Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care.

BACKGROUND: Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives. RESULTS: Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs. CONCLUSIONS: Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.

'I want him to tell me he loves me': A smart audio device, Tochie, for resident-family connection in long-term care.

BACKGROUND: Older people living in long-term care homes are particularly susceptible to loneliness and social isolation, which the COVID-19 pandemic has exacerbated further. 'Tochie' is a smart audio device that allows family members to remotely record and send messages, such as daily reminders and comforting recordings, to their loved ones in LTC settings. The purpose of this study was to assess the feasibility and acceptability of using Tochie to improve resident-family connections, and to investigate user experience, impact and lessons learned. METHODS: Participants included 10 residents, nine family members and six care staff from two LTC homes in British Columbia, Canada. A Tochie was provided to each resident to use with their family members over a 4-week intervention period. The research team provided support and gathered feedback from family members and care staff through weekly phone and email correspondence. Qualitative descriptive design was used, including pre- and post-intervention focus groups and interviews held via Zoom and phone to gather participants' experiences with Tochie. Themes were identified through thematic analysis. RESULTS: Three themes were identified: (1) Facilitating emotional connection, (2) Using the device in creative and personalised ways and (3) Structural challenges and supports. Based on these findings, recommendations for future research and practice are provided. CONCLUSION: The COVID-19 pandemic has prompted a rethinking of what it means to 'stay in touch' with loved ones in LTC settings. This study found that Tochie has opened up new opportunities for family connection and provided emotional support for residents. The results of this study offer valuable insights into the implementation of assistive technology in LTC homes to support resident care.

The perceptions of university students on technological and ethical risks of using robots in long-term care homes.

Introduction: The COVID-19 pandemic has disproportionately impacted long-term care (LTC) residents and exacerbated residents' risks of social isolation and loneliness. The unmet emotional needs of residents in LTC have driven researchers and decision-makers to consider novel technologies to improve care and quality of life for residents. Ageist stereotypes have contributed to the underuse of technologies by the older population. Telepresence robots have been found to be easy to use and do not require older adults to learn how to operate the robot but are remotely controlled by family members. The study aimed to understand the perspectives of multidisciplinary university students, including healthcare students, on using telepresence robots in LTC homes. The study would contribute to the future planning, implementation, and design of robotics in LTC. Methods: Between December 2021 and March 2022, our team conducted interviews with 15 multidisciplinary students. We employed a qualitative descriptive (QD) approach with semi-structured interview methods. Our study aimed to understand the perspectives of university students (under the age of 40) on using telepresence robots in LTC homes. Participants were invited to spend 15 min remotely driving a telepresence robot prior to the interview. A diverse team of young researchers and older adults (patient and family partners) conducted reflexive thematic analysis. Results: Six themes were identified: Robots as supplementary interaction; privacy, confidentiality, and physical harm; increased mental well-being and opportunities for interactions; intergenerational perspectives add values; staffing capacity; environmental and cultural factors influence acceptance. Conclusion: We identified a diverse range of perspectives regarding risk and privacy among participants regarding the implementation of telepresence robots in long-term care. Participants shared the importance of the voice of the resident and their own for creating more equitable decision-making and advocating for including this type of technology within LTC. Our study would contribute to the future planning, implementation, and design of robotics in LTC.

Telepresence Robots in Long-Term Care Settings in British Columbia During the COVID-19 Pandemic: Analyzing the Experiences of Residents and Family Members.

Telepresence robots are being increasingly used in long-term care (LTC) homes for virtual visits between families and residents. This study investigated the impacts and experiences of residents and their families using a telepresence robot (Double 3) for 4 to 12 months during the COVID-19 pandemic. A total of 51 participants were recruited through purposive sampling, including 9 residents, 15 family members, and 27 staff from 4 LTC homes in British Columbia, Canada. Conversational interviews were conducted with residents and family members. Focus groups and one-to-one interviews were held with frontline staff. Thematic analysis was performed, with five themes identified: (1) Stay connected, (2) Regain autonomy, (3) Relieve caregiver burden, (4) Environmental and technical issues, and (5) Scheduling concerns. In conclusion, telepresence robots helped maintain social connections between residents and families, despite the COVID-19 restrictions.

Facilitators and barriers to using telepresence robots in aged care settings: A scoping review.

