Setting Priorities to Inform Assessment of Care Homes’ Readiness to Participate in Healthcare Innovation: A Systematic Mapping Review and Consensus Process

Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.

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PP102 Developing A Contextually-Informed Deprescribing Intervention

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318002441 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 104-105

Author(s):

Charlene Ronquillo ◽

Ken Stein

Keyword(s):

Health Care Professionals ◽

Care Home ◽

Stakeholder Involvement ◽

Care Homes ◽

Successful Implementation ◽

Allied Health Professionals ◽

Home Setting ◽

Stakeholder Consultation ◽

Care Home Staff ◽

Local Stakeholder

Introduction:Deprescribing – a process for reducing or stopping drugs when the balance of benefits and harms may no longer be in a person's interests – is a key aspect of managing multimorbidity and polypharmcacy in older people. Several deprescribing interventions have been developed (e.g. in Australia and Canada), although significant challenges for successful implementation remain. Through key stakeholder consultation in the care home setting in South West England, we take the initial steps to develop a context-informed deprescribing approach. Engaging stakeholders from the outset gains insight into acceptability, feasibility, and relevance of deprescribing interventions developed elsewhere informing co-production of an effective, implementable approach.Methods:Consultation workshops were held with two groups of stakeholders: (i) care home residents and their families; (ii) care home staff and health care professionals (general practitioners, medical specialists, pharmacists, nurses, allied health professionals). Focus groups were held with each group separately to understand perspectives on: deprescribing in general; contextual considerations; and, perspectives on deprescribing interventions developed in other countries. A combined focus group then considered components of a deprescribing intervention for care homes. Qualitative data were audio recorded, transcribed, and thematically coded.Results:Participants described the nature of local relationships, dynamics, structures, and resources, as important considerations in the development of a deprescribing approach in care homes. Perspectives and concerns around deprescribing among the stakeholder groups varied, although the importance of eliciting local stakeholder feedback in the early stages of developing a deprescribing intervention was a common thread.Conclusions:Early engagement and co-production are crucial in developing an approach to deprescribing in care homes. The combination of stakeholder involvement and qualitative research is important for developing an effective, contextually relevant intervention as the balance between interests can be incorporated into the approach. Leveraging the experience in other countries is a novel and valuable step.

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A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes

BMC Geriatrics ◽

10.1186/1471-2318-12-31 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 20

Author(s):

Adam L Gordon ◽

◽

Phillipa A Logan ◽

Rob G Jones ◽

Calum Forrester-Paton ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Care Homes ◽

Controlled Trials ◽

Systematic Mapping ◽

Randomized Controlled ◽

Mapping Review ◽

Systematic Mapping Review

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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

BMC Health Services Research ◽

10.1186/s12913-019-4662-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

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.

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Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK

BMJ Open ◽

10.1136/bmjopen-2021-049486 ◽

2021 ◽

Vol 11 (2) ◽

pp. e049486

Author(s):

Aisha Macgregor ◽

Alasdair Rutherford ◽

Brendan McCormack ◽

Jo Hockley ◽

Margaret Ogden ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Care Home ◽

Care Homes ◽

Successful Implementation ◽

Life Care ◽

Care Home Staff ◽

Palliative Care Teams ◽

The Uk

IntroductionPalliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysisThis implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and disseminationFrenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration detailsRegistration details: ISRCTN15863801.

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Exploring factors that affect the uptake and sustainability of videoconferencing for healthcare provision for older adults in care homes: a realist evaluation

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01372-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Louise Newbould ◽

Steven Ariss ◽

Gail Mountain ◽

Mark S. Hawley

Keyword(s):

Older Adults ◽

Care Home ◽

Realist Evaluation ◽

Care Homes ◽

Successful Implementation ◽

Healthcare Provision ◽

Home Culture ◽

Factors Affecting ◽

Care Home Staff ◽

Remote Healthcare

Abstract Background Videoconferencing has been proposed as a way of improving access to healthcare for older adults in care homes. Despite this, effective uptake of videoconferencing remains varied. This study evaluates a videoconferencing service for care home staff seeking support from healthcare professionals for the care of residents. The aim was to explore factors affecting the uptake and sustainability of videoconferencing in care homes, to establish what works for whom, in which circumstances and respects. The findings informed recommendations for commissioners and strategic managers on how best to implement videoconferencing for remote healthcare provision in care homes for older adults. Methods Realist evaluation was used to develop, refine and test theories around the uptake and maintenance of videoconferencing in three care homes across Yorkshire and the Humber, England. The care homes were selected using maximum variation sampling regarding the extent to which they used videoconferencing. A developmental inquiry framework and realist interviews were used to identify Context, Mechanism and Outcome Configurations (CMOCs) regarding uptake and sustainability of the service. Participants included care home residents (aged > 65) and staff, relatives and strategic managers of care home chains. The interviews were an iterative process conducted alongside data analysis. Transcripts of audio recordings were entered into NVIVO 12, initially coded into themes, then hypotheses developed, refined and tested. Results Outcomes were generated in relation to two main contextual factors, these were: (1) communication culture in the home and (2) the prior knowledge and experience that staff have of videoconferencing. The key facilitators identified were aspects of leadership, social links within the home and psychological safety which promoted shared learning and confidence in using the technology. Conclusions Videoconferencing is a valuable tool, but successful implementation and sustainability are dependent on care home culture and staff training to promote confidence through positive and supported experiences.

