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Occupational therapist-led environmental assessment and modification (EAM) is effective in reducing falls for populations at high risk. Two regional and rural public health services in Queensland devised an implementation strategy to embed best practice occupational therapist-led EAM.A qualitative study was conducted to compare the determinants of implementation success across the different health services, using the COM-B model of behaviour change. Six semi-structured interviews were completed with occupational therapists involved at each site, following 12 months of implementation. Interview data were triangulated with minutes from three combined site steering committee meetings, eight local steering committee meetings, and field notes. Thematic analysis was completed to compare barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites.Both sites commenced implementation with similar states of capability and motivation. After 12 months, one site considered that practice change had been embedded as noted in steering committee minutes and comments; however, the other site observed limited progress. According to the COM-B analysis, opportunity (the factors that lie outside the individual's control) had a significant influence on how both sites were able to respond to the practice change and navigate some of the unexpected challenges that emerged, including the COVID-19 pandemic. Existing team structure, multiple responsibilities of key stakeholders, differences in access to resources, and lack of connection between complementary services meant that COVID-19 disruptions were only a catalyst for unveiling other systemic issues.This study highlights the power of external factors on influencing behaviour change for best practice implementation. Learnings from the study will provide deeper understanding of completing implementation projects in regional and rural contexts and support the future implementation of EAM in occupational therapy clinical settings.

Sedation encompasses a continuum from complete unconsciousness to drowsiness and anxiolysis where some awareness might be expected. Most patients undergoing endoscopy sedation expect to be completely unconscious during the procedure and thus have unmet expectations regarding their state of consciousness. This study aimed to evaluate whether endoscopy sedation information sheets reduce the level of concern regarding possible awareness during endoscopy sedation at a major regional hospital. Our findings were that 28.8% of patients who received the endoscopy sedation information sheet (n = 82) were concerned about awareness during the procedure, compared to 36.5% of patients in the control group (n = 105). However, the difference was not statistically significant. We also found that the incidence of awareness was higher (13.9%) in the intervention group compared to 8.8% in the control group but, again, not statistically different. This study allowed us to elucidate the level of concern regarding possible awareness during sedation and the incidence of awareness during endoscopy sedation. This will enable future work investigating the role of endoscopy sedation information methods involving written and video material in assisting pre-procedure patient counselling.

Evidence-based practice in radiography is an emerging practice, due to a lack of evidence. Beyond the diagnostic requirements of the examination, imaging technique decisions are guided by the radiographer's tertiary education and clinical experience. Imaging technique decisions should include all aspects of evidence-based practice: research-based evidence, patient circumstances and clinical experience. Previous research suggests radiographers do to not fully engage with the latter, which may jeopardise progress in the field and lead to outdated practices and suboptimal outcomes for patients. This study aimed to examine the motivators and influences involved in radiographers' decision-making when modifying imaging acquisition techniques.An exploratory descriptive, inductive qualitative interview-based design was used with a convenience sample of radiographers from three public hospital sites in Queensland. Twelve one-on-one semi-structured interviews were performed via video conference, the data were analysed through thematic analysis.Five themes emerged from the data: advancement of technology; experience rather than evidence; radiology's influence on radiographic practice; information sources; and image quality. The pursuit of image quality was the key motivator and criterion that influenced radiographers' choices in imaging technique modification. Interviewees did not engage routinely with research-based evidence, preferring to rely on empirical observations and professional experience.The exclusion of research-based evidence can lead to outdated and ineffective clinical decisions. Further work is needed to promote more research in the field of radiography and increase the willingness and capacity of radiographers to follow the principles of evidence-based practice.

Introduction: Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service. Methods: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed. Results: Twenty-four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty-eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change. Conclusion: Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings.

