%) residents a medicine was stopped, and for a quarter of residents, changes involved a medicine linked to increased falls risk. Qualitative data indicated participants noted increased medication safety and improved resident quality of life. Contextual barriers to implementation were apparent in the few triads where PIP was not known previously to the GP and care home before the trial. In three triads, PIPs did not deliver the intervention. Conclusions The intervention was generally implemented as intended, and well-received by most stakeholders. Whilst there was widespread deprescribing, contextual factors effected opportunity for PIP engagement in care homes. Implementation was most effective when communication pathways between PIP and GP had been previously well-established. Trial registration The definitive RCT was registered with the ISRCTN registry (registration number ISRCTN 17847169).

scholarly journals 102 Process Evaluation Exploring the Delivery and Uptake of Posture and Mobility Training for Staff in Care Homes

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i34-i36
Author(s):  
R Williams ◽  
D Clarke ◽  
L Graham ◽  
R Hawkins ◽  
B Cundill ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Care Homes ◽  
Positive Interaction ◽  
Complex Needs ◽  
Care Home Staff ◽  
Mobility Training ◽  
Randomised Controlled

Abstract Introduction Provision of care for care home residents with complex needs is challenging. Physiotherapists can play a major role in enhancing the confidence, skills and abilities of care home staff. The Skilful Care Training Package (SCTP) aims to provide staff with an understanding of good posture and training in skilled facilitation of movement. This process evaluation explored barriers and facilitators to delivery and uptake of the SCTP within the context of a feasibility cluster randomised controlled trial (cRCT) in 10 care homes. Methods A mixed methods process evaluation, incorporating non-participant observations and interviews, conducted in the five care homes receiving the SCTP intervention. Interviews were audio recorded and transcribed verbatim; resident conversations were captured via a Dictaphone and/or field-notes. Data analysis used the Framework approach. Results Fourteen staff training sessions were observed. Interviews with 22 staff and four trainers, and 13 conversations with residents were completed. Five factors influenced delivery and uptake of the SCTP:Organisational factors: strategies to publicise and facilitate access to training improved attendance; a convenient training location and trainer flexibility encouraged attendance and staff engagement.Intervention delivery: a practical participatory element to the training was highly valued; adapting the training to meet the needs of the homes was well-received.Engagement and interaction: relating training to workplace and residents’ experiences engaged staff; high levels of engagement and positive interaction within the training sessions were reported; challenges relating to staff hierarchy affected training delivery in some homes.Intervention content: posture and mobility elements were seen as important; however, some repetition with prior training was highlighted.Training impact: there were indications that staff adopted SCTP techniques. Staff reported an increase in their wellbeing and confidence in movement facilitation; cascade training was reported in some homes. Conclusions Training was well-received, and feedback on its impact was largely positive. Practical elements were viewed favourably over classroom-based learning. Intervention content should be revised to optimise focus and avoid overlap with other training.

scholarly journals Protocol for the process evaluation of a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of independent pharmacist prescribing in care home: the CHIPPS study

2020 ◽  
Author(s):  
Christine Bond ◽  
Richard Holland ◽  
David Alldred ◽  
Antony Arthur ◽  
Garry Baton ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Outcome Data ◽  
Care Homes ◽  
Main Trial ◽  
Independent Prescribing ◽  
Gp Care

Abstract Background: Prescribing, monitoring and administration of medicines in care homes could be improved. A cluster RCT is ongoing to evaluate the effectiveness of an independent prescribing pharmacist assuming responsibility for medicines management in care homes compared to usual care. Aims and Objectives: To conduct a mixed methods process evaluation of the RCT, in line with MRC process evaluation guidance, to inform interpretation of main trial findings and if the service is found to be effective and efficient, to inform subsequent implementation. Objectives:1. To describe the intervention as delivered in terms of quality, quantity, adaptations and variations across triads and time. 2. To explore the effects of individual intervention components on the primary outcomes.3. To investigate the mechanisms of action. 4. To describe the perceived effectiveness of relevant intervention components (including PIP training and care home staff training) from participant (GP, care home, PIP and resident/relative) perspectives.5. To describe the characteristics of GP, care home, PIP and resident participants to assess reach.6. To estimate the extent to which intervention delivery is normalised among the intervention healthcare professionals and related practice staff.Methods: A mix of quantitative (surveys, record reviews) and qualitative (interviews) approaches will be used to collect data on the extent of the delivery of detailed tasks required to implement the new service, to collect data to confirm the mechanism of action as hypothesised in the logic model, to collect explanatory process and final outcome data, and data on contextual factors which could have facilitated or hindered effective and efficient delivery of the service. Discussion: Recruitment is ongoing and the trial should complete in early 2020. The systematic and comprehensive approach that is being adopted will ensure data is captured on all aspects of the study, and allow a full understanding of the implementation of the service and the RCT findings. With so many interrelated factors involved it is important that a process evaluation is undertaken to enable us to identify which elements of the service were deemed to be effective, explain any differences seen, and identify enablers, barriers and future adaptions. Trial Registration ISRCTN 17847169 Date registered: 15/12/2017Link: http://www.isrctn.com/ISRCTN17847169

scholarly journals Exploring the role of external experts in supporting staff to implement psychosocial interventions in care home settings: results from the process evaluation of a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Claire A. Surr ◽  
Emily Shoesmith ◽  
Alys W. Griffiths ◽  
Rachael Kelley ◽  
Joanne McDermid ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Care Home ◽  
Psychosocial Interventions ◽  
Care Homes ◽  
Successful Implementation ◽  
Care Home Staff ◽  
People With Dementia ◽  
External Expert ◽  
Expert Support

