Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

Facilities with no plans to implement the toolkit

Interviewees who indicated that their facility had no plans to implement the CSI toolkit were asked a further four questions.

What is your understanding of the initiative and the purpose of the project?

Only four of those who had no plans to implement provided a response to this question. Two interviewees were not sure about the initiative and its purpose, one stating that they had not been spoken to about it. Those that did know about the initiative thought the purpose of the project was:

To build capacity and awareness of best practice skin care amongst staff, especially less skilled staff and to help implement a program of evidence based skincare in the RACF.

Why do you not intend to implement the CSI toolkit within your facility?

All of the interviewees in this group answered this question. One interviewee indicated that they had no knowledge of the toolkit. Three interviewees stated that the staff who had attended the training had moved on and implementation was not pursued. Of these, one interviewee did not know whether or not they had the toolkit at the facility. The other noted that:

We get our wound management guidance from the 'Better Health' Channel.

Another participant felt they were too new to their organisation to be able to implement change. Two participants felt that they did not need the toolkit as they already had good resources in place such as a good system of wound management and policies and procedures, including training, access to allied health care workers, doctors and specialists from a nearby public hospital.

One participant did provide an outline as to why they eventually did not implement the toolkit:

After the training the facility I work in changed over to a new computerised patient management system. This proved a challenging process as many of the aged care workers here had not used a computer before. We also didn't realise how big the Tool kit was and I felt that it would be a lot of work to implement. I had thought about using it in 2015 but we are now in construction mode at our facility and I simply have no time. We are a very busy smaller facility and time is precious.

What do you see as the main barriers to implementation within your facility?

All but one participant from this group answered this question. Of these two participants were not sure what the main barriers were. Time and staff changes were noted as barriers to implementation. One participant felt that a ‘whole of government’ approach to change was needed.

The importance of getting the right person to the training session was noted by one participant. It was felt that people who are primarily interested in wounds and wound care need to be specifically targeted.

Another participant stated that their facility felt that the toolkit could possible conflict with directives from specialist care.

What else would you like to add?

Only two interviewees had any additional comments. Comments were somewhat ambivalent towards the project, although quite opposite in how they viewed the project. Participants noted the following:

It provides great resources for less well resourced RACFs. Staff from here went out of personal interest.

It was a bit daunting for me as it was not what I thought it would be.

Facilities Planning to Implement the Toolkit

Facilities that were planning to implement the CSI project were asked four questions about their progress towards implementation.

What is your understanding of the initiative and the purpose of the project?

Seven participants answered this question, although one participant indicated only that they were not sure of their understanding of the initiative or the purpose of the project.

A number of participants indicated that their understanding of the project was in relation to wound care, including the improvement of wound care, the better assessment and treatment of wounds and sores and to gain information and education about wound care. One participant viewed the project as relating to the promotion of healthy skin. Other participants noted issues relating to the practices of staff including the implementation of best practice and changing staff practices in wound care. A number of participants saw information and education or the building of skills and knowledge as a way to bring about improvements and changes. One participant’s understanding of the project was:

To build up skills and knowledge of staff so that they can better assess and treat wounds and sores.

Have there been any changes to policies and procedures as a result of the project?

Of the eight participants in this group only one facility had made any changes as a result of the project. Changes involved ‘an increased use of moisturisers for the lower legs’. It is interesting to note that the interviewee at this facility had previously indicated their understanding of the project to be about promoting healthy skin as opposed to wound management as noted by other facilities.

What steps have you taken to implement the CSI Toolkit?

There was an even split among facilities in this group who had taken some steps and those who had not. Time, staff leave and other priorities were reasons why facilities had not yet taken any steps to implement the toolkit. Of those who had not yet taken any steps, all stated that they intended to discuss the project with specific/key staff to start planning..

Of those who had taken some steps to implement the toolkit, one facility had engaged in initial planning meetings only. Another facility had conducted initial meetings, gathered baseline knowledge and started to develop a plan. Further action had ceased though while a key staff member was on sick leave. Another facility stated that they had done some training and accessed expert advice:

I have trained an EN. We have a Nurse Practitioner who comes in and provides advice on practice and on serious/chronic cases.

Staffing issues, such as staff turnover, continue to be an issue in some facilities as to why initial steps have not resulted in the implementation of the toolkit, as evidenced in the following quote:

We did encourage the use of fluids and extra hydration after the RN attended the workshop but that is as far as we got. The RN left our organisation and didn't do a hand-over of the toolkit. It was forgotten about until Qld Uni contacted us about evaluation. I have since booked another staff member to attend another workshop early this year and we will attempt to implement after that.

Is there anything else you would like to add?

Five participants made an additional comment about the project. Two of these comments were positives affirmations about the initiative and the workshop. One participant made the following comment.

Very good course, very interesting. Eye opener on a lot of issues

Another participant also noted that the initiative:

Made more people aware of these issues, especially for new personal carers. We were pleased with the day.