EBPAC Round 3

Page last updated: 27 September 2016

EBPAC Round 3

EBPAC Round 3 projects commenced in June 2012 and were concluded in June 2015. Under this funding round, organisations established consortia that included residential aged care facilities and/or community aged care services, researchers and educators to implement the most up-to-date, evidence-based care practices for recipients of residential and community aged care services. 

Bridging the Leadership Skill Gap - TAFE QLD

This project was led by TAFE Qld Brisbane in conjunction with Strategon, a South Australian based business advisory and enterprise development consultancy and Recovery Station, a New South Wales based provider of allied health. Ten aged care facilities participated in the project across the three states. The project involved a competency based framework approach to underpin training and development opportunities for participants to undertake a leadership project in a subject of their choice.

What was done?

The project developed and provided leadership training to 120 residential community and residential aged care staff, recruited and selected by ten participating RACPs across three states. The implementation framework used to develop the Emerging Leaders training resource comprised a five stage process: 

stage process:

  • Initial consultations with registered residential aged care providers across three states
  • Capability profiling
  • Development of the training resource
  • Piloting phase comprised of a one-day workshop series and action learning projects
  • Finalisation of training resources based on feedback from stakeholders 

What was achieved?

Changes observed as a result of participation in the program included:

  • Improved care processes for clients with a greater focus on the client and the provision of individualised care.
  • The empowerment of staff to identify areas for improvement and help foster change for better client care outcomes.
  • Increased confidence amongst staff in the care process addressed in the project due to sharing of information and ability of project staff in seeking evidence to help guide practice.
  • An increased understanding of the roles between all staff with greater communication and collaboration across disciplines.
  • Greater work efficiencies with improved care and communication processes.

What resources are available?

A learning and development methodology has been developed, including a training resource that RACPs can use to skill ‘emerging leaders’ across the staff pool in the leadership skills required to achieve strong outcomes for clients.

Clinical Mentoring from Evidence-Base to Outcomes for Older People - Resthaven

​The project built on a range of research and development initiatives undertaken by Resthaven in recent years, and its existing working relationship with Flinders University. The two organisations were successful in receiving funding for a Training and Research Aged Care Services (TRACS) initiative at the same time as the EBPAC project funding. The project involved supporting and developing clinical mentors in six facilities across three states (SA, NSW and Qld), each of which had a focus on a specific clinical/workforce issue pertinent to that organisation.

What was done?

Funding was provided for clinical mentors (2 days/week) and champions (1 day/week) in each participating facility. Clinical mentors were selected from each site and participated in workshops with clinical mentor experts; upon returning to their home facility/service, mentors worked with local champions to create a team to support them in their area of clinical focus. This small team received ongoing support from external mentors, both face to face and over the phone, as they sought to identify the evidence, practices and processes for change.

The primary focus of the clinical mentor was to provide leadership in change management; the clinical area of practice change was essentially secondary to this primary objective. Mentors were chosen who were identified as ‘influencers’ within an organisational context, had research and project management skills, and a capacity to influence staff working with them, as well as management.

What was achieved?

Clarification of mentor attributes, and development of a model of change that could be used across care settings and the sector more widely.

What resources are available?

Aged Care Clinical Mentor Model of Change: Six Steps to Better Practice. A guide for Implementing Clinical Change through Workforce Development

Better practice for older people living with or at risk of chronic wounds in the community – Royal District Nursing Services

This project comprised three sub-projects, all of which built on existing processes within RDNS and broadened to different audiences and modes of delivery: the Leg Ulcer Prevention Program and the Skin Awareness Program, both of which targeted older people living in their own homes, and a clinical leadership model in the area of wound care.

What was done?

The Leg Ulcer Prevention Program (LUPP) implemented a clinical practice guideline based e-learning package which was delivered by nurses to educate people with venous leg ulcers about their wounds. The aim was to encourage clients to increase adherence to evidence-based treatments, and thereby improve health outcomes.

The Skin Awareness Package (SAP) sought to prevent skin injury through the development and implementation of a clinical practice guideline based e-learning package on skin health; this was also delivered by health workers to educate older people on skin health.

The clinical leadership group model was expected to underpin the above training processes and evidence based practice in wound care management.

