Personal and organisational attributes that support transformational leadership in acute healthcare: scoping review.

ObjectiveTransformational leadership benefits both patients and staff. The objective of this scoping review was to explore personal and organisational attributes that support transformational leadership in acute health care.MethodsA scoping review was undertaken using Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medline Complete, PsycInfo and Emerald Insight databases. Search terms were related to transformational leadership and acute care hospitals.ResultsA total of 18 studies were included: 14 reported personal attributes and 8 reported organisational attributes supporting transformational leadership. The most common personal attributes were manager educational preparation (n = 5), years of management experience (n = 4), age (n = 3) and emotional intelligence (n = 3). The most common organisational attributes reported were larger organisational size (n = 2) and culture (n = 2). Personal (manager) attributes were synthesised into the following categories: demographics, role characteristics, leadership preparation and traits. Organisational attributes were categorised as manager support, organisational characteristics and organisational processes.ConclusionsDespite the beneficial outcomes of transformational leadership for patients, staff and organisations, the personal and organisational attributes supporting transformation leadership are not well understood.

Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis.

Background: Women comprise the majority of the nursing profession, yet nurses are underrepresented in healthcare leadership. We aimed to explore barriers for women nurses to advance in healthcare leadership to inform organisational interventions for career advancement. Methods: In this systematic review and meta-synthesis, studies examining advancing women nurses and midwives in leadership within healthcare and academia in the international literature were included. Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL PLUS) were searched for studies published in English between January 1 2000 and October 17 2023. The Grading of Recommendations Assessment, Development, and Evaluation tools (GRADE) was followed to assess confidence in the findings. Retrieved full texts were assessed for methodological rigour using the Critical Appraisal Skill Programme Qualitative Studies checklist and the Joanna Briggs Institute Cross-sectional and Prevalence Studies checklists. Reported barriers for women nurses' leadership attainment were identified and generated themes were mapped to the Abilities, Motivation, and Opportunities (AMO) framework. Findings: There were 32 eligible studies; 18 qualitative, 11 quantitative, and 3 mixed-methods. Studies included high-income countries (n = 20), middle-income countries (n = 7) and across countries (n = 3) with two unspecified. Samples included registered nurses, nurse academics, executives, and leaders. The key barriers highlighted were related to: role modelling and leadership development (ability); multiple complex and interacting factors, including gender stereotyping, perception of professionalism, human relations policies, and gender bias (motivation); and systemic issues, such as organisational setting, structure, and support (opportunity). Interpretation: The prevailing belief in the literature is that caregiving is a feminine occupation and along with societal expectations of women's subordinate position, these present substantial obstacles that limit women nurses from advancing into healthcare leadership. Ultimately, these factors restrict women nurses in career advancement and need to be addressed at a systems and organisational level. Funding: The National Health and Medical Research Council (NHMRC), Australia.

Perinatal mental health screening for women of refugee background: Addressing a major gap in pregnancy care.

BACKGROUND: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non-refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. METHODS: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non-refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. RESULTS: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non-refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). CONCLUSION: Similarly, high proportions of women of refugee and non-refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave).

Introduction: The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs. Methods: During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors. Results: Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing. Conclusion: This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

Nurses' experiences of using falls alarms in subacute care: A qualitative study.

Bed and chair alarms have been included in many multifaceted falls prevention interventions. None of the randomised trials of falls alarms as sole interventions have showed significant effect on falls or falls with injury. Further, use of bed and chair alarms did not change patients' fear of falling, length of hospital stay, functional status, discharge destination or health related quality of life. The aim of this study was to explore nurses' experiences of using bed and chair alarms. A qualitative descriptive study using semi-structured interviews with a purposive sample of 12 nurses was conducted on a 32-bed Geriatric Evaluation and Management ward in Melbourne, Australia. Participants were interviewed between 27 January and 12 March 2021.Transcribed audio-recordings of interviews were analysed using inductive thematic analysis. NVIVO 12.6 was used to manage the study data. Three major themes and four subthemes were constructed from the data: i) negative impacts of falls alarms (subthemes: noisy technology, imperfect technology), ii) juggling the safety-risk conflict, and iii) negotiating falls alarm use (subthemes: nurse decision making and falls alarm overuse). Nurses' experience of using falls alarms was predominantly negative and there was tension between falls alarms having limited impact on patient safety and risks associated with their use. Nurses described a need to support nurse decision making related to falls alarms use in practice and policy, and a desire to be empowered to manage falls risk in other ways.

