Research continues to improve knowledge and understanding, but translating this research into clinical practice remains a challenge.
New research from Monash University, published in Implementation Science, has found that strategic, systems-level approaches can significantly improve how guidelines are followed in aged care. This translates theoretical best practice into everyday clinical application, ultimately raising the quality of care for residents.
Researchers from the Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences (MIPS) evaluated strategies through a major multi-state trial called EMBRACE.
To shift staff behaviour, the trial deployed multiple approaches, rather than simply distributing a manual and hoping for the best. Guideline resources have been designed to facilitate research translation including nine targeted fact sheets, a practical 10-item checklist to monitor for medication side-effects and a companion guide for people living with dementia and their families.
Monash University partnered with four aged care provider organisations, tracking outcomes across 19 residential facilities in New South Wales, Queensland, Western Australia and Victoria, to apply Australia's Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Care.
Professor Simon Bell, the Director of CMUS, said the traditional model of disseminating guidelines often fails to account for the complex, fast-paced environment of aged care.
"Improving medication safety in residential aged care requires new strategies to bridge the gap between research evidence and clinical practice," Professor Bell said.
A companion study, published in BMJ Quality & Safety, further explored the evolving role of knowledge brokers - intermediaries who bridge evidence-to-practice gaps. Knowledge brokers worked at a systems-level to develop, deliver and evaluate local quality improvement initiatives.
"Over the course of the 12-month trial, we watched these roles evolve from the ground up," Professor Bell said.
"The knowledge brokers began by understanding the local context and building relationships with staff."
Their effectiveness, however, was not created in a vacuum. CMUS Senior Research Fellow Dr Amanda Cross said that successful quality improvement involves more than high quality research, it requires an in-depth understanding of the structure and function of aged care services.
"Our companion study found that a knowledge broker's success was heavily shaped by facility leadership, organisational culture and dedicated implementation support," Dr Cross said.
"Together, the studies demonstrate that developing a high-quality guideline is only one part of improving evidence-based care, but how guidelines are implemented is equally important.
"New Guidelines being developed in accordance with Australia's National Health and Medical Research Council standards involve an integrated knowledge translation approach, where the acceptability and feasibility of recommendations are considered at the outset."
The implications of these findings extend well beyond the management of psychotropic medications. Australia continues to transform its residential aged care sector by introducing new models of care and integrated workforce roles, such as embedding onsite pharmacists into facilities.
This research provides a crucial blueprint for that transition. It offers industry leaders a framework for how these new roles can be leveraged at a system-level to translate clinical evidence into practice.
Read the research papers: doi.org/10.1186 | doi.org/10.1136
