Investigating facilitators and barriers to the implementation of Action Falls
Abstract
Introduction: Falls are a prevalent issue impacting older people in care homes. Injuries can occur after a fall like fractures and there are many tools in use to manage patients who fall. However, few that focus on care home residents. Action Falls is a checklist that aids in diagnosing and highlighting risk of falls while providing healthcare professionals direct actions to take for prevention.
Method: Interviews were conducted over 4 weeks via Microsoft Teams. 3 doctors from each of the specialties Orthopaedics, General Practice, Geriatrics and 4 Psychiatrists were participants to a total 13. 30-minute semi-structured interviews had participants highlight what they identified as positives and negatives to the checklist. Following this, Braun and Clarke’s 6 steps thematic analysis was utilised after each interview was recorded, transcribed and manually coded to highlight themes and sub-themes. Secondary research into factors affecting the implementation of evidence-based research into clinical practice was investigated along with comparisons of alternative fall prevention tools.
Results: 5 themes and 27 sub-themes were identified. Major themes included creating an electronic format for Action Falls and reducing length of the checklist. Almost all participants found the checklist useful with many positives identified, like having actions attached to each factor and a high level of detail aiding their understanding of falls. Many participants identified the checklist as laborious, concerned on how long it may take to fill out.
Conclusion: Action Falls proved valuable, but with areas of improvement to increase uptake. Length was a consistent barrier pushing healthcare professionals away due to being viewed as more paperwork. One of the key strengths was its comprehensiveness with direct solutions. Further research on software integration into clinical practice is recommended to combat time and paperwork fatigue. Awareness of the tool was also seen to potentially enhance implementation.
Comments
Congratulations
Dear authors,
Congratulations to this important work!
I would like to know more about how to reduce these barriers, as these barriers are so common and difficult to manage in my clinical practice.
Regards,
Juliana Ansai
Questions about sample
Hello,
Great job! I really think it is important to understand factors that influence implementation efforts.
I'm curious about the participants you selected for your interviews. Could you walk me through the context of the reasons you selected them (would they be the implementers of Action falls, what about personnel from care homes, how does the collaboration look like between these two?)
Thanks!
Hi there!Good question to…
Hi there!
Good question to ask. We brainstormed about other stakeholders involved in Action Falls the team had not spoken to in as much detail. There was a greater emphasis of physio and occupational therapists in the development of Action Falls which was brilliant. We looked at the document, medics and surgeons are all involved in the care of a fall but hadn’t been as heavily consulted and thought they could have really interesting perspectives. The sample was made of 4 groups just to allow the data to be processed effectively for me in an efficient time frame and we tried to select specialties who could broadly cover aspects of falls not just in the present part of a fall but what specialties may be involved in the beginning of a fall as well as the after of a fall. We also wanted to speak with doctors and surgeons as thought of how so much care of a fall is done in hospital and general practice that follows through to discharge home they would be strong stakeholders in recommending resources they find effective for their patients.
Hope my ramble made sense!
Best wishes,
Maddy