EBPRAC Round 1 Projects

Page last updated: 18 August 2017

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Overview

EBPRAC Round 1 projects commenced in December 2007 and concluded in December 2009. Five projects each established a consortium which comprised of a number of residential aged care facilities, researchers and educators. Thirty-nine residential aged care facilities across all states were involved. The projects focused on improving evidence-based clinical practice in the areas of:

Round 1 Projects

Oral Health

Lead Organisation - South Australian Dental Service

Better oral health in residential care

Project overview

The project aimed to develop an evidence-based, oral health practice model that utilised a portfolio of resources, including new educational resources and the existing Oral Health Assessment Toolkit for GPs, for residents in six residential aged care facilities located in South Australia, Victoria and New South Wales.

This project was led by the Central Northern Adelaide Health Service, South Australian (SA) Dental Service and supported by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide, the Department of Human Services Victoria and the Centre for Oral Health Strategy NSW Health.

What was done?

  • An Oral Health Assessment Tool, developed in 2005, was modified during the project to become a one-page document for use by GPs and RNs. It recommends that a resident have an oral health assessment performed by a GP or RN on admission to the aged care facility and subsequently on a regular basis and as the need arises.
  • Three educational resource portfolios, accompanied by a series of posters, resident information and an oral health resource kit, were developed to support the key processes of the Better Oral Health in Residential Care Model.
  • GPs and RNs were provided with a Professional Portfolio which consisted of self-directed learning resources to help them develop their knowledge and skills in relation to oral health assessment, oral health care planning and dental referral protocols.
  • An education and training program was developed to support the key process of daily oral hygiene. Selected RNs took part in a ‘train the trainer’ program to prepare them to train aged care staff at their facility. A Facilitator Portfolio and resource kit was developed and provided to assist RNs in this role.
  • A Staff Portfolio for direct care nurses and care workers was developed and implemented to support the oral health education and training program.
  • Simple key messages were formulated to reinforce the change processes.

What was achieved?

What was the impact for residents?

  • Oral health assessments undertaken by GPs and RNs before and after the implementation of the Better Oral Health in Residential Care Model showed significant improvement in oral health status of residents over the life of the project.
  • The quality of life measures for residents who suffered impacts from poor oral health improved significantly. Residents’ improvement in oral health had a significant contribution to their wellbeing and general health. It was reported that residents:

    – had more positive social experiences,

    – showed higher levels of interpersonal confidence and self-esteem,

    – realised they did not have to live with discomfort or pain,

    – smiled more often,

    – enjoyed eating, and

    – had a better appearance.

What was the impact for staff?

  • Staff better understood the impact of oral health on general health, which motivated them to deliver better oral health care for residents.
  • RNs did 60 per cent of oral health assessments and were very positive about the Oral Health Assessment Toolkit and other resources.
  • Care workers were very positive about the training program and increased their effectiveness and competency in oral health care.
  • Staff became more confident and able to perform the activities of daily oral hygiene, and more confident in identifying problems and referring residents for dental care.

What could be adopted in other services?

Examples of small changes that facilities could make to have a positive impact on resident’s oral and dental health include:

  • Adopt the following practices to maintain a healthy mouth and protect residents’ oral health:

    – Brush morning and night

    – Use high fluoride toothpaste on teeth

    – Use a soft toothbrush on gums, tongue and teeth

    – Use an antibacterial product after lunch

    – Keep the mouth moist

    – Cut down on sugar
  • Employ a team approach to maintain a healthy mouth – Work together to protect your residents’ oral health.
  • Use GPs and RNs to identify residents requiring a dental referral.
  • Utilise RNs to champion oral health. They can also use the oral health assessment tool to inform oral care planning, monitor residents’ oral health and evaluate oral hygiene interventions.
  • Consider participating in the Better Oral Health in Residential Care education and training program. Consider using RNs to deliver the training to other staff, following a ‘train the trainer’ model.
  • Consider how dentists and other dental professionals might be encouraged to visit residential aged care facilities through appropriate supports, such as access to portable equipment.
  • Use simple toothbrushes that can be bent easily. They are the most economic and effective tool for improving oral health.

What resources are available?

