Safewards implementation in residential aged care: a pilot and feasibility study

The prevalence of restrictive practices in residential aged care (RAC) remains unacceptably high. To address this, feasible, evidence-informed interventions that can be integrated into routine practice are needed. Safewards, a model and set of ten interventions that explains and reduces conflict and restrictive practice use in mental health care settings, presents a promising approach for application within RAC. This study evaluated the feasibility of implementing Safewards to reduce restrictive practice use in RAC.

This pilot and feasibility study used a mixed methods process and outcomes evaluation. Safewards was implemented in two Australian care homes. Implementation outcomes were assessed using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and the Consolidated Framework for Implementation Research (CFIR) guided qualitative data collection to identify the contextual factors that facilitated or hindered implementation.

Eight Safewards interventions were suggested for implementation in RAC. Three Safewards interventions were implemented at site 1 and five interventions at site 2 with between 28-52 % staff attending training across sites. Physical restraint use decreased at site 2 but not at site 1. Most implementation enablers and barriers were identified within the CFIR domains of inner setting and implementation process.

Safewards was feasible to implement in RAC, with 5/8 interventions contributing to reduced physical restraint use. The variation in findings across sites, including greater reach and adoption and stable and engaged leadership at site 2, emphasises the importance of contextual factors for successful implementation. Findings from this study can inform future implementation of Safewards into RAC.

A person with lived experience as a caregiver for a family member with dementia was employed as a Safewards facilitator and as a member of the project steering committee and had input into all stages of the project.