In Australian hospitals and residential aged care facilities, how do we train nursing and direct care staff to assist patients and residents to move? A national survey.

Objective Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion Most Australian health and aged care services provide clinical staff with regular manual handling training for staff-assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in-the-moment risk assessment during staff-assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.

Feasibility of implementing an innovative manual handling risk assessment training program for staff working in long-term care.

BACKGROUND: The Risk Assessment for moving Individuals SafEly (RAISE) program is a hospital-based manual handling nursing training program. RAISE involves upskilling on continual risk assessment during patient-assisted movements. RAISE aims to optimise staff and patient safety while providing the patient with movement and rehabilitation opportunities. Implementation of RAISE in the hospital setting has been established. The aim of this study was to explore the feasibility of implementing RAISE in the long-term care setting. METHODS: We examined three feasibility domains: acceptability, practicality, and limited efficacy (observed nursing behaviour change which has the potential to reduce nursing injuries), using a prospective pilot pre-post design in the long-term care setting. Staff completed a 4-hour training session on RAISE delivered by two physiotherapists, followed by 8 h of supported behaviour change in the workplace. Staff acceptability and practicality of incorporating risk assessment strategies into manual handling approaches were explored through pre- and post-training staff surveys and a semi-structured interview. Resident acceptability of manual handling practices was explored via survey data collected after the RAISE training. Pre to post-training changes in staff knowledge and behaviour were examined through the pre- and post-training staff survey, and observation of staff assisting resident movement. RESULTS: Two enrolled nurses and five residents participated. Staff reported the RAISE program was acceptable and practical to implement in the long-term care setting. There were no adverse events or safety concerns. Staff reported the RAISE program provided guidance and enhanced staff empowerment to make decisions during assisted resident movement. There were 26 observed resident-staff manual handling interactions recorded, with 13 pre-training and 13 post-training. Post-training, RAISE skills had improved and were completed 100% of the time, except for completing a physical risk assessment which improved from 46 to 85%, demonstrating limited efficacy. Residents reported it's important for staff to be trained on how to assist them to mobilise and they found the concept of the RAISE program acceptable. CONCLUSIONS: This pilot study supports the feasibility of long-term care facilities participating in future studies testing the effectiveness and cost-effectiveness of the Risk Assessment for moving Individuals SafEly (RAISE) patient and resident manual handling program.

Nurse job task analysis: a profile of medical and surgical nursing activities.

Objective We aim to examine the activities undertaken by medical and surgical ward nurses at a major health service in Victoria, Australia, to inform nursing and midwifery strategic workforce planning. Methods This descriptive, exploratory study was conducted on 17 wards from three acute care hospitals in one of Victoria's largest health services. The Work Observation Method by Activity Timing tool was used to enable participants to document the time spent in each of 10 nursing activity domains. Results Data from 70 respondents across all shifts showed nurses spent one-third of their time in direct care. Registered nurses spent a lower proportion of time than enrolled nurses in direct care and medications overall. Compared with enrolled nurses, registered nurses spent less time in direct care on morning shifts and documentation on afternoon shifts, and more time on ward-related activities on afternoon shifts. Conclusions Medical and surgical enrolled nurses and registered nurses spent comparable proportions of time engaged in specific activities. Further research is required to understand the influences on the time devoted to direct care and how time spent in direct care intersects with other activities, and the relationship with patient outcomes and quality of care indicators.

The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis.