The project produced a comprehensive suite of resources, including three educational resource portfolios, accompanied by a series of posters, resident information and an oral health resource kit:

  • The Professional Portfolio was developed for GPs and RNs as a self-directed learning resource supporting the key processes of oral health assessment, oral health care planning and dental treatment. It includes the modified Oral Health Assessment Tool.
  • The Facilitator’s Portfolio and an oral health resource kit were developed to support the RN trainer.
  • The Staff Portfolio was compiled as a take-home resource for direct care nurses and care workers attending the education and training program. It is highly visual and easy to read.

These resources are available at:http://webarchive.nla.gov.au/gov/20140801083400/http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-better-oral-health.htm

Better Oral Health in Residential Care training

Building on the EBPAC project, the Better Oral Health in Residential Care training project was rolled out nationally to all residential aged care facilities in 2010. A number of registered training organisations were selected to deliver the training. Using a train-the-trainer approach, the intention is to train up to two registered nurses or dedicated trainers in each Australian Government funded residential aged care facility, multi-purpose service and Indigenous flexible residential aged care service as trainers, so that they in turn, can train and support aged care workers in ensuring residents’ daily oral hygiene is maintained.

For more information visit Better Oral Health in Residential Care training webpages.

Medication Management focusing on PRN (as required) Medicines

Lead Organisation - Repatriation General Hospital Drugs and Therapeutics Information Service (DATIS)

Time for evidence based action around PRN medicines in aged care (TEAM Aged Care)

Project overview

The purpose of the project was to implement evidence-based improvements in the use of PRN1 medicines using the evidence-based strategy known as academic detailing (or educational visiting) in ten residential aged care facilities across South Australia and Victoria.

What was done?

The main intervention was ‘educational visiting’ on the use of PRN medication in three specific areas: 1) sleep 2) behaviours of concern and 3) pain assessment and management.

Education module development

Education models were developed for each of these areas. The framework for each module was built on the acronym PRN. The goal was to change how PRN was used in practice from an ‘as required’ to ALWAYS thinking

P – perceive the need

R – report and relieve

N – note the effects Module development involved:

  • Consultation with the aged care homes regarding current practice
  • An extensive literature review to gather the evidence
  • Preparation of a background materials folder and resources for module delivery including the ‘detailing’ aid
  • A structured two day workshop was conducted for each module to prepare the educational visitors

Module implementation

Aged care staff were visited by a knowledgeable health professional to discuss evidence-based information arranged in each of the three modules. It involved structured educational encounters aimed to increase the skills and knowledge of each aged care staff member by providing flexible information at a level that was appropriate for the individual. Through discussion, the educational visitor aimed to identify health and clinical literacy issues, barriers and enablers for each individual to adopt best practice.

Education sessions were held on site and in normal working hours (including night shift) so that the messages were delivered as close to real time resident management as possible. All staff were eligible to participate. Sessions were scheduled via a link staff person in each aged care home.

At least two resident meetings were held in each facility; one to inform the residents of the project and discuss the topic of pain (and constipation) and the second to discuss the topic of sleep. Resident brochures were produced and used in a variety of ways by the aged care homes to engage the residents including:

  • display on public notice boards and in resident lounges
  • distribution at education meetings
  • distribution with resident and family newsletters
  • inclusion in admission packs

Staff evaluations were conducted for each module. Overall assessment of staff self rated skills and competence was evaluated through pre and post project questionnaires and also via evaluation forms after each individual educational visit.

Quality use of medicines was also evaluated using National Prescribing Service Drug Use Evaluation audits of PRN use of benzodiazepines and antipsychotics.

What was achieved?

What was the impact for residents?

Residents benefited from increased staff awareness leading to more evidence-based PRN medicines use. Specific examples included:

  • high percentages of staff became more aware of the adverse effects of antipsychotics – as a result PRN doses administered reduced by 37.5%
  • staff were more likely to assess for factors contributing to sleep difficulty
  • a larger number of staff recognised the signs and symptoms of pain – as a result the prescribed use of paracetamol increased by 30%

Resident knowledge of PRN medicine issues was also increased. For instance, of 209 residents and/or family members who attended ‘Module 3, Sleep’ meetings, 136 attendees said that they learnt something new.

Residents asked questions and gave feedback such as:

  • How much sleep do I need as an older person?
  • Is alcohol appropriate to use to help me relax prior to going to sleep?
  • The effects of caffeine can last for a long time
  • Sleeping tablets don’t help quality of sleep
  • The opportunity to talk about sleep together was appreciated

What was the impact for staff?

