Abstract
Background
Falls are a leading cause of morbidity among older people living in care homes. The Action Falls programme includes a multicomponent falls risk assessment checklist and guidance on mitigating actions. It demonstrated a 43% reduction in falls in a clinical trial. Initially developed as a paper-based tool embedded within care plans, Action Falls faced limited adoption when adapted as a standalone digital version. Care homes indicated they could not implement digital checklists that operated outside their electronic care planning systems. Since the COVID-19 pandemic, the Digitising Social Care Programme (initiated in 2021) has rapidly expanded the use of digital care records. Adoption increased from 40% of providers in December 2021 to 72% by mid-2024. This study reports on implementation efforts within the FinCH Imp National Study to embed the Action Falls checklist into digital care record systems.
Methods
We engaged with care software providers, care homes, commissioners, and industry bodies to enable direct integration of the Action Falls checklist into digital care systems. A free, collaborative licensing model was offered to encourage adoption by software manufacturers.
Results
Over a three-year period, we approached four individual care software manufacturers and their national industry body representing over 52 companies. Two providers agreed in principle to adopt the checklist, though concerns about development costs and limited demand were noted as key barriers. Facilitators identified included potential mandates from professional bodies or Minimum Operational Data Standards, and market incentives such as competitive advantage.
Discussion
The digitisation of care records has introduced care software providers as new stakeholders in the implementation of evidence-based interventions into care homes. Navigating this landscape is complex due to the intersection of healthcare, social care, and private provision. Building sustained, collaborative partnerships is essential to embedding clinical evidence into digital systems and ensuring impact at scale in care homes.
Comments
Market forces and mandates
This is so interesting - and emphasises the point that all the research that we don't is really for nothing if we can't influence policy and incentivise health or social care practioners (by financial or regulatory means) to practice evidence based care. Do you have a route to influence policy/practice in the electronic care record?
Thank you so much for your…
Thank you so much for your comment and interest in our work. Yes, it is frustrating and concerning that currently there is very little in the way of guidelines for digital care software suppliers as to what their commitment to evidence based care should be. In this work we have had discussions with large care software suppliers who have stated that evidence based interventions are not their priority, they follow common practice as this is more likely to lead to sales. There is a route to practice in the PRSB standards, the PRSB produces standards for digital suppliers to sign up to, however, in our case, although the PRSB were happy to produce a standard around the Action Falls programme, they need to charge for this and the costs was over £100k, which as a research team was prohibitively expensive for us. We are currently issuing free licences to a couple of smaller software companies and we hope that this will enable us to gain some momentum in the market.
We feel that there needs to be a wider conversation about the responsibilities of software companies to ensure care homes have access to the best quality, evidence based interventions in their care records. This is particularly important because care home staff are unable to use interventions that sit outside their digital care platforms.
Good project, well done!
Good project, well done!