Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. Subjects & setting One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. Methods Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. Results At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. Conclusion This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257. Registered 14 December 2018.

The rapid introduction of technology into acute healthcare settings, specifically the presence of point-of-care health information technology at patients' bedsides, is expected to impact patients' healthcare experience by altering nursepatient interactions. This research was a multi-method naturalistic pilot study designed to explore patients' perception of their interactions with nurses using bedside point-of-care health information technology in acute care. Data were collected using observation, interviews and surveys. Twenty-four participants were purposefully recruited from medical and surgical wards, to capture variability in their self-reported confidence with information technology; 29% were not confident, 38% were somewhat confident and 33% were completely confident with information technology. Participants' mean age was 68.6 years (SD 11.1) and 63% were male. Qualitative observation, interview and survey data showed some nurses directly involved patients and explained or demonstrated how the point-of-care health information technology was being used to complement and enhance their care; while others used the point-of-care health information technology as an electronic documentation tool without engaging their patients. Patients' experiences of point-of-care health information technology differed with their self-reported confidence with information technology; those with complete information technology confidence were better at recognising the potential and opportunities for point-of-care health information technology to support self-directed care than those with less confidence using information technology. Some participants reported that the use of point-of-care health information technology impeded interpersonal communication with nurses. Participants recognised the benefits of point-of-care health information technology to support clinical practice but generally desired greater engagement with the nurses when they used the system.

No abstract

Despite the recognised importance of falls prevention in rehabilitation settings, there is limited research focusing on falls risk assessment tools designed to guide both patient screening and therapy. This study evaluated the predictive accuracy and inter-rater reliability of the Shkuratova Assessment of Falls-risk in Rehabilitation settings (SAFER) tool. The study was conducted at a subacute rehabilitation facility in Australia. Patient assessments were performed on admission to subacute care by trained physiotherapists, and the incidence of falls was documented prospectively. Of the 147 patients, 45 had at least one fall and were compared to 102 who had no falls. The inter-rater reliability of the SAFER tool when used by trained physiotherapists was high with the level of agreement for individual items ranging from 74 to 99%. Thirty-two (76%) patients who experienced a fall during their admission and 46 (44%) who did not fall were identified as having a high falls-risk. Using a SAFER tool cut-off of 12/26: sensitivity is 69%, specificity is 66%, area under the curve 0.71 (95% confidence interval: 0.62–0.80). The high negative predictive values at a range of cut-offs provided strong evidence that patients identified as having a low falls-risk were unlikely to experience a fall. Performing a comprehensive assessment of specific deficits in gait, balance and mobility on admission provided a streamlined approach to identification of patients who would benefit from tailored falls prevention interventions.

Aims and objectives To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter‐hospital transfer from a subacute to an acute care hospital. Background Patients who experience emergency inter‐hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in‐hospital mortality (15%). Design This prospective, exploratory cohort study was a subanalysis of data from a larger case–time–control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. Methods Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not‐for‐cardiopulmonary resuscitation (CPR) orders) were compared using chi‐square or Kruskal–Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. Findings. Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not‐for‐CPR. Compared to patients for full resuscitation, patients with not‐for‐CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not‐for‐CPR were less likely to be readmitted to acute care and more likely to return to subacute care. Conclusions Two‐thirds of patients in subacute care who experienced an emergency inter‐hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not‐for‐CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. Relevance to Clinical Practice As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.