Social isolation has been a significant issue in aged care settings, particularly during the COVID-19 pandemic, and is associated with adverse outcomes, including loneliness, depression, and cognitive decline. While robotic assistance may help mitigate social isolation, it would be helpful to know how to adopt technology in aged care. This scoping review aims to explore facilitators and barriers to the implementation of telepresence robots in aged care settings. Following the Joanna Briggs Institute scoping review methodology and the PRISMA extension for scoping reviews reporting guidelines, we searched relevant peer-reviewed studies through eight databases: CINAHL, MEDLINE, Cochrane, PsychINFO (EBSCO), Web of Science, ProQuest Dissertations and Theses Global, IEEE Xplore, and ACM Digital Library. Google was used to search gray literature, including descriptive, evaluative, quantitative, and qualitative designs. Eligibility includes: studies with people aged 65 years and older who interacted with a telepresence robot in a care setting, and articles written in English. We conducted a thematic analysis to summarize the evidence based on the constructs in the Consolidated Framework of Implementation Research. Of 1183 articles retrieved, 13 were included in the final review. The analysis yielded three themes: relative advantages, perceived risks and problems, and contextual considerations. The key facilitators to telepresence robot adoption are as follows: a feeling of physical presence, ease of use, mobility, and training. The barriers to implementation are as follows: cost, privacy issues, internet connectivity, and workflow. Future research should investigate the role of leadership support in implementation and practical strategies to overcome barriers to technology adoption in aged care settings.

Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review.

Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.

Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: a systems-based intervention.

BACKGROUND: The central venous catheter (CVC) is a necessary, yet inherently risky, modern medical device. We aimed to carry out a systems-based intervention designed to facilitate the use of maximal sterile barrier precautions and the use of chlorhexidine for skin antisepsis during insertion of CVC. METHODS: All patients in whom a CVC was inserted at a medical-surgical intensive care unit at a university-affiliated public hospital were included in a before-after trial. The standard CVC kit in routine use before the intervention included a small sterile drape (24" by 36") and 10% povidone-iodine for skin antisepsis. We special ordered a customized kit that, instead, included a large sterile drape (41" by 55") and 2% chlorhexidine gluconate in 70% isopropyl alcohol. Both the standard kit in use before the intervention and the customized kit included identical CVCs. Baseline data included the quarterly CVC-associated bloodstream infection (BSI) rates during the 15 months before the intervention. Comparison data included the quarterly CVC-associated BSI rates during the 15 months after we instituted exclusive use of the customized kit. RESULTS: The mean quarterly CVC-associated BSI rate decreased from a baseline of 11.3 per 1000 CVC-days before the intervention to 3.7 per 1000 CVC-days after the intervention (P < .01). Assuming direct costs of at least 10,000 dollars per CVC-associated BSI, we calculated resultant annualized savings to the hospital of approximately 350,000 dollars. CONCLUSION: Infection control interventions that rely on voluntary changes in human behavior, despite the best intentions of us all, are often unsuccessful. We have demonstrated that a systems-based intervention led to a sustained decrease in the CVC-associated BSI rate, thereby resulting in improved patient safety and decreased cost of care.

Changes in thrombolytic and inflammatory markers after initiation of indinavir- or amprenavir-based antiretroviral therapy.

HIV-infected subjects who have lipodystrophy and insulin resistance on prolonged antiretroviral therapy have elevated levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) antigens, markers of impaired thrombolysis that are associated with hyperinsulinemia and increased cardiovascular risk. We studied HIV-infected, protease inhibitor (PI)-naive adults treated with indinavir (n = 11) or amprenavir (n = 14) plus two nucleoside reverse transcriptase inhibitors enrolled in two independent prospective trials. Antiretroviral and immune responses were similar in both studies. Over 8 wk, indinavir was associated with decreased insulin sensitivity, whereas amprenavir was not. Levels of tPA antigen declined by approx 25% with both treatments (p < 0.05 for each); levels of PAI-1 antigen did not change. Levels of the inflammatory marker soluble tumor necrosis factor-alpha receptor II (sTNFr2) correlated positively with tPA antigen (r = 0.33, p = 0.02), and mean (SD) plasma concentrations of sTNFr also declined with treatment (4.44 +/- 1.11 ng/mL pretherapy, 3.75 +/- 1.21 posttherapy, p = 0.007). Short-term improvement in a marker of impaired thrombolysis and increased vascular risk can occur during PI-based antiretroviral therapy, perhaps as a consequence of improvement in HIV-related inflammation. This improvement occurred independent of development of insulin resistance, which occurred only with indinavir.

Personal health records: key adoption issues and implications for management.

Electronic Personal Health Records (PHRs) has been perceived as the tool to empower consumers to become active decision-makers of their healthcare instead of leaving the decision to providers. However, there has been the lack of enthusiasm and adoption of PHRs. This paper examines the current healthcare climate and attempts to understand the major challenges associated with PHRs adoption. The paper-based and fragmented healthcare system is no longer appropriate for the digital economy of the 21st century. The integrated health information technology system is the solution to transform clinical practice to consumer centric and information driven. Tools such as PHRs are means to an end that provide better, safer and more affordable healthcare for consumers. However, there has been little research conducted to demonstrate PHR's tangible value, despite the widespread perceived value of these technologies. Although survey data reveals that there is a lack of awareness among the public, consumers are receptive to this concept, especially when a physician recommends it. Key issues in adopting PHRs and strategies for successful implementation of PHRs are discussed.