What was the impact for staff?

Two hundred nurses delivered LUPP to 229 people with venous leg ulcers. In people with venous leg ulcers, LUPP led to an increase in knowledge of venous leg ulcers, and the adoption of some of the recommended behaviour changes promoted in LUPP. The nursing staff delivering LUPP felt that LUPP taught them additional information about the care of people with venous leg ulcers, and also systematised the care they already delivered.

Ninety-five health workers were trained to deliver SAP to 100 older community members, with 22 health workers facilitating SAP delivery. The community members who engaged with SAP increased their knowledge of skin health and adopted some of the behaviours recommended by SAP. The health workers who had SAP training also increased their knowledge of skin health which led them to increase their roles and responsibilities, including applying a preventative approach to prevent the escalation of minor skin issues to more serious problems. This increase in health worker roles and responsibilities led to an increase in respect by nurses of the role health workers can play in preventing serious skin issues, and ultimately led to a more collaborative approach in care delivery by these care providers. 

What resources are available?

The LUPP Resource Kit included a LUPP information sheet, LUPP protocol, LUPP protocol flow chart, data collection tools, LUPP clinician guideline, information for healthcare providers and LUPP study training guide. A DVD and supporting LUPP booklet was also made available as an e-learning device. Miscellaneous skin care samples, bandages and a water bottle were also supplied as part of the kit.

The SAP Resource Kit included a SAP information sheet, data collection tools, a skin assessment tool, the SAP study training guide and additional information for healthcare providers. A DVD and supporting SAP booklet was also made available as an e-learning device. Miscellaneous skin care samples, bandages and a first aid pack were also supplied as part of the kit.

The Lifestyle Engagement and Activity Program (LEAP) for Life Project in Community Care – University of NSW

Home care programs have traditionally focussed on catering for the physical and domestic needs of their client, with less focus on social and recreational needs. The LEAP project has developed training materials for care workers to deliver an individualised package of care that combines the best elements of activity programs in aged care, such as physical activities, Montessori activities, music, reminiscence and humour. It takes the evidence base for person-centred activities in residential care and applies them to community care.

What was done?

There were three stages in implementing LEAP:

  • Engaging management and staff to support the program: Engagement was supported by the role of the project officer who provided dedicated support to each of the five aged care community services. Sites were given the flexibility to implement LEAP in a manner which suited their model of care.
  • Employing a LEAP Champion one day per week to drive practice change: LEAP Champions were trained at each site to drive the sustained behavioural change of care workers and case managers. The Champions also accompanied each care worker on a buddy visit to a client in order to support care workers in practising client engagement techniques.
  • Staff training: LEAP Champions received one, five hour training session focussing on clarifying the role of the Champion, change management and improving interpersonal skills.

What was the impact for staff?

The evaluation featured multiple observations at four occasions both pre, during and post intervention. Evaluation subjects included case managers, LEAP Champions, care workers, clients and family/carer. Methods included semi-structured interviews, questionnaires and the analysis of care worker diary records. Specific assessment tools were also used to measure client outcomes such as client agitation, loneliness depression apathy and satisfaction with care. 

A total of 189 clients, 152 care workers and 28 case managers participated in the evaluation. Twelve months after the program commenced 87% of clients had a social/recreational goal and 76% had an engagement strategy in their care plans. Clients showed a significant increase in researcher-rated engagement, and a significant decrease in researcher-rated apathy, dysphoria and agitation. Both case managers and case workers reported a significant increase in their confidence to socially and recreationally engage clients. Case managers also reported a significant increase work satisfaction.

What resources are available?

Numerous resources were developed to support the implementation of LEAP. These included

  • 1 x Case Manager Training Facilitator Manual (+ handout booklet)
  • 1 x LEAP Champion Training Facilitator Manual (+ handout booklet)
  • 4 x Care worker Training Facilitator Manuals (+ a handout booklet for session 2).
  • 1 X ‘Guide for the Trainer’ booklet including program overview and a recommended reading list.

Five short videos about LEAP were also produced as training and promotional resources as follows:

  • A 12-minute summary of LEAP
  • A 3-minute overview of LEAP
  • A 3-minute video of late-stage dementia
  • A 3-minute video of early-stage dementia
  • A 3-minute care recipient video case study

Home-based Preferred Music Listening Program - Chinese Community Social Services Centre Inc.