OBJECTIVES: The mental health impacts of the COVID-19 pandemic continue to be documented worldwide with systematic reviews playing a pivotal role. Here we present updated findings from our systematic review and meta-analysis on the mental health impacts among hospital healthcare workers during COVID-19. METHODS: We searched MEDLINE, CINAHL, PsycINFO, Embase and Web Of Science Core Collection between 1st January 2000 to 17th February 2022 for studies using validated methods and reporting on the prevalence of diagnosed or probable mental health disorders in hospital healthcare workers during the COVID-19 pandemic. A meta-analysis of proportions and odds ratio was performed using a random effects model. Heterogeneity was investigated using test of subgroup differences and 95 % prediction intervals. RESULTS: The meta-analysis included 401 studies, representing 458,754 participants across 58 countries. Pooled prevalence of depression was 28.5 % (95 % CI: 26.3-30.7), anxiety was 28.7 % (95 % CI: 26.5-31.0), PTSD was 25.5 % (95 % CI: 22.5-28.5), alcohol and substance use disorder was 25.3 % (95 % CI: 13.3-39.6) and insomnia was 24.4 % (95 % CI: 19.4-29.9). Prevalence rates were stratified by physicians, nurses, allied health, support staff and healthcare students, which varied considerably. There were significantly higher odds of probable mental health disorders in women, those working in high-risk units and those providing direct care. LIMITATIONS: Majority of studies used self-report measures which reflected probable mental health disorders rather than actual diagnosis. CONCLUSIONS: These updated findings have enhanced our understanding of at-risk groups working in hospitals. Targeted support and research towards these differences in mental health risks are recommended to mitigate any long-term consequences.

Nurses sustain manual handling risk assessment behaviours six-months after a training program to move patients safely: a pre-post study.

PURPOSE: To determine if a patient manual handling training program focused on dynamic manual handling risk assessment for staff and patient safety, together with the patient's need for physical rehabilitation, can be transferred and sustained in clinical practice. MATERIALS AND METHODS: Using a pre-post design, nurses (n = 72) from acute and rehabilitation wards participated in a 4-hour training session teaching dynamic manual handling risk assessment to safely move patients. Clinical observations audits of patient transfers were conducted prior to, and at 1-month and 6-months post training. Surveys determined experiences of training. Nurse musculoskeletal injuries and patient falls were measured 6-months after training. RESULTS: Program patient handling skills were competently implemented 89% of the time 1-month following training and were sustained 6-months following training. There was no change in falls rates and staff injury rates were very low pre- and post-training. Training was well received and all nurses passed the competency assessment. CONCLUSION: The patient handling training program taught nurses to better identify factors associated with risk to themselves and their patients and gave them improved skills to help patients move. Skills were incorporated safely into clinical practice and sustained at 6-months. It is uncertain whether training impacted musculoskeletal injuries.Implications for rehabilitationA dynamic manual handling risk assessment program for safely transferring and moving patients balances staff safety with the patient's need for physical rehabilitation.Nurses can be taught risk assessment skills to better identify factors associated with risk to themselves and their patients that can be translated to clinical practice.Thorough risk assessment at the point of the nurse-patient interaction can enable a patient to move at their highest level of function thus providing patients with opportunities to progress their rehabilitation at every interaction.

Care in the time of COVID: An interpretative phenomenological analysis of the impact of COVID-19 control measures on post-partum mothers' experiences of pregnancy, birth and the health system.

Background: Findings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system. Methods: This study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association's social media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis. Results: Mothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience. Conclusion: This study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures.

Evaluating the strengths and challenges of PAX dream makers approach to mental health promotion: perspectives of youth and community members in indigenous communities in Manitoba, Canada.

PAX Good Behaviour Game (PAX-GBG) is an evidence-based approach to co-create a nurturing environment where all children can thrive. This school-based approach was identified as a promising intervention for suicide prevention by First Nations communities in Manitoba, Canada. To enhance this mental health promotion approach, PAX Dream Makers was developed. It is a youth-led addition to PAX-GBG for middle and high school students. This study's aim was to examine, from the communities' perspectives, the influence of PAX Dream Makers on youth as well as its strengths, challenges and suggestions for future improvements. A case study method was conducted using interviews and focus groups with 30 youth and 17 adult mentors and elders. Participants reported that PAX Dream Makers provided support and encouragement to the youth, increased their resilience and provided an opportunity to be positive role models. It strengthened PAX-GBG implementation in schools. Challenges included: adult mentors availability, frequent teacher turn-over and community mental distress. Suggestions expressed were: being mindful of cultural and community contexts, increasing community leadership's understanding of PAX-GBG and better recruitment of mentors and youth. PAX Dream Makers approach was well-received by communities and holds great promise for promoting the well-being of First Nations youth.