Introduction: The underpinning principles of radiation protection are justification, optimisation and limitation. Each medical imaging referral that uses ionising radiation must balance the justification of exposure to radiation against the benefits of the examination. Scrutiny of justification is the role of radiographers, for general radiography, and is usually performed using the clinical details provided on the referral. International studies report up to 77% of medical imaging examinations are unjustified or inappropriate. In regional Queensland, justification seems to involve a subjective assessment and enforcement is ad hoc. This study aimed to determine the number of unjustified emergency department x-ray examinations performed in a regional Queensland hospital. Methods: An audit of the clinical details provided on x-ray referrals and in the medical records was performed on x-ray examinations undertaken within an 11-day period. Justification was determined by compliance with the Government of Western Australia's diagnostic imaging pathways. Results: Of the 186 referrals assessed, 75.3% were categorised as not having complied with the imaging pathway and were considered unjustified. When the clinical details in the patient's medical record were reviewed, in conjunction with the referral, the unjustified rate reduced to 49.2% of examinations. Conclusion: Results demonstrate a lack of information transfer by referring clinicians and a lack of compliance with justification requirements for imaging by medical imaging staff. Improved communication regarding the need for imaging, and the refusal of referrals that are not justified, will ensure that patients are only exposed to radiation when clear benefit has been demonstrated.

Introduction X‐ray Operator (XO) supervision in Queensland is performed by radiographers in a site removed from the XO site. This has historically been performed by telephone when the XO requires immediate help, as well as post‐examination through radiographer review and the provision of written feedback on images produced. This project aimed to improve image quality through the provision of real‐time support of XOs by the introduction of video conference (VC) supervision. Methods A 6‐month pilot project compared image quality with and without VC supervision. VC equipment was installed in the X‐ray room at two rural sites, as well as at the radiographer site, to enable visual and oral supervision. The VC unit enabled visualisation of the X‐ray examination technique as it was being undertaken, as well as the images produced prior to transmission to the Picture Archiving and Communication System (PACS). Results Statistically significant improvement in image quality criteria measures were seen for patient positioning (P = 0.008), image quality (P < 0.001) and diagnostic value (P < 0.001) of images taken during this project. No statistically significant differences were seen during case level assessment in the inclusion of only appropriate imaging (P = 0.06), and the inclusion of unacceptable imaging (P = 0.06), however improvements were seen in both of these criteria. The survey revealed 24.6% of examinations performed would normally have involved the XO contacting the radiographer for assistance, although, assistance was actually provided in 88.3% of examinations. Conclusion This project has demonstrated that significant improvement in image quality is achievable with VC supervision. A larger study with a control arm that did not receive direct supervision should be used to validate the findings of this study.

Evidence is mounting regarding the positive effects of Interprofessional Education and Collaborative Practice (IPECP) on healthcare outcomes. Despite this, IPECP is only in its infancy in several Australian rural healthcare settings. Whilst some rural healthcare teams have successfully adopted an interprofessional model of service delivery, information is scarce on the factors that have enabled or hindered such a transition. Using a combination of team surveys and individual semi-structured team member interviews, data were collected on the enablers of and barriers to IPECP implementation in rural health settings in one Australian state. Using thematic analysis, three themes were developed from the interview data: IPECP remains a black box, drivers at the system level, and the power of an individual to make or break IPECP. Several recommendations have been provided to inform teams transitioning from multi-disciplinary to interprofessional models of service delivery.

