Learning Objective 1: Describe why local interactions strategies used by nursing home staff may influence quality of care such as reduction of resident falls.
Learning Objective 2: Name three local interaction strategies that nursing home staff may use to improve information exchange about resident care in nursing homes.
Studies show that nursing home (NH) fall rates drop when risk-factor reduction is performed by researchers, but programs implemented by existing NH staff have been less successful. We hypothesized that an intervention improving staff connections, communication, and problem solving (CONNECT) would improve uptake of a traditional falls education program (FALLS).
Community (n=4) and VA NHs (n=4) were randomized to receive FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3-months. CONNECT was designed to help staff identify communication gaps, share information across disciplines to make sense of residents’ problems, and practice interaction strategies. FALLS used quality improvement approaches such as team in-services, teleconferences, academic detailing, and audit/feedback. Interdisciplinary staff participated in sessions (n=599; 49 %), and completed 3 waves of communication measures (n=470). A random sample of resident charts (n=481) was abstracted to measure fall-risk modification activities. The study outcome was change in facility fall-rates measured in the 6 months before and after the interventions.
Improvements in staff perceptions of communication quality, nurse aide participation in decision making, safety climate, care giving quality, and use of local interaction strategies were observed in intervention community NHs (treatment by time effect p=.01), but not in VA NHs. Fall-risk modification activities did not change significantly. In control facilities, fall rates were similar in pre- and post-intervention (2.61 and 2.64 falls/bed/yr), whereas they decreased by 12% in intervention facilities (2.34 to 2.06 falls/bed/yr); the effect of treatment on rate of change was 0.81 (0.55, 1.20).
CONNECT improves measures of staff communication in community, but not VA nursing homes where we observed a ceiling effect in survey measures. Fall-risk modification activities measured by chart abstraction are insensitive to change; however, a trend toward improved fall rates occurred for the intervention group but requires confirmation in a larger study.