"Did You Bring It Home with You?" A Qualitative Investigation of the Impacts of the COVID-19 Pandemic on Victorian Frontline Healthcare Workers and Their Families.

Concerns regarding the physical and mental health impacts of frontline healthcare roles during the COVID-19 pandemic have been well documented, but the impacts on family functioning remain unclear. This study provides a unique contribution to the literature by considering the impacts of the COVID-19 pandemic on frontline healthcare workers and their families. Thirty-nine frontline healthcare workers from Victoria, Australia, who were parents to at least one child under 18 were interviewed. Data were analysed using reflexive thematic analysis. Five superordinate and 14 subordinate themes were identified. Themes included more family time during lockdowns, but at a cost; changes in family responsibilities and routines; managing increased demands; healthcare workers hypervigilance and fear of bringing COVID-19 home to their family members; ways in which families worked to "get through it". While efforts have been made by many healthcare organisations to support their workers during this challenging time, the changes in family functioning observed by participants suggest that more could be done for this vulnerable cohort, particularly with respect to family support.

The context, contribution and consequences of addressing the COVID-19 pandemic: A qualitative exploration of executive nurses' perspectives.

AIMS: To explore (1) the context in which nursing executives were working, (2) nursing's contribution to the healthcare response and (3) the impact from delivering healthcare in response to the pandemic. DESIGN: Retrospective, constructivist qualitative study. METHODS: Individual interviews using a semi-structured interview guide were conducted between 12 February and 29 March 2021. Participants were purposively sampled from the Victorian Metropolitan Executive Directors of Nursing and Midwifery Group, based in Melbourne, Victoria the epi-centre of COVID-19 in Australia during 2020. All members were invited; 14/16 executive-level nurse leaders were participated. Individual interviews were recorded with participant consent, transcribed and analysed using thematic analysis. RESULTS: Four inter-related themes (with sub-themes) were identified: (1) rapid, relentless action required (preparation insufficient, extensive information and communication flow, expanded working relationships, constant change, organizational barriers removed); (2) multi-faceted contribution (leadership activities, flexible work approach, knowledge development and dissemination, new models of care, workforce numbers); (3) unintended consequences (negative experiences, mix of emotions, difficult conditions, negative outcomes for executives and workforce) and (4) silver linings (expanded ways of working, new opportunities, strengthened clinical practice, deepened working relationships). CONCLUSION: Responding to the COIVD-19 health crisis required substantial effort, but historical and industrial limits on nursing practice were removed. With minimal information and constantly changing circumstances, nursing executives spearheaded change with leadership skills including a flexible approach, courageous decision-making and taking calculated risks. Opportunities for innovative work practices were taken, with nursing leading policy development and delivery of care models in new and established healthcare settings, supporting patient and staff safety. IMPACT: Nursing comprises the majority of the healthcare workforce, placing executive nurse leaders in a key role for healthcare responses to the COVID-19 pandemic. Nursing's contribution was multi-faceted, and advantages gained for nursing practice must be maintained and leveraged. Recommendations for how nursing can contribute to current and future widespread health emergencies are provided.

Bayesian prediction of emergency department wait time.

Increasingly, many hospitals are attempting to provide more accurate information about Emergency Department (ED) wait time to their patients. Estimation of ED wait time usually depends on what is known about the patient and also the status of the ED at the time of presentation. We provide a model for estimating ED wait time for prospective low acuity patients accessing information online prior to arrival. Little is known about the prospective patient and their condition. We develop a Bayesian quantile regression approach to provide an estimated wait time range for prospective patients. Our proposed approach incorporates a priori information in government statistics and elicited expert opinion. This methodology is compared to frequentist quantile regression and Bayesian quantile regression with non-informative priors. The test set includes 1, 024 low acuity presentations, of which 457 (44%) are Category 3, 425 (41%) are Category 4 and 160 (15%) are Category 5. On the Huber loss metric, the proposed method performs best on the test data for both median and 90th percentile prediction compared to non-informative Bayesian quantile regression and frequentist quantile regression. We obtain a benefit in the estimation of model coefficients due to the value contributed by a priori information in the form of elicited expert guesses guided by government wait time statistics. The use of such informative priors offers a beneficial approach to ED wait time prediction with demonstrable potential to improve wait time quantile estimates.

