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Engaging clinicians in practice development initiatives can be a daunting task, especially if those staff groups are spread over a five-site NHS Trust. Within Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), the geography across the city adds a unique dimension to bringing about changes in practice and using the best possible evidence. Specific strategies need to be put in place in order to enable clinicians to access specialist help within the Trust, using the available networks to their best advantage and thereby reducing repetition. The role of a practice development team situated within such a large organization can influence changes in practice and encourage newer innovative ways of working. Copyright © 2009 John Wiley & Sons, Ltd.

Objectives: To evaluate the effect of advice about hip fracture prevention on clinical practice in residential aged care facilities (RACFs) and to survey consumer knowledge. Methods: Cluster randomised trial using modified two-by-two factorial design. Clinicians received written advice in three RACFs; online advice in three RACFs; both in three RACFs and three RACFs were controls. Free hip protectors were offered in one RACF from each intervention group. Consumer awareness and attitudes to hip fractures were surveyed. Results: Baseline rate of calcium plus vitamin D prescription was 3.5%. Information provision failed to produce a significant effect on clinical practice during 12-week follow up. Offering free hip protectors was effective (P

High numbers of hip fractures in residential aged care make the institution of a practical prevention program an urgent priority. We developed and implemented a pilot multidisciplinary practice guideline integrating fall prevention, hip protectors, and osteoporosis management in a group of 50 residents at very high risk of hip fracture. We describe the characteristics of these residents and report the outcome of this observational study, which resulted in an implementation rate of between 50% and 86% for six individually considered interventions at 6-month follow-up.