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Multifaceted intervention to Reduce Antimicrobial Prescribing in Care Homes: a process evaluation of a UK-based non-randomised feasibility study

BMJ Open ◽

10.1136/bmjopen-2019-032185 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032185 ◽

Cited By ~ 1

Author(s):

Rachel Potter ◽

Anne Campbell ◽

David R Ellard ◽

Catherine Shaw ◽

Evie Gardner ◽

...

Keyword(s):

Decision Making ◽

Process Evaluation ◽

Demographic Data ◽

Care Home ◽

Care Staff ◽

Care Homes ◽

Normalisation Process Theory ◽

Successful Implementation ◽

Care Home Staff ◽

Antimicrobial Prescribing

ObjectivesTo explore the facilitators and obstacles to the development and implementation of the Reduce Antimicrobial Prescribing in Care Homes intervention.DesignWe used a mixed-methods approach. We conducted focus groups with care home staff and relatives of residents, and interviews with general practitioners (GPs) and home managers, completed observational visits and collected demographic data, training attendance records and data on the use of a decision-making algorithm. We used normalisation process theory to inform topic guides and interpretation of the data.SettingSix care homes, three in Northern Ireland and three in the West Midlands, England.InterventionA decision-making algorithm for urinary tract, respiratory tract and skin and soft-tissue infections, plus small group interactive training for care home staff.ResultsWe ran 21 training sessions across the six homes and trained 35/42 (83%) of nurses and 101/219 (46%) of all care staff. Care home staff reported using the decision-making algorithm 81 times. Postimplementation, staff reported being more knowledgeable about antimicrobial resistance but were unsure if the intervention would change how GPs prescribed antimicrobials. The pressures of everyday work in some homes meant that engagement was challenging at times. Staff felt that some of the symptoms included in decision-making algorithm, despite being evidence based, were not easy to detect in residents with dementia or urinary incontinence. Some staff did not use the decision-making algorithm, noting that their own knowledge of the resident was more important.ConclusionWe delivered a training package to a substantial number of key staff in care homes. A decision-making algorithm for common infections in care homes empowered staff but was challenging to operationalise at times. A future study should consider the findings from the process evaluation to help ensure the successful implementation on a larger scale.

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Making things personal: a project promoting the wellbeing of older residents and staff in sheltered housing and care homes

Journal of Public Mental Health ◽

10.1108/jpmh-04-2020-0029 ◽

2020 ◽

Vol 19 (3) ◽

pp. 251-257

Author(s):

Heather Edwards

Keyword(s):

Personal Information ◽

Care Home ◽

Care Staff ◽

Care Homes ◽

Sheltered Housing ◽

Successful Implementation ◽

Content Type ◽

Care Home Staff ◽

Experience Of Care ◽

Personal A

Purpose This paper aims to present findings of a project implementing training to enable care staff to create simple audio-biographical resources with older tenants and residents in sheltered housing and care homes. Design/methodology/approach This paper draws on written evaluations by participants of training workshops delivered to 136 care home staff within 28 care homes of the NorseCare group in Norfolk, UK and of their experience after three months in the workplace. Findings The evaluations showed a high degree of satisfaction with training and impact of the intervention. Successful implementation of training in the workplace depended on factors of time and leadership within individual homes and housing schemes. Originality/value Making innovative personal information documents valued carers’ unique understanding of residents and tenants. This creative co-production may have benefits in personalising and enriching the experience of care for both staff and residents.

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Advance care planning for adults with a progressive condition approaching end of life or loss of mental capacity: a systematic mapping review of the evidence

10.3310/hsdr-tr-130864 ◽

2020 ◽

Author(s):

Sian Thomas ◽

◽

Lindsay Claxton ◽

Kath Wright ◽

Alison Eastwood

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

Mental Capacity ◽

Care Planning ◽

Systematic Mapping ◽

Mapping Review ◽

Advance Care ◽

Systematic Mapping Review

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Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

BMC Geriatrics ◽

10.1186/s12877-021-02053-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fiona Marshall ◽

Adam Gordon ◽

John R. F. Gladman ◽

Simon Bishop

Keyword(s):

Central Government ◽

Resource Constraints ◽

Care Delivery ◽

Care Home ◽

Third Sector ◽

Care Homes ◽

Framework Analysis ◽

Local Networks ◽

Care Home Staff ◽

East Midlands

Abstract Background From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed. Methods Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals. Results Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care. Conclusions This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

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