Health initiatives to reduce the potentially preventable hospitalisation of older people in rural and regional Australia.

ISSUE ADDRESSED: Australia's ageing population has growing health care needs, challenging timely health service provision. In rural and regional areas, older Australians have poorer health care outcomes and higher rates of potentially preventable hospital (PPH) admissions. The objective of this study was to identify Australian Governmental initiatives designed to reduce PPH of older adults (65 years and over) in rural and regional areas. METHODS: An internet search, underpinned by an environmental scan methodology, was utilised to systematically search the websites of Australian government health departments for relevant initiatives. Stakeholder interviews were then conducted to enrich the findings of the environmental scan. Thematic analysis was utilised to analyse all data. RESULTS: We identified 13 initiatives currently in existence in Australia that fulfilled the search criteria. Stakeholder interviews revealed a range of other local interventions in rural communities across the country, driven largely by community need and a lack of health service accessibility. CONCLUSIONS: The identified small number of Governmental health initiatives designed to reduce the PPH of older people living in rural and regional Australia may indicate gaps in the provision of services designed to enable older adults to remain at home and avoid subsequent hospital admissions. SO WHAT?: A coordinated, systemic approach to health promotion targeting older people in rural and regional areas should be explored, with a focus on collaboration between sectors (including primary care, allied health and prehospital services).

Emergency ambulance demand by older adults from rural and regional Victoria, Australia.

OBJECTIVE: To describe the demographic profile and clinical case mix of older adults following calls for an emergency ambulance in rural Victoria, Australia. METHODS: Retrospective cohort study using ambulance electronic patient care records from rural-dwelling older adults (≥65 years old) who requested emergency ambulance attendance during 2017. RESULTS: A total of 84 785 older adults requested emergency ambulance attendance, representing a rate of 278 per 1000 population aged ≥65 years. More than 10% of calls were to residential aged care homes. Medical complaints and trauma accounted for 69% and 18% of attendances, respectively. The predominant cause of trauma was ground-level falls. Common reasons for call-outs were for pain (17.5%), respiratory problems (9.7%) and cardiovascular problems (8.5%). Increased demand was associated with increasing age and winter months. CONCLUSIONS: Older adults from rural Victoria have high rates of emergency ambulance attendance and transportation to an emergency department, particularly with increasing age.

Disinvestment in the presence of uncertainty: Description of a novel, multi-group, disinvestment trial design and protocol for an application to reduce or cease use of mobilisation alarms for preventing falls in hospitals.

Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a "Reduced" (<3%) or "Eliminated" (0%) mobilisation alarm condition. Dynamic randomisation will be used to determine which ward in each pair will be allocated to either the reduced or eliminated condition to promote equivalence between wards for the embedded parallel, cluster randomised component of the design. A project governance committee will set non-inferiority margins. The primary outcome will be rates of falls. Secondary clinical, process, safety, and economic outcomes will be collected and a concurrent economic evaluation undertaken.

Being Your Best: protocol for a feasibility study of a codesigned approach to reduce symptoms of frailty in people aged 65 years or more after transition from hospital.

INTRODUCTION: The population is ageing, with increasing health and supportive care needs. For older people, complex chronic health conditions and frailty can lead to a cascade of repeated hospitalisations and further decline. Existing solutions are fragmented and not person centred. The proposed Being Your Best programme integrates care across hospital and community settings to address symptoms of frailty. METHODS AND ANALYSIS: A multicentre pragmatic mixed methods study aiming to recruit 80 community-dwelling patients aged ≥65 years recently discharged from hospital. Being Your Best is a codesigned 6-month programme that provides referral and linkage with existing services comprising four modules to prevent or mitigate symptoms of physical, nutritional, cognitive and social frailty. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in frailty (Modified Reported Edmonton Frail Scale), cognition (Mini-Mental State Examination), functional ability (Barthel and Lawton), loneliness (University of California Los Angeles Loneliness Scale-3 items) and nutrition (Malnutrition Screening Tool) will also be measured at 6 and 12 months. ETHICS AND DISSEMINATION: The study has received approval from Monash Health Human Research Ethics Committee (RES-19-0000904L). Results will be disseminated through peer-reviewed journals, conference and seminar presentations. TRIAL REGISTRATION NUMBER: ACTRN12620000533998; Pre-results.