Age Ageing. 2026 Oct 31;55(11):afag329. doi: 10.1093/ageing/afag329.
ABSTRACT
BACKGROUND: Effective implementation of guidelines into residential aged care facilities (RACFs) is important for high-quality care. The 12-month Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) helix-counterbalanced randomised controlled trial evaluated three strategies to implement Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care: (i) passive distribution of Guideline material, (ii) pharmacist-led staff education and (iii) knowledge broker-led Guideline implementation. All three strategies reduced Guideline non-concordance over time, with no significant difference between strategies. This mixed-method process evaluation examined delivery of the implementation strategies, including contextual factors important for Guideline implementation.
METHODS: Semi-structured interviews conducted with 34 health and care professionals at 12 months were thematically analysed using a deductive approach informed by the Grant framework. Descriptive statistics summarised quantitative data from a post-trial survey completed by intervention pharmacists.
RESULTS: Distribution of Guideline materials occurred opportunistically with RACF staff preferring summary materials (e.g. one-page factsheets). Pharmacist-led staff education was tailored to be shorter, more frequent and delivered one-on-one or in small groups. Knowledge broker pharmacists spent a median 70% of time delivering quality improvement activities including audit and feedback and integrating psychotropic best practice into RACF procedures and digital systems. Facilitators of successful Guideline implementation included early engagement with aged care leadership and knowledge broker integration into the team.
CONCLUSION: Guideline implementation efforts in RACFs may benefit from a multifaceted implementation approach involving early engagement with aged care leadership and contextualised delivery of implementation strategies according to staff preferences and needs.
PMID:43023740 | DOI:10.1093/ageing/afag329