Abstract Background Psychosocial interventions offer opportunities to improve care for people with dementia in care homes. However, implementation is often led by staff who are not well prepared for the role. Some interventions use external experts to support staff. However little is known about external expert, care home staff and manager perceptions of such support. This paper addresses this gap. Methods Multi-methods study within a process evaluation of a cluster randomised controlled trial of Dementia Care Mapping™ (DCM). Interviews were conducted with six external experts who also completed questionnaires, 17 care home managers and 25 care home staff responsible for DCM implementation. Data were analysed using descriptive statistics and template analysis. Results Three themes were identified: the need for expert support, practicalities of support and broader impacts of providing support. Expert support was vital for successful DCM implementation, although the five-days provided was felt to be insufficient. Some homes felt the support was inflexible and did not consider their individual needs. Practical challenges of experts being located at a geographical distance from the care homes, limited when and how support was available. Experts gained knowledge they were able to then apply in delivering DCM training. Experts were not able to accurately predict which homes would be able to implement DCM independently in future cycles. Conclusions An external expert may form a key component of successful implementation of psychosocial interventions in care home settings. Future research should explore optimal use of the expert role.

scholarly journals Staff experiences of implementing Dementia Care Mapping to improve the quality of dementia care in care homes: a qualitative process evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alys Wyn Griffiths ◽  
Olivia C. Robinson ◽  
Emily Shoesmith ◽  
Rachael Kelley ◽  
Claire A. Surr
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Care Home ◽  
Dementia Care ◽  
Practice Change ◽  
Care Homes ◽  
Complex Nature ◽  
Care Home Staff ◽  
Care Mapping ◽  
Dementia Care Mapping

Abstract Background Dementia Care Mapping™ (DCM) is a widely used, staff-led, psychosocial intervention to support the implementation of person-centred care. Efficacy evaluations in care homes have produced mixed outcomes, with implementation problems identified. Understanding the experiences of staff trained to lead DCM implementation is crucial to understanding implementation challenges, yet this has rarely been formally explored. This study aimed to examine the experiences of care home staff trained to lead DCM implementation, within a large cluster randomised controlled trial. Methods Process evaluation including, semi-structured interviews with 27 trained mappers from 16 intervention allocated care homes. Data were analysed using template variant of thematic analysis. Results Three main themes were identified 1) Preparedness to lead - While mappers overwhelmingly enjoyed DCM training, many did not have the personal attributes required to lead practice change and felt DCM training did not adequately equip them to implement it in practice. For many their expectations of the mapper role at recruitment contrasted with the reality once they began to attempt implementation; 2) Transferring knowledge into practice – Due to the complex nature of DCM, developing mastery required regular practice of DCM skills, which was difficult to achieve within available time and resources. Gaining engagement of and transferring learning to the wider staff team was challenging, with benefits of DCM largely limited to the mappers themselves, rather than realised at a care home level; and 3) Sustaining DCM - This required a perception of DCM as beneficial, allocation of adequate resources and support for the process which was often not able to be provided, for the mapper role to fit with the staff member’s usual duties and for DCM to fit with the home’s ethos and future plans for care. Conclusions Many care homes may not have staff with the requisite skills to lead practice change using DCM, or the requisite staffing, resources or leadership support required for sustainable implementation. Adaptations to the DCM tool, process and training may be required to reduce its complexity and burden and increase chances of implementation success. Alternatively, models of implementation not reliant on care home staff may be required.

scholarly journals Using advance and emergency care plans during transfer decisions: A grounded theory interview study with care home staff

2021 ◽  
pp. 026921632110593
Author(s):  
Fawn Harrad-Hyde ◽  
Natalie Armstrong ◽  
Chris Williams
Keyword(s):  
Grounded Theory ◽  
Care Home ◽  
Care Homes ◽  
Structured Interviews ◽  
Care Home Staff ◽  
Care Plans ◽  
Modifiable Factors ◽  
Advance Care ◽  
The Moment ◽  
Staff Experiences

