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Journal of the New Zealand Medical Association, 29-January-2010, Vol 123 No 1308

[full text] [PDF]

A complex intervention to support ‘rest home’ care: a pilot study

Shankar Sankaran, Tim Kenealy, Allan Adair, Vivienne Adair, Heather Coster, Noeline Whitehead, Nicolette Sheridan, Matthew Parsons, Elaine Marshall, Leslie Bailey, Catherine Price, Dwayne Crombie, Harry Rea

Abstract

Aims
To describe an intervention supporting Aged Related Residential Care (ARRC) and to report an initial evaluation.

Methods
The intervention consisted of: medication review by a multidisciplinary team; education programmes for nurses; telephone advice ‘hotlines’ for nursing and medical staff; Advance Care Planning; and implementing existing community programmes for chronic care management and preventing acute hospital admissions.
Semi-structured interviews were conducted with members of the multidisciplinary team, rest home nurses and caregivers. Quantitative data were collected on medication changes, hotline use, use of education opportunities and admissions to hospital.

Results
Medications were reduced by 21%. Staff noted improvements in the physical and mental state of residents. There was no significant reduction in hospital admissions. Nurses were unable to attend the education offered to them, but it was taken up and valued by caregivers. There was minimal uptake of formal acute and chronic care programmes and Advance Care Planning during the intervention. Hotlines were welcomed and used regularly by the nurses, but not the GP.

Conclusions
The provision of high status specialist support on site was enthusiastically welcomed by ARRC staff. The interventions continue to evolve due to limited uptake or success of some components in the pilot.