Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): Investigating the impact on quality use of medicines

This trial will examine interventions to implement new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care (Guideline, https://app.magicapp.org/#/guideline/jMMeqj). This is a RACF level intervention and each RACF will be randomised to one of three groups (Group A, B or C) . Each facility will receive all three levels of implementation strategies, one for each psychotropic medication class (antipsychotics, antidepressants, benzodiazepines). Each level of implementation strategy will be delivered simultaneously throughout the 12-month intervention period. The outcomes from RACFs delivering the level 3 or 2 intervention will be compared to the outcomes from RACFs delivering the level 1 intervention within each medication context. Each knowledge broker will be a registered pharmacist and will deliver each level of implementation strategy. The possible implementation strategy to medication combinations include: *Group A: Level 1 implementation strategy for antidepressants; Level 2 implementation strategy for benzodiazepines; Level 3 implementation strategy for antipsychotics. *Group B: Level 1 implementation strategy for antipsychotics; Level 2 implementation strategy for antidepressants; Level 3 implementation strategy for benzodiazepines. *Group C: Level 1 implementation strategy for benzodiazepines; Level 2 implementation strategy for antipsychotics; Level 3 implementation strategy for antidepressants. Level 1 - Distribution of Guideline and supporting materials The level 1 strategy will involve distribution of the Guideline and supporting materials in both hard copy and electronically to each RACF (including on-site staff and visiting healthcare professionals). Materials will be distributed by the knowledge broker at baseline as well as on request. Distributed materials will include the NHMRC-approved Guideline, a companion guide, medication factsheets on antipsychotics, benzodiazepines and antidepressants, and a curated inventory of existing resources. The level 1 resources will be standardised and no local tailoring of materials will be provided. The level 1 resources have been developed as part of the dissemination strategy for the new Guideline. Level 2 - Current best practice The level 2 strategy will involve provision of quality use of medicines (QUM) services and distribution of the Guideline and supporting materials. QUM services are an Australian government funded service. The QUM service will be a series of sessions focused on a medication class (antipsychotics, benzodiazepines or antidepressants). Each QUM session will run for up to 70-minutes. The sessions will be a face-to-face group education activity delivered by the knowledge broker to RACF registered nurses, enrolled nurses and aged care workers directly employed by the aged care provider organisation. Delivery of a session will occur once a every 3 months, with four QUM sessions delivered over the 12 months. The level 2 resources will be standardised and no local tailoring of materials will be provided. The level 2 resources have been developed as part of dissemination strategy for the new Guideline. Level 3 - Knowledge broker service The level 3 strategy will involve an onsite knowledge broker who will develop and lead local action plans, as well as provision of QUM services and distribution of the Guideline materials. The knowledge broker will be a registered pharmacist. Each knowledge broker will undergo a training program over a 4-5 week period prior to commencement of the trial. The training program consists of: *3 x 1.5 hour workshops on knowledge translation delivered by implementation science experts *1 x 1.5 hour webinar on the EMBRACE study design delivered by the chief investigators *1 x 1.5 hour webinar on the Clinical Practice Guideline delivered by the chief investigators * Residential Aged Care Pharmacist: Foundation Training Program (9 hours) developed and delivered by the Pharmaceutical Society of Australia The knowledge brokers will work across each participating RACF for that organisation at 1-4 days a week (depending on the number of RACFs they oversee). The knowledge broker will assess local needs, tailor strategies and activities for each RACF. Local action plans will be updated at each study time point (baseline, 3, 6, 9 and 12). Ongoing fidelity of the intervention delivered by the knowledge brokers will be monitored using the discussion boards, local action plans and monthly meetings with the investigator team. Monthly project meetings will be held with the knowledge brokers and the aged care provider organisation to monitor ongoing project progress and intervention fidelity for all three levels of intervention.