This project aims to improve the mood status of clients of the CCSSCI through a ‘music intervention’ implemented whilst personal and home care services are being provided by Direct Care Workers (DCW) in the client’s home. The client’s favourite music is played for about 30 minutes and a smiling face mood scale tool is used to measure whether the intervention had a positive impact on the client’s mood.

What was the impact for clients?

A ‘Faces Scale’ was used to assess the participants’ mood pre and post the music listening activities. These data were collected and collated by the home care worker for a five month period. Focus group and telephone interviews were held with clients, family carers and Home Care Workers. Case studies were undertaken to profile individual HCPP clients, Home Care Workers and Case Managers to share their experiences about the music intervention.

The Faces Scale highlighted that 83.3% of participants experienced improvements in their mood after the home-based music listening activities. Focus groups and interviews with clients and their carers/families demonstrated that music listening helped them to be distracted from negative feelings and pains and helped them to relax. Families and carers experienced reduced stress in their caring role. Home Care Workers experienced an improved working relationship and an increased level of trust with their clients. They also reported that their job satisfaction increased as a result of participating in the program.

What resources are available?

Each client who participated in the program and their family/carers received a personalised music CD and a CD player. They also received a ‘Step by Step’ manual to facilitate their preferred music listening activities as well as a songbook with contains the lyrics to the selected songs.

Choices - Uniting Care LifeAssist and Deakin University

This project is based on the People at Centre Stage project (PACS), a previously funded Australian Research Council project conducted by Uniting Care Community Options. The PACS model was developed with direct input from both service users and service providers and was designed to assist participants maintain/build their health, strengthen their capabilities and attain their preferred level of independence. It was specifically designed for people with complex care needs and places great emphasis on capacity building. The CHOICES model specifically targets Cultural issues specific to the three (3) distinctive needs groups (ATSI, CALD and Regional).

What was done?

The key stages to the delivery of the CHOICES model involved the following steps:

  • To develop a CDC model responsive to the needs of people living in regional/rural, Greek, and Indigenous communities.
  • To develop training packages for case managers and care coordinators supporting people in regional/rural, Greek, and Indigenous communities.
  • To evaluate the effectiveness of the CDC model.

What was the impact for staff?

The quantitative data suggests that the CHOICES model had a statistically significant effect on the perceived quality of case management. Overall, clients felt more respected, informed, and appreciated the new financial arrangements.

Aboriginal Elders and participants in rural/regional communities commented positively on their ability to spend their package funds more flexibly and appeared to be more aware and empowered to receive care responses that resonated better with their needs. However, only half of the sample experienced key aspects of the CHOICES model and as a result the sample size was not statistically significant.

The findings do demonstrate that many frailer old people will require considerable support in order to take advantage of CDC opportunities.

What resources are available?

The project produced a number of resources in support of the CHOICES model:

  • An online training package
  • Training workshop materials
  • A suite of practice tools and an Implementation Guide
  • A CM readiness questionnaire
  • A CHOICES information booklet
  • A Community Connectors Program

Many of these resources are available on the project website Choices in Aged Care.

NOTE: The Choices in Aged Care Model does not take into account the home care services exclusions currently identified in the Aged Care Act 1997.

Building Better Oral Health Communities - SA Dental Service

This project builds on the work previously undertaken in Round 1 of EBPRAC, which targeted residential aged care, extending the skills development and capacity building to community dwelling aged care clients and service providers.

What was done?

The development of a home care model of oral health care builds on the seminal research of Dr Jane Chalmers and the findings of the Better Oral Health in Residential Care Project. Key to this was the integration of four key oral health processes (oral health assessment, evidence-based oral health care planning, support with daily oral care and referral to a dental professional) into routine care. A suite of oral health education and training resources were developed to support the implementation of these processes.

The Better Oral Health in Home Care Model was designed to promote a home care team approach aimed at maintaining a client’s oral health. Its aim was to encourage GPs, nurses, care coordinators, home care workers, dental professionals, clients and their families to share the responsibility for implementing one or more of the four key oral health processes.

What was achieved?