Changes as a result of the educational visiting included:

  • 96% of care staff indicated that they were more aware of the adverse effects of antipsychotics
  • 97% of care staff indicated they were more likely to assess factors contributing to sleep difficulty after the Sleep module
  • Significantly increased staff recognition of the signs and symptoms of pain
  • Significant increase in awareness of the evidence regarding potential harm from medicines particularly for personal care staff. This resulted in greater use of non-pharmacological treatment options.

What could be adopted in other services?

As a consequence of the educational visiting, staff learnt many strategies to assist residents in the three targeted areas. Examples of small changes that facilities could make to improve the use of PRN medicines include:

Sleep

  • offer milo at night or warm milk and honey instead of tea/coffee
  • let residents stay up for as long as carers can allow for
  • consider delaying the use of night time sedation until the night shift, when the medication is only given if needed
  • consider the effects of diet, visitors and outings on sleep patterns
  • monitor sleep by using 3-4 day sleep charts before notifying GPs of sleep problems
  • consider the use of paracetamol in some cases rather than a hypnotic
  • monitor adverse effects of sedative use and consider alternatives or ceasing the medication
  • increased focus on using non-drug measures and tender-loving-care

Behaviours of concern

  • use more body language when communicating
  • encourage staff to share ideas on managing residents with difficult behaviours
  • try to learn more about difficult residents, to enable staff to better divert residents’ attention at critical times
  • encourage staff to be more patient and confident in trying different approaches
  • review the need for continuing antipsychotic medication in some residents
  • actively monitor the possible side effects of antipsychotics
  • consider documenting more behaviours and verbally reporting more about behaviour and suggesting changes to care plans
  • check what other measures have been put in place before resorting to medicine

Pain assessment and management

  • understand and recognise body language signs of pain and follow up with residents exhibiting these signs
  • encourage staff to be more confident in documenting pain and reporting pain to nurses
  • consider using the Abbey pain scale for cognitively impaired residents
  • adjust analgesia doses where required and Webster pack analgesics
  • give medicines earlier to aid with mobility prior to getting up
  • encourage staff to be more observant regarding pain associated with movement

What resources are available?

Pain, Behaviours of Concern and Sleep ‘educational visiting’ modules were developed and include a 4 page card which provides brief evidence based information and pictures, to guide discussion in the educational visiting sessions. In addition to the cards, a manual of resources was developed which includes:

  • resident brochures for each module, including an Italian translation
  • background information and references
  • checklists for educational visitors
  • charts of drug information, caffeine and signs of pain in older people
  • a behaviours of concern flowchart
  • evaluation forms for staff and residents

1. Pro re nata (PRN) from the Latin for ‘an occasion that has arisen’ is commonly used in medicine as a short hand for ‘when required’ or ‘as needed’. These medicines include both those prescribed by the GP for the resident, e.g. haloperidol for aggressive behaviour, and nurse initiated medicines, e.g. coloxyl and senna for constipation.

Falls management

STAR Project – An individualised, facilitated and sustainable approach to implementing the evidence in preventing falls in residential aged care facilities

Project overview

The purpose of the project was to successfully implement an evidence-based falls prevention project that reduced falls and falls-related injuries across nine residential care facilities from Victoria, Queensland and Tasmania.

The project was led by the National Ageing Research Institute (NARI) and supported by two research teams from the University of Tasmania and the University of Queensland.

What was done?

The project used the falls prevention evidence which was based on the Victorian Quality Council Guidelines (for hospitals and residential care settings) and the Australian Quality and Safety Council Guidelines – Preventing Falls and Harm from Falls in Older People, Resource suite for Australian hospitals and Residential Aged Care Facilities 2005. The project used an action research approach to support the implementation of the above evidence.

The project included the following key activities:

  • A falls scoping audit was conducted at baseline and following implementation of activities.
  • An education resource was developed

    – Falls Prevention Training Expo. The training package provides information and resources to run an interactive and experiential style training expo. The training aimed to raise the profile of falls prevention, with the motto, ‘falls prevention is everyone’s responsibility’. The resource provided individual session guidelines covering the following topics:

    – Medicines (including side effects),

    – Transfers and mobility,

    – Nutrition,

    – Environmental considerations,

    – Feet and footwear, and

    – Psycho-social considerations (including fear of falling).
  • Each facility hosted a training expo. This process not only maximised the reach of falls prevention training to as many staff within each facility as possible, but the falls prevention training resource was also available for longer term use.

