Strategies for the implementation of an electronic fracture risk assessment tool in long term care: a qualitative study

Abstract

Background Older adults in long-term care (LTC) homes experience high rates of fractures, which are detrimental to their quality of life. The purpose of this study is to identify and make recommendations on strategies to implementing an evidence-based Fracture Risk Clinical Assessment Protocol (CAP) in LTC. Methods Following the Behaviour Change Wheel framework, we conducted six focus group interviews with a total of 32 LTC stakeholders (e.g. LTC physicians) to identify barriers and facilitators, suggest implementation strategies, and discuss whether the identified strategies were affordable, practicable, effective, acceptable, safe, and if they promote equity (APEASE). The interviews were transcribed verbatim and analyzed using thematic content analysis. Results Themes of implementation strategies that met the APEASE criteria were minimizing any increase in workload, training on CAP usage, education for residents and families, and persuasion through stories. Other strategy themes identified were culture change, resident-centred care, physical restructuring, software features, modeling in training, education for staff, social rewards, material rewards, public benchmarking, and regulations. Conclusions To implement the Fracture Risk CAP in LTC, we recommend using implementation strategies centred around minimizing any increase in workload, training on CAP usage, providing education for residents and families, and persuading through stories. Through improving implementation of the fracture risk CAP, results from this work will improve identification and management of LTC residents at high fracture risk and could inform the implementation of guidelines for other conditions in LTC homes.

The iCARE feasibility non-experimental design study: An integrated collection of education modules for fall and fracture prevention for healthcare providers in long term care

“…Indeed, guidelines have the capacity to promote high quality practice informed by evidence, enable appropriate resource allocation, and advance research by identifying knowledge gaps (10); however, the existence of guidelines alone is not enough to change practice (10,11). The lack of guideline uptake in practice is evident with the ongoing high morbidity and mortality associated with fractures in LTC (12)(13)(14). The major gap is the limited evidence on effective knowledge translation strategies to prevent falls and low trauma fractures in residents who are at high risk of fractures (12,15,16).…”