The Better Oral Health in Home Care Model demonstrated positive improvements in home care clients’ oral health related quality of life and wellbeing, as well as improvements in care staff knowledge and skills.

What resources are available?

The project developed a variety of resources in different mediums as follows:

 
Templates for dental referral and dental care recommendations; dental referral pathway; dental visit checklist; and an oral health changes reporting guide; and

Client resources, including bathroom prompts in the care of natural teeth and care of dentures; and Oral health self-care booklets for indigenous and non-indigenous communities.

Valuing People: Person-Centred Dementia Support Project - Alzheimer’s Association Vic

This project builds on a project that was funded through Alzheimer’s Australia’s National Quality Dementia Care Initiative. The additional funding under EBPAC enabled additional pilot testing of the tools and targeted resource development. It aimed to provide a tool to enable consumers as well as providers assess the capacity of a community care service to deliver person-centred care for people with dementia.

What was done?

Following an initial literature review and consultation with key stakeholders including consumers and academics, a draft ‘Organisational Self-Assessment Tool (OSAT) was piloted in a range of aged care community care services. The interim evaluation indicated the need for significant refinements. The re-worked tools were more succinct and accessible, and re-piloted with a further group of services, including one for-profit agency. It was recognised that delivering person-centred care was appropriate for all clients, not just those with dementia; in addition, it shifted its focus to include internal staff processes in recognition of the fact that if staff weren’t feeling valued, they were unlikely to value and respect their clients.

What was achieved?

The project resulted in the development of a resource that supports organisational change to focus on relationships, rather than processes.

What resources are available?

An organisational self-assessment tool  is available at the Alzheimer’s Australia website.

National Rollout of the Palliative Approach Toolkit for Residential Aged Care Facilities - Brisbane South Palliative Care Collaborative

This project was previously funded in Round 2 of the EPBRAC program. Under Round 2 the Comprehensive Evidence-Based Palliative Approach in Residential Aged Care project was able to demonstrate successful changes in clinical practice which resulted in improvements in resident care, staff knowledge and family satisfaction. This current project tests the rollout of the model on a national basis.

What was done?

The rollout of the project was divided into five key stages:

  • Stage 1: Governance and structures - staff recruitment, establishment of steering committees, clinical reference groups and project working group.
  • Stage 2: Communication - communication strategy developed that promoted the use of the PA Toolkit and the workshops to key stakeholders.
  • Stage 3: Resource development - six new resources developed and distributed along with the existing toolkit.
  • Stage 4: Training – the delivery of national workshops.
  • Stage 5: Continuous quality improvement - promoted the need for continuous quality improvement through two audit tools related to the RACF accreditation processes.

What was achieved?

The team delivered a total of 42 workshops to promote the use of the PA Toolkit to RACF management, educators, staff and external providers. In addition, 19 one day train-the-trainer workshops were held in Victoria for the VPCC. These were attended by approximately 2,250 staff from 1,276 RACFs.

The PA Toolkits have been distributed nationally: 2,720 to approved RACFs, 70 to other RACFs (i.e. private, multi-purpose sites and new facilities), and 210 to organisations to support RACFs to implement the palliative approach including the VPCC, aged care trainers, and SPCS.

Participant feedback about training indicated that a significant majority found the workshops to be directly relevant to their day-to-day practice and were of a high quality. Evaluation data also suggested that the workshop content had increased participants’ knowledge about, and confidence in, implementing an evidence-based palliative approach to care.

The project facilitated the establishment of sustainable links between RACF generalist providers and SPCS through the development of the PA Toolkit resource Workplace Implementation Guide: Support for Managers, Link Nurses and Palliative Approach Working Parties.

The project promoted continuous quality improvement by promoting the use of two audit tools to support the implementation of the PA Toolkit: the After Death Audit Tool and the Organisational Policies and Structures Audit Tool. These tools allow staff to review resident end of life outcomes based on the use of the PA Toolkit.

What resources are available?

The toolkit was developed in Round 2 of the EPBRAC program. However, new management, clinical and educational resources were added to the existing PA Toolkit. These resources were developed to guide and support RACFs to implement a comprehensive, evidence-based, person-centred and sustainable approach to palliative care for appropriate residents. The resources were developed with input from members of the Steering Committee and Clinical Education Reference Group after extensive input from the aged care sector.