Introduction: Healthcare professionals often provide substandard chest compression following cardiac arrest. This is deemed a preventable harm because this skill can be acquired. The recent development of technology-enhanced cardiac compression training devices provides an alternative to traditional instructor-facilitated training. This pilot study compared the effectiveness of conventional and technology-enhanced training modalities. Methods: A pilot randomised controlled trial design was used in a regional hospital in Queensland. Following baseline assessment, healthcare staff were randomised to one of three groups: traditional instructor-facilitated training; high-fidelity mannequin training and continuous access to the training system to practise skills; and, high-fidelity mannequin training with no further access to the training system to practise skills. The primary outcome, cardiac compression skill levels, was analysed using analysis of co-variance, adjusting for predictive co-variates. Secondary measures were analysed using inferential statistics or presented descriptively. Results: Between January and February 2017, 502 healthcare staff were recruited. At baseline, 21\% were competent in cardiac compression, increasing to 38% on reassessment. The mode of training did not affect skill level (F(92,392) = 0.061, p = .94), however, participants in the high-fidelity mannequin training group who practised their skills had statistically significantly higher reassessment scores (z = -2.34, p = .019). Baseline score and the number of times participants practised their skills were significant predictors of reassessment scores (F(2,392) = 7.73, p = .001). Conclusions: Most hospital staff who may need to perform cardiac compression were not competent in this skill. Neither training modality was more effective. Both training and practise increased cardiac compression skill levels, indicating that frequent, low-dose training is required.

What you need to know One third of people over the age of 65 experience a fall.1 The health and social care costs of falls are increasing with longevity.23 Falls are one of the leading causes of morbidity and death caused by injury in people over 75. Nearly a quarter of older people who fall are concerned about further falls, and some restrict activity. This can result in physical deconditioning, increased risk of future falls, institutionalisation, and reduced quality of life.4 Box 1 lists features that predispose older people to falls.5 Box 1 ### Risk factors for falls in community dwelling older people #### We categorise falls risk asRETURN TO TEXT Risk factors for falls can be categorised as Environmental …

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects (benefits and harms) of environmental interventions (such as assistive devices, and reduction of fall hazards in home, outdoors, and public places) for preventing falls in older people living in the community.

IntroductionFalls and fall-related injuries are a serious cause of morbidity and cost to society. Environmental hazards are implicated as a major contributor to falls among older people. A recent Cochrane review found an environmental assessment, undertaken by an occupational therapist, to be an effective approach to reducing falls. However, none of the trials included a cost-effectiveness evaluation in the UK setting. This protocol describes a large multicentre trial investigating the clinical and cost-effectiveness of environmental assessment and modification within the home with the aim of preventing falls in older people.Methods and analysisA two-arm, modified cohort randomised controlled trial, conducted within England, with 1299 community-dwelling participants aged 65 years and above, who are at an increased risk of falls. Participants will be randomised 2:1 to receive either usual care or home assessment and modification. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by monthly patient self-report falls calendars. Secondary self-reported outcome measures include: the proportion of single and multiple fallers, time to first fall over a 12-month period, quality of life (EuroQoL EQ-5D-5L) and health service utilisation at 4, 8 and 12 months. A nested qualitative study will examine the feasibility of providing the intervention and explore barriers, facilitators, workload implications and readiness to employ these interventions into routine practice. An economic evaluation will assess value for money in terms of cost per fall averted.Ethics and disseminationThis study protocol (including the original application and subsequent amendments) received a favourable ethical opinion from National Health Service West of Scotland REC 3. The trial results will be published in peer-reviewed journals and at conference presentations. A summary of the findings will be sent to participants.Trial registration numberISRCTN22202133; Pre-results.

Introduction The potential of environmental assessment and modification to reduce falls has recently received attention within the gerontology literature. Research investigating the clinical effectiveness of this intervention in falls prevention reports conflicting results. Discrepancies are due to variation in the risk profile of study participants and the health care background of the person providing the environmental intervention or the intensity of the intervention provided. Method The purpose of this paper is to compare and contrast two systematic reviews, which include meta-analyses, of environmental interventions for falls prevention in community dwelling older people, using the critical appraisal skills programme tool for systematic reviews. Findings Both reviews found that: environmental assessment and modification was effective in falls prevention; intervention was effective with high but not low risk participants; and that high intensity environmental assessment was effective, whereas low intensity intervention was not. Environmental interventions which were delivered by occupational therapists were deemed high intensity, probably because their underpinning theoretical frameworks focus on the impact of the environment on function. Conclusion We discuss possible reasons why occupational therapist led environmental assessment and modification is clinically effective in falls prevention, for people at high risk of falls, whereas non occupational therapist led intervention is not.

