title: FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes.
abstract: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes.
  
  
  
  An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation.
  
  
  
  Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes.
  
  
  
  The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Dawn J
authors.initials: DJ
authors.lastname: Brooker
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Latham
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Evans
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Jacobson
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Perry
authors.affiliation: a Association for Dementia Studies, University of Worcester , Worcester , UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bray
authors.affiliation: b King's College London , London , UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: c Oxford Health NHS Foundation Trust , Oxford , UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Fossey
authors.affiliation: d Alzheimer's Society , London , UK.
authors.forename: James
authors.initials: J
authors.lastname: Pickett
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy*; D005240:Feasibility Studies; D006282:Health Personnel / Q000193:education* / Q000523:psychology; D006801:Humans; D009735:Nursing Homes; D018802:Patient-Centered Care / Q000379:methods*; D011787:Quality of Health Care; D011788:Quality of Life; D012648:Self Care; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic medication and dementia; care homes; person centred care; quality of care; training, staff roles