Table 1 Key Components of the Multifaceted ViD OS intervention

Interactive Educational Sessions

Presentation of three learning modules that include a summary of best practices, special considerations for assessing/treating the elderly, key messages, integration of OP/fracture prevention into care processes, and a case study. Opportunity for discussion and active participation via problem-based learning and completion of action plans.

Expert Opinion Leader/ Study Coordinator

Expert opinion leader leads first and second interactive educational sessions via webinar (with study coordinator facilitating on-site). A Geriatric Nursing Consultant leads the third interactive educational session via webinar.

DVD

A 10-min DVD, ‘Meeting the Challenge of Osteoporosis and Fracture Prevention,’ is viewed at the first interactive educational session (and a copy left for the team to educate other/new staff members, residents, families). This DVD was created by the Osteoporosis Strategy for LTC (http://www.osteoporosislongtermcare.ca[54]) and is specific to the LTC context.

Performance Reports (Audit and Feedback)

Performance reports for vitamin D, calcium, and osteoporosis medications prescribing (aggregated for all residents in a home) and benchmarked against other ViDOS intervention homes, are presented at each interactive educational session. Confidential, individual performance reports are also provided to each physician.

Reminders/Point of Care Tools

Treatment Alert: A tool used by consultant pharmacists to alert physicians and nurse practitioners to assess and consider osteoporosis treatment for residents at increased risk for fracture (based on the 2010 Osteoporosis Canada Clinical Practice Guidelines [21].

X-ray Requisition Stamp: A stamp labeled ‘please rule out vertebral fractures’ to add to chest X-ray requisitions.

Process Indicator Checklist: This tool assists teams with creating internal processes and policies that support and sustain appropriate prescribing and other osteoporosis and fractures best practices (e.g., admission/quarterly assessment, diagnoses documentation, ongoing staff education and training).

Action Planning for Quality Improvement

Discussion/completion of a work-sheet to set specific action items for team members, address barriers and facilitators, and outline best practices strategies. Homes work on action plans between study sessions.

Internal Champion

A PAC team member, such as consultant pharmacist and/or Director of Care, who will network with champions at other LTC homes (via online forum http://www.osteoporosislongtermcare.ca[54]) and continue to promote best practices after the research team has left.

Tool-kit*

The tool-kit includes: the 10-min DVD (‘Meeting the Challenge of Osteoporosis and Fracture Prevention’), informational pocket cards, case studies, and posters. Distributed to all LTC homes as part of the Ontario Osteoporosis Strategy for LTC.

Osteoporosis Long-Term Care Website*

The website (http://www.osteoporosislongtermcare.ca[54]) with an interactive forum for Internal Champions, is promoted to all LTC homes via the Ontario Osteoporosis Strategy for LTC.