Improving Wound Management: - School of Nursing, Queensland University of Technology

This project was previously funded in Round 2 of the EPBRAC program where the Champions for Skin Integrity Program was successful in increasing implementation of evidence based wound management and decreasing the prevalence and severity of wounds in residents of RACFs. This project had an overall aim of further promoting the skin integrity of the residents of residential aged care facilities throughout Australia by utilising the resources developed and knowledge gained in the EBPRAC-CSI Stage 1 project to promote the uptake of the CSI model of evidence based wound management. This was facilitated by conducting a series of Promoting Healthy Skin ‘Train the Trainer’ workshops in the capital cities and major regional centres throughout Australia.

What was done?

The original resources developed in the EBPRAC-CSI Stage 1 project were submitted for a secondary review by academics with expertise in the area. Also, a full review of the latest evidence was carried out to ensure that the resources developed as part of the new project reflected the latest evidence. The finalised resources were refurbished and redesigned and distributed to all residential aged care facilities throughout Australia. Learning materials were then  developed to support a one day intensive workshop focussed on providing attendees with the knowledge and skills to implement the CSI model of wound management. These ‘train the trainer’ workshops were then rolled out in the capital cities and major regional centres throughout Australia.

What was achieved?

The CSI Resource Kits were so popular a second print run was necessary to meet demand. In total, 6,000 kits were distributed. Thirty seven workshops were delivered to 1286 participants who represented 835 facilities. Feedback from workshop participants was positive and pre/post surveys of participants found significantly improved confidence in managing common wound types in older adults, finding and applying evidence in their practice, and implementing change in their workplace. Longer term evidence of uptake of the CSI model in the workplace was demonstrated by action plans and reports detailing progress on implementation projects that were initiated at a CSI Workshop. Resident outcomes from these projects included improved skin integrity, reduced prevalence of wounds, shorter time to healing, increased implementation of EB prevention strategies, improved resident comfort and education and involvement of residents and family in their care. Staff outcomes included increased education provided, improved knowledge, and implementation of protocols and resources which lessened workload.

What resources are available?

The Champions for Skin Integrity Program kit includes a wealth of resources including evidence base guideline summaries, brochures for health professionals, clients, families and carers, flow charts and tip sheets.

TOrCCh (Towards Organisational Culture Change): a process & toolkit for sustainable culture change in residential aged care - University of Western Australia, Curtin University & RSL Care

This study aimed to develop, implement and evaluate a toolkit and training resources to support sustainable culture change in residential aged care facilities in Western Australia and Queensland.

As one of the projects funded under the ACSIHAG Program, a key element of this project was to establish the requirements for sustainability of an organisational culture change intervention both within the participating aged care services but also more widely throughout the aged care sector.

What was done?

The TOrCCh model follows a systematic change process which is facilitated by research staff working with ‘champions’ at the facility level. This process follows an Action Research approach that follows the QPAR cycle (Question, Plan, Act and Reflect). The toolkit has a strong focus on staff development and recognises the importance of leadership, teamwork and communication. The TOrCCh process itself aims to help multidisciplinary teams to implement change in a workplace by going through four stages: Getting ready, getting started, getting active and getting success. Each stage is supported by tools or templates which the team can work through to plan, implement and evaluate their change.

What was achieved?

Surveys and interviews were used to assess participants’ personal views and experiences of implementing the TOrCCh toolkit. Several validated tools were also used such as the Shortell Organisation and Management Survey to measure aspects of team work and collaboration and the Healthcare team Vitality instrument to measure engagement, empowerment and team communication.

What resources are available?

Several resources were produced to support the culture change toolkit:

  • The Workteam Members’ Flipchart: for use by teams making a change in residential aged care facilities. The Flipchart is a step by step guide to help a workteam make a change that they think is necessary; and
  • Managers and Workteam Leaders Flipchart: to assist leaders to educate, support and guide teams making a change in residential aged care facilities. It is focused on introductory level information so that a multidisciplinary team can make a change in the workplace.

Additional resources and tools that may be of interest can be found at the WA Centre for Health and Ageing website.

More information

For further information regarding other EBPAC projects see the Department of Health website.