What was achieved?

What was the impact for residents?

Improvements in fall prevention practice were identified at all facilities with residents benefiting from:

  • improvements in staff training in relation to falls prevention,
  • use of hip protectors and high-low and low-low beds,
  • use of bed and chair alarms,
  • increased observation,
  • increased use of Vitamin D and calcium supplementation,
  • increased sunlight exposure,
  • increased information for residents,
  • increased access to allied health and medical support,
  • improvements in falls risk assessments,
  • improvements in foot care and appropriate footwear,
  • increased identification of high falls risk residents, and
  • increased environmental auditing and monitoring of sensory aids.

What was the impact for staff?

  • Staff surveys on safety culture, sustainability and professional practice showed improvements in staff perceptions of the culture of the facility in relation to falls prevention activities and safety.
  • The project team concluded that the use of action research was a beneficial process for engaging a broad mix of staff in facilities, facilitating reflection on practice, developing a best practice approach to falls prevention and supporting ‘buy in’ and staff ownership of innovation.

What could be adopted in my service?

Examples of small changes that facilities could make to have a positive impact on falls prevention and management include:

  • Regularly review residents’ sensory aids (hearing and sight).
  • Review current resident footwear and consider developing a system for purchasing appropriate footwear for residents.
  • Provide residents with vitamin D and calcium supplements.
  • Consider how increased use of physiotherapy and individual or group exercise programs might assist in preventing falls, particularly for at risk residents.
  • Consider increased use of hip protectors, high-low and low-low beds and alarms.
  • Review falls risk assessment practice for individual residents (e.g. falls risk, mobility, etc) and for facilities (e.g. environmental falls risk factors).
  • Review processes for identification and observation of high falls risk residents.
  • Review the falls prevention information provided to residents.

What resources are available?

The Project website contains a number of resources developed through this project including, the Working Together to Prevent Falls in Residential Care – Resource Package. This resource provides a guide to implementing falls prevention interventions in a simple to use package with links to various resources such as:

  • information on how to use falls incident data and how to define a fall,
  • evidence based guidelines;
  • the falls risk assessment tool used in this project,
  • the scoping audit tool modified for use during the project for facilities to monitor their practice against evidence based guidelines,
  • a guide to action research, and
  • a guide to implementing an interactive falls prevention expo.

The website also contains an educational training package the Falls Prevention Training Expo which provides information and resources to run an interactive and experiential style training expo. It is designed for use in the acute, community and residential care sectors.

In addition, the Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Residential Aged Care Facilities 2009, have been designed to assist residential aged care facilities and health professionals working in facilities reduce the risk of falling for older residents. They replace the 2005 guidelines used in this project and contain the latest evidence on falls prevention.

The guidelines can be found on the Australian Commission on Safety and Quality in Health Care website.

Nutrition and hydration

Encouraging best practice nutrition and hydration in residential aged care

Project overview

The purpose of this project was to enable best practice nutrition and hydration approaches described in the Best Practice Food and Nutrition Manual for Aged Care Facilities to be implemented in nine residential aged care facilities throughout NSW. Facility staff were encouraged to be alert for factors that place residents at risk of poor nutrition and hydration and to apply best practice approaches. The ultimate goal was to improve nutrition and hydration and quality of life for the residents.

What was done?

The project used Participatory Action Research as a means to support development of practice within the facilities in line with the Best Practice Food and Nutrition Manual for Aged Care Facilities2. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide practice development strategies. Champions were identified in each facility – people who were enthusiastic and credible advocates for nutrition change, generally being senior nursing staff.

The project included a number of key activities, including:

  • Interviews with key staff and focus groups and surveys for residents to identify opportunities for change. – Staff were asked to identify nutrition and hydration problems they believed could be the focus of their intervention. – Residents were asked to discuss the positive and negative aspects of meals and meal times at the facility, with an emphasis on the positive. – An anonymous food services survey was also offered to all residents.
  • Nutrition meetings to discuss results of staff interviews and resident focus groups, relevant literature and identify and prioritise opportunities for change within the facility.
  • Plate waste studies were conducted, with Nutrition Assessors recording the amount of food left on each resident’s plate after they had finished eating their meal. Breakfast, lunch, dinner, morning and afternoon tea and supper were observed over a 24 hour period.
  • Comprehensive nutrition assessments were conducted three times during the project which included measures of demographics, malnutrition screening, global assessment, anthropometric measures, lean body mass and quality of life. Feedback from the nutrition assessment identified residents at risk.