Background: Advance care planning has been identified as one of few modifiable factors that could reduce hospital transfers from care homes. Several types of documents may be used by patients and clinicians to record these plans. However, little is known about how plans are perceived and used by care home staff at the time of deterioration. Aim: To describe care home staff experiences and perceptions of using written plans during in-the-moment decision-making about potential resident hospital transfers. Design: Qualitative semi-structured interviews analysed using the Straussian approach to grounded theory. Setting/participants: Thirty staff across six care homes (with and without nursing) in the East and West Midlands of England. Results: Staff preferred (in principle) to keep deteriorating residents in the care home but feared that doing so could lead to negative repercussions for them as individuals, especially when there was perceived discordance with family carers’ wishes. They felt that clinicians should be responsible for these plans but were happy to take a supporting role. At the time of deterioration, written plans legitimised the decision to care for the resident within the home; however, staff were wary of interpreting broad statements and wanted plans to be detailed, specific, unambiguous, technically ‘correct’, understood by families and regularly updated. Conclusions: Written plans provide reassurance for care home staff, reducing concerns about personal and professional risk. However, care home staff have limited discretion to interpret plans and transfers may occur if plans are not specific enough for care home staff to use confidently.

scholarly journals Protocol for the process evaluation of a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of independent pharmacist prescribing in care home: the CHIPPS study

2019 ◽  
Author(s):  
Christine Bond ◽  
Richard Holland ◽  
David Alldred ◽  
Antony Arthur ◽  
Garry Baton ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Outcome Data ◽  
Care Homes ◽  
Main Trial ◽  
Independent Prescribing ◽  
Gp Care

Abstract Background Prescribing, monitoring and administration of medicines in care homes could be improved. A cluster RCT is ongoing to evaluate the effectiveness of an independent prescribing pharmacist assuming responsibility for medicines management in care homes compared to usual care. Aims and Objectives To conduct a mixed methods process evaluation of the RCT, in line with MRC process evaluation guidance, to inform interpretation of main trial findings and if the service is found to be effective and efficient, to inform subsequent implementation. Objectives 1. To describe the intervention as delivered in terms of quality, quantity, adaptations and variations across triads and time. 2. To explore the effects of individual intervention components on the primary outcomes. 3. To investigate the mechanisms of action. 4. To describe the perceived effectiveness of relevant intervention components (including PIP training and care home staff training) from participant (GP, care home, PIP and resident/relative) perspectives. 5. To describe the characteristics of GP, care home, PIP and resident participants to assess reach. 6. To estimate the extent to which intervention delivery is normalised among the intervention healthcare professionals and related practice staff. Methods A mix of quantitative (surveys, record reviews) and qualitative (interviews) approaches will be used to collect data on the extent of the delivery of detailed tasks required to implement the new service, to collect data to confirm the mechanism of action as hypothesised in the logic model, to collect explanatory process and final outcome data, and data on contextual factors which could have facilitated or hindered effective and efficient delivery of the service. Discussion Recruitment is ongoing and the trial should complete in early 2020. The systematic and comprehensive approach that is being adopted will ensure data is captured on all aspects of the study, and allow a full understanding of the implementation of the service and the RCT findings. With so many interrelated factors involved it is important that a process evaluation is undertaken to enable us to identify which elements of the service were deemed to be effective, explain any differences seen, and identify enablers, barriers and future adaptions.

scholarly journals The Contribution of Pharmacists and Pharmacy Technicians to Person-Centred Care within a Medicine’s Optimisation in Care Homes Service: A Qualitative Evaluation

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 34
Author(s):  
Sally Fowler Davis ◽  
Rachel Cholerton ◽  
Louise Freeman-Parry ◽  
Jo Tsoneva
Keyword(s):  
Care Home ◽  
Pharmacy Practice ◽  
Qualitative Evaluation ◽  
Care Homes ◽  
Framework Analysis ◽  
Medicines Management ◽  
Team Members ◽  
Care Home Staff ◽  
Management Interventions ◽  
Pharmacy Technicians

Pharmacists and pharmacy technicians seek to improve person-centred care. Improvements to systems for care homes seeks to reduce medicines waste and inefficiency, particularly through supporting care home staff, to enhance safer administration of medicines. A complex evaluation used qualitative design and utilised narrative enquiry, and team members and key stakeholders were interviewed. Framework analysis was used, aligning findings to a person-centred care framework for older people. The Medicines Optimisation in Care Homes (MOCH) team brokered improvement practices across care homes to enhance person-centred care. The framework analysis confirms that the team used ‘authentic attention’ in relation to the residents’ experiences and flexibility in relation to negotiating medication. The importance of transparency of processes and systems in medicines management is highlighted, alongside requirements for person-centred care to make explicit the reason for taking a medication, and the continuous discussion with a range of stakeholders about the continuing need for particular medications. The outcome of the evaluation includes insights into a new area of pharmacy practice in community, based on the skills, knowledge, and experience of pharmacists and pharmacy technicians working in the care home sector. Further study is needed into the efficacy and outcomes of medicines management interventions.

scholarly journals Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e050665
Author(s):  
Jason Scott ◽  
Katie Brittain ◽  
Kate Byrnes ◽  
Pam Dawson ◽  
Stephanie Mulrine ◽  
...  
Keyword(s):  
Data Extraction ◽  
Care Home ◽  
Incident Reporting ◽  
Care Homes ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Safety Issues ◽  
Care Home Staff ◽  
Service Specification ◽  
The Impact

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

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