Background/Aims: The increasing demand for health services necessitates workforce redesign to reduce inefficiencies while maintaining quality of care. Health services have been implementing professional skill-sharing models of care to enable allied health practitioners to expand their scope of practice. This article reports the outcome of a randomised controlled trial that investigated the clinical effectiveness of professional skill-sharing. Methods: The Calderdale Framework was used to establish a model of professional skill-sharing. A randomised controlled trial was carried out with community-dwelling older people aged 65 years and above experiencing functional decline (n=153). Participants were randomised to professional skill-sharing intervention (n=77) or uni-professional occupational therapy and/or physiotherapy care control (n=76). Disability, mobility, independence in activities of daily living and quality of life were measured by a blinded assessor at baseline, 1 and 4 months post-randomisation. Results: There were no statistically significant differences in any of the outcome measures between groups. Less than half (43%) of the controls received uni-professional intervention. Sub-group analysis of intervention and control participants who had received uni-professional intervention upheld the results of the main analysis. Conclusions: Professional skill-sharing was equivalent in outcome to conventional, uni-professional occupational therapy and/or physiotherapy for a community-dwelling ageing population experiencing functional decline. Further research is required.

Objective: We compared the research experience or support needs of allied health professionals in rural versus regional cities to identify if they were the same or different. Design: Descriptive study using a cross sectional survey. Setting: This study was carried within Queensland Health’s northern six health services. Participants: Queensland health staff classified as Health Practitioners. Interventions: This survey was conducted as part of a research capacity building initiative within Queensland Health to increase AHPs’ participation in research in regional cities and rural areas of Queensland. Main outcome measures: Questions in the survey identified demographics, research experience, need for research support, research knowledge and beliefs about research. Data were compared using Chi-square and t-tests. Results: The total response rate was 54.5% with 18% of the HPs located in rural communities of less than 5000 people and the rest from the three major cities in northern Queensland. Rural HPs have less research experience in most research activities than regional city HPs and need more research support. Rural HPs have more qualitative research experience than regional city HPs and research is perceived positively by both. Barriers to conducting research were similar across both groups and included insufficient time, lack of staff and no statistical support. Conclusion: Rural HPs are younger and have less research experience than their counterparts working in regional cities. Therefore, building rural HP research capacity initiatives may require more access to facilitators such as the Research Fellows.

Purpose: This paper describes the exploration of clinical educator and student perspectives on the implementation of the Calderdale Framework (CF) as a model for pre-entry occupational therapy clinical placement. Setting: The study was undertaken within a regional health service in Queensland, Australia. The orthopaedic inpatient ward at the regional hospital and mixed inpatient and outpatient community based caseloads in rural hospitals were the focus of this study. Methods: The Calderdale Framework is a seven stage process which involves: engaging staff with the framework; identifying which clinical tasks are carried out within the service; analysing which tasks can be allocated to students; setting up supervision systems; developing Clinical Task Instructions (CTIs); providing competency training and assessment; and developing organisational systems to sustain the new ways of working. In the first week of placement, students were ‘taught’ background and theoretical information for nine Clinical Task Instructions. In the remainder of their placement they achieved competence in these tasks and implemented clinical interventions with patients. Results: Separate focus groups and in-depth interviews were used to explore clinical educator and student opinions about their experience of the application of the Calderdale Framework in clinical education. Five themes emerged from the data analysis: experience of new model; adjustment to change in approach to the placement model; impact of the Calderdale Framework Clinical Task Instructions; impact of the Calderdale Framework learning model on student confidence and impact of the Calderdale Framework placement model on service delivery. Conclusion: In this pilot study, the application of the Calderdale Framework in clinical education was supported by both clinical educators and students as a model that supported student learning and safe contribution to patient service delivery. The time invested in planning, resource development and implementing this application of the Calderdale Framework in clinical education has resulted in a model which can continue to be implemented within our health service and could be applied to other professions or replicated elsewhere.