What was achieved?

What was the impact for residents?

  • A favourable change or maintenance of good nutrition was observed for 30-65% of residents in eight of the nine facilities, where prior to the project, data suggested that 20-60% of residents might be considered mildly malnourished, with a further 15 % of residents considered to be severely malnourished.
  • Plate waste was reduced in many of the facilities. The lowest plate waste items were for cereal, hot breakfasts, fruit, juice, cold lunch options and dessert, indicating that servings of these food items could be increased.
  • Residents reported that creating an atmosphere (i.e. addition of music) improved meal times, with most residents looking forward to their meals, viewing it as an essential part of their daily routine.

What was the impact for staff?

  • Improved knowledge and skills in nutrition as well as increased willingness, confidence and capability to trial new approaches.
  • Increased attention to nutritional practices as staff became more aware of nutritional issues in their residents, and why they mattered.
  • Dramatic changes in the attitude of catering staff in terms of trialling new approaches.
  • Overall staff were positive and enthusiastic about the changes that occurred.

What could be adopted in other services?

Examples of small changes that facilities could make to have a positive impact on residents’ nutrition and hydration include:

  • monitor residents’ weights to identify and respond to the needs of residents who are higher risk
  • review plate wastage to assess food preferences and resident intakes
  • review menus, consider resident preferences and try to include fresh-cooked items, consider the use of bread-makers and soup tureens to allow ‘cooked on site’ options
  • conduct an analysis of food handling
  • change preparation of pureed meals i.e. the use of puree moulds to improve the look and texture of pureed meals
  • use coloured plates to help visually impaired residents with their meals and square plates to help identify those residents whose food intake requires close attention
  • use insulated mugs and bowls to help regulate food temperatures
  • use nutritional supplements
  • hold a food taste-testing session to evaluate residents’ preferences
  • purchase bread makers and include bread making in the recreation activity program
  • roster staff to optimise catering skills and support residents at meal times
  • consider how the dining room could be made more relaxed and friendly, to encourage residents’ attendance and make meal times more congenial and interactive

What resources are available?

The project produced the Implementing Best Practice Nutrition and Hydration Support in Residential Aged Care Tool Kit which contains:

  • Introductory materials
  • Screening and Assessing Nutrition Needs information sheets, tools and charts
  • Accurate Measurement information sheets and DVDs
  • Medicare Allied Health information sheets and tools
  • Food Options and Preferences information sheets and chart
  • Plate Waste information sheet, charts and examples
  • Food Quality information sheets and DVD
  • Broadening the Sensory Experience information sheets
  • Additional Resources including posters, a tape measure, badge and ‘The Practice Food and Nutrition Manual for Aged Care Facilities’ A revised version of the Best Practice Food and Nutrition Manual for Aged Care Facilities will be available from the Department of Social Services in 2011. This will be followed by the public release of the Implementing Best Practice Nutrition and Hydration Support in Residential Aged Care Tool Kit.

2. Central Coast Health in association with the Australian Nursing Home Extended Care Association NSW 2004, Best Practice Food and Nutrition Manual for Age Care Facilities.

Pain management

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities

Project overview

The purpose of this project was to provide education and training to all aged care staff within five residential aged care facilities across Victoria, Western Australia and Queensland in best practice pain management for older residents with bothersome pain. The project was led by the National Ageing Research Institute (NARI), aided by six academic organisations.

What was done?

