Activating daily life (ADaL)-programme together with technology solutions

Why was this example implemented?

With an ageing society and increasing numbers of those in need of help in their daily life, shortage of labour will become evident in the coming years. Furthermore, older people are increasingly frail with multiple service needs. Resident safety is a prominent issue in nursing homes where falls and injuries are unwanted outcomes of independent locomotion, particularly in the presence of a short supply of the nursing staff. Any new innovation that can support older people or their carers for an independent life should be encouraged.

Unnecessary restrictions such as the use of bedrails can impact on the quality of care and ultimately the resident's quality of life. The risk of accidents can be reduced if a nurse is made aware that a resident with a high risk of falling is getting out of bed. The nurse is able to go to the room and help the resident before he or she gets up. When a technology solution is in use the resident feels safe to move and staff can follow the resident's movements and give help only when needed, enhancing independence and privacy. Thus, the technological solution eases the work of the nurses and increases the efficiency of the facility. The target group in this pilot project was older residents in four intervention units in Kustaankartano Centre for Elderly people. Intervention wards implemented the ADaL-programme to create a restraint free and safe environment.  The goal of the intervention was to give these frail older people more privacy, freedom and independence in their daily living; enhancing quality of their life without compromising safety. 

Description

The main aim of the pilot was to introduce a multidisciplinary intervention with the help of technological solutions, and to revise nursing patterns in the nursing home wards.

The other objectives of the ADaL-programme focussed on:

1. facilitatation of patient safety
2. reduction of falls, injuries, restraints and bedrails
3. supporting functional capacity
4. the enhancement of quality of life of the residents involved.

Together with residents and multidisciplinary team (nurses, physiotherapists), the main principle was to create a safe environment and an individual programme for daily living for each resident utilising technology solutions.  

The ADaL-programme was created in one nursing home, the Kustaankartano Centre for Elderly people (600 residents). The project nurses and physiotherapists collaborated in four intervention wards, each ward having about 10 - 15 residents. The programme consisted of:

• a detailed mapping of the preferences of the residents  (strengths and risks assessed among other aspects using the Resident Assessment Instrument - RAI )
• individual weekly exercises (gym and  movement therapy machine, Motomed)
• use of movement sensors (Emfit floor sensor)  to alert the nurses for those at risk of falling when trying to stand up from a bed or chair. When the rooms for the residents' are equipped with the movement sensor, the staff are supported in monitoring their resident's movements 24 hours a day. Independent movement is supported without risking the safety of the resident. Furthermore, this helps the staff to concentrate on helping residents’ mobility and to decrease the need for routine checkups, especially at night.

The pilot project ran from 2006 - 2008. During this period the ADaL-programme was developed and implemented into practice. The project team consisted of a physiotherapist in collaboration with the head nurse responsible for the wards, and the nurses /other workers (assistant nurse, care assistant, social adviser) in the intervention wards. All the staff were trained to conduct a risk analysis and to assess residents with RAI biannually in order to make comprehensive individual care and service plans and to compare the results to other facilities that provide care for similar residents. Furthermore, the staff were trained to give rehabilitation therapy and to use the technological solutions.

Helsinki City Innovation fund granted €2.7 million to the Kustaankartano Centre for Older People from 2006 to 2010 with the primary aim of developing technological solutions for long-term care institutions with a secondary aim to support home care. 

What are/were the effects?

Residents in the intervention wards in the Kustaankartano Centre for Elderly people (n=52-54) were assessed with RAI twice a year during the four years of the intervention and the results were compared to other Finnish RAI-using nursing homes (n=4,200-5,600). The comparisons showed, first, an increase in the intervention wards:

• in nursing rehabilitation from 64% to 81%
• the number of those residents with social contacts from 53% to 94% (refers to maintaining social contacts with friends and family through visits or telephone)
• the use of antipsychotic medications  from 24% to 26%
• the number of fallers from 15% to 20% (this may have been due to the greater mobility; falls were however not serious and as stated below, new fractures were reduced).

Secondly, the comparison showed a decrease of

• behavioural problems from 51% to 43%
• those residents with one or more social conflicts from 42% to 21% (refers to arguments with or repeated criticism of other residents)
• residents without any hobbies or activity pursuits from 62% to 11%
• the use of bedrails (75% to 47%), trunk restraints (device or clothing that the older person cannot remove around the waist) (29% to 8%) and bedbound residents (6% to 2%)
• Grade 1-4 bedsores from 7% to 2%
• use of anxiolytics  (31% to 19%) and hypnotics (65% to 2%)
• new fractures (within six months) from 6% to 2%   

Furthermore, the number of falls were assessed using a follow-up questionnaire. Professionals considered the knowledge acquired useful and it made them realise the extent of the risk for falls.  It also improved documenting falls and the risks of fall injuries.

A 'safety interview' was conducted with the professionals and informal care-givers assessing how they evaluated the safety of the ward and possible risks. However this evaluation failed to produce any relevant results.

In conclusion, the residents' independence and quality of life increased with ADaL-programme together with technology solutions without increasing the amount of ward staff. Also, collaboration between multidisciplinary staff was improved.

What are the strengths and limitations?

Strengths

• ADaL-programme together with technology solutions can facilitate improvements in self empowerment and quality of life of long term care residents, also of residents with dementia and multiple dependencies.
• It was possible to decrease use of bedrails and trunk restraints without increasing the amount of ward staff.
• Cooperation with nurses and physiotherapists and the application of the rehabilitating nursing methods were increased.

Weaknesses

• The utilisation of the technology is not always perfect, in practice the alarm system does not always work correctly.
• The technology solutions demand money, training and time.
• New interventions take time to implement.

Opportunities

• Technology solutions enable new approaches to older people's care and support older people's autonomy.

Threats

• There is no money and no time to develop practices.
• Formal carers/professionals as well as clients have prejudices and both object new technology.

Credits

External Links and References

• Finne Soveri H, Metsälä A, Pohjola L, Raivio K, Pulkkinen T, Mustonen S  (2008). Teknologia aktivoivan hoitotyön palvelijaksi ympärivuorokautisessa hoidossa. Turvallisesti aktivoivaan arkeen konseptin kehittäminen 2006-2007 [Activating daily life-programme together with technology solutions. Developing the concept]. Helsingin kaupungin sosiaalivirasto Tutkimuksia 3/2008.  [in Finnish]
• A Safe Combination – Technology and an Active Way of Life [abstract in English]
• Emfit