Linda Furness, Occupational Therapy Clinical Education Support Officer, Darling Downs Hospital and Health Service Contact:

Linda Furness, Occupational Therapy Clinical Education Support Officer, Darling Downs Hospital and Health Service Contact: linda.furness@health.qld.gov.au

Why? 1 older person dies every 5 hours following fall in the home Falls are lead cause of injury induced mortality in people aged 75 years & older Occupational Therapist led EAM (1-3). is effective approach to reducing falls (4-7) > minimise known falls hazards > change how person interacts with surroundings BUT. EAM is not routinely implemented

Regional and Rural Impacts (9-11) Geographical & professional isolation Access to education, journals, internet Work as generalist (12) Minimal research on update of evidence in regional& rural locations Aim: Identify factors that support the local adoption of best practice in EAM in falls prevention for OTs within a regional Hospital and Health Service.

Method: concurrent mixed methods Promoting Action of Research Implementation in Health Services (PARHIS) Framework (13) Baseline data collection: Chart audit Self report survey of current OT practice 2 x focus group discussions: 1 rural and 1 regional centre group

Results 58 charts audited OT Survey 14 OTs completed 2 Focus groups (12 OTs) Impacts on implementation of best practice EAM Mixed level understanding of available evidence OTs high level confidence in being able to conduct home falls Ax BUT limited evidence of application of best practice EAM in chart audit

Contextual issues: Impacts of rural & regional service delivery Broad geographical area serviced Professional isolation Access to education Operational management not from OT Knowledge of OT role (referrers, multidisciplinary team) Workforce (disperse & sometimes transient workforce)

Discussion/Conclusions PARHIS Framework (13) Key elements for knowledge translation: evidence, context, facilitation

References 1. Nikolaus T, Bach M. Preventing Falls in Community-Dwelling Frail Older People Using a Home Intervention Team (HIT): Results From the Randomized Falls-HIT Trial. Journal of the American Geriatrics Society. 2003;51(3):300-5. 2. Pighills AC, Torgerson DJ, Sheldon TA, Drummond AE, Bland JM. Environmental Assessment and Modification to Prevent Falls in Older People. 2011:26. 3. Campbell AJ, Robertson MC, Grow SJL, Kerse NM, Sanderson GF, Jacobs RJ, et al. Randomised controlled trial of prevention of falls in people aged 75 with severe visual impairment: the VIP trial. BMJ. 2005;331(7520):817. 4. College of Occupational Therapists. Falls: the role of occupational therapy in the prevention and management of falls - practice guideline. London: COT Specialist Section Older People, 2015. 5. Australian Commission on Safety and Quality in Healthcare. Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Community Care. Canberra: Commonwealth of Australia; 2009. 6. Gillespie L, Robertson M, Gillespie W, Sherrington C, Gates S, Clemson L, et al. Interventions for preventing falls in older people living in the community. Cochrane database of Systematic Reviews,. 2012(9):1-416. 7. Clemson L, Mackenzie L, Ballinger C, Close JC, Cumming RG. Environmental interventions to prevent falls in community-dwelling older people a meta-analysis of randomized trials. Journal of Aging and Health. 2008;20(8):954-71. 8. Clemson L, Donaldson A, Hill K, Day L. Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to occupational therapy home visits. Australian Occupational Therapy Journal. 2014:n/a-n/a. 9. Mills J, Field J, Cant R. Rural and remote Australian general practice nurses' sources of evidence for knowledge translation: a cross-sectional survey. International Journal of Evidence-Based Healthcare. 2011;9(3):246-51. 10. Winters CA LH, Besel J, Strand A, Echeverri R, Jorgensen KP, Dea JE.. Access to and use of research by rural nurses. Rural and Remote Health. 2007;7(758). 11. S. M. The rural and urban realities of family medicine. Canadian Medical Association Journal. 2001;164(1611). 12. Wellard S, Bethune E. WLearning issues for nurses in renal satellite centres.. Australian Journal of Rural Health 2000; 8: 322-326. 2000;8:322-6. 13. Stetler CB, Damschroder LJ, Helfrich CD, Hagedorn HJ. A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science. 2011;6(1):99.

Contact linda.furness@health.qld.gov.au