The general framework for the process of change management in each facility was based on the ADKAR Change Management Model3:

  • Awareness of the need to change
  • Desire to participate and support the change
  • Knowledge of how to change (and what the change looks like)
  • Ability to implement the change on a day-to-day basis
  • Reinforcement to keep the change in place

The project included the following key activities:

  • Appointment of facility ‘Pain Champions’ and assistants to case manage individual residents with pain and engage external health services where needed. Pain management teams were appointed in most facilities to help bring about change.
  • Resident, staff and facility data was collected before changes were made, i.e. incidence of pain, incidence of untreated pain, number of pain reports unaddressed, which pain assessment tools were used and how often, how pain was documented, and focus group interviews. 92% of all available residents were interviewed.
  • Dedicated 1:1 on-the-job training and supervision of pain management practice. Approximately 350 aged care staff were intensively trained as over 2000 hours of instruction and training were delivered. Training was aimed at:

    – improving knowledge of current best evidence;

    – familiarity with Australian Pain Society guidelines;

    – use of pain assessment tools; and

    – how to conduct revised in-house pain management procedures.
  • In one facility a multidisciplinary pain clinic was provided onsite that offered individual treatments as well as a short group program.
  • The development of online information on best practice pain management was also undertaken to improve the reach of the educational initiatives and help to sustain a useful training resource beyond the life of the project.

What was achieved?

What was the impact for residents?

  • Overall, residents reported improvements to pain management practices, including a perceived increase in staff awareness of resident pain needs and being asked more regularly about their pain status.
  • Residents spoke of increased access to both medicines and other treatments. This was supported by data that showed varying degrees of increased use of analgesics in four of the five facilities. In addition, the use of other methods for managing pain, such as use of heat packs, massage, TENS and physical therapy, was said to have increased in the majority of facilities. Some residents found these methods very helpful and comforting.
  • Residents with severe, persistent pain who participated in the multidisciplinary pain management clinic reported that it was informative, and helpful to meet with others who have a shared understanding of pain.
  • Pain related impact on mood, function and quality of life showed a significant change or strong trend for improvement in residents at 4 out of 5 RACFs. This finding is important because in multidisciplinary pain clinics, a reduction in pain impact is often seen as being more valuable than a change in pain, itself.

What was the impact for staff?

  • 27 evidence-based standards were compiled and evaluated in each facility. Before changes in pain management were made, facilities complied with only 6-12 of those standards. At the end of the project, 21-24 of the 27 standards were being met.
  • In all facilities there was increased awareness and understanding of resident pain. Personal care assistants more readily informed the nursing staff that a resident had reported or demonstrated signs of pain. Nursing staff also stated that Personal Care Assistants were more interested in residents’ pain and more involved in the management of pain for residents in their care. Some Personal Care Assistants stated that they were more confident in assessing pain and more likely to consider pain management as their responsibility now.
  • Staff expressed that the education had particularly helped them to understand the pain assessment documentation. With knowledge of the tools, staff (at all levels) reported that pain was being more accurately recorded, including documenting pain assessments in histories/nursing plans, which in turn assisted nurses with management strategies.
  • Informal feedback from the Clinical Nurse Educators suggested that the 1:1 pain assessment training was successful in involving carers directly in the pain assessment process.

What could be adopted in my service?

Examples of small changes that facilities could make to have a positive impact on residents’ pain management include:

  • Assess residents’ levels of pain and needs regularly and monitor impact of pain management strategies
  • Consider more active involvement of Personal Care Assistants in identifying and managing pain issues
  • Review the use of pain medication on a regular basis, where appropriate, rather than on a PRN (as required) basis
  • Consider the use of non-pharmacological therapies, including heat packs, Dencorub, repositioning, passive / active exercises, massage, hernia belts, prostheses (such as hand splint), TENS and aromatherapy
  • Assess staff training and resourcing needs to support better pain management
  • Review Care Plans to ensure they include how to achieve better pain management
  • Engaged with GPs and Allied Health Professionals to establish a multidisciplinary approach to pain management
  • Consider self assessment against the draft 27 key standards compiled from the Australian Pain Society guidelines4 for the provision of best practice pain management to gauge current facility strengths and areas that could be improved

What resources are available?

The project website contains all educational tools on pain assessment and management used in the project. The site includes a self-directed learning package for staff, residents and families including materials produced and successfully trialled in the five participating facilities. The draft 27 key standards compiled from the Australian Pain Society guidelines for the provision of best practice pain management. This tool has yet to be formally validated across a range of settings, so further development may be required. Please contact the Department of Health or NARI for further information.

3. Hiatt, J 1998 The Perfect Change. Prosci. Learning Center Publications, Loveland.

4. Australian Pain Society 2005. Pain in Residential Aged Care Facilities: Management Strategies.

More information

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

 

EBPAC Round 1 - Cover