Considerations for hospital fall prevention programs: results from three studies
Abstract
Introduction: Multifactorial prevention interventions can reduce hospital falls, however their implementation can be challenging and inconsistent. We aimed to provide evidence to inform the design and implementation of hospital fall prevention programs reflecting the diverse needs and challenges in acute hospitals.
Methods: 1) An Intervention Component Analysis (ICA) of 45 hospital falls trials in a Cochrane review update, 2) a qualitative study with 50 hospital staff and patients, and 3) an implementation feasibility study of supported implementation of tailored multicomponent fall prevention interventions across four acute hospital wards, evaluated via 97 staff pre- and post-implementation surveys and 12 staff post-implementation interviews.
Results: The ICA identified contextually tailored approaches and involvement of multidisciplinary ward staff, patients and families in fall prevention as features that may impact effectiveness of interventions. In our qualitative study, key considerations when implementing hospital fall prevention programs included: 1) Fall prevention is a priority, but whose? 2) Disempowered stakeholders, 3) Shared responsibility may be a solution. The feasibility study found that staff perceived the implementation strategies to be acceptable (mean score 7.4/10) and feasible. Barriers and facilitators relevant to the intervention, implementation strategies, recipients and context were identified (deductively coded to the i-PARiHS framework). Barriers included lack of accountability, competing priorities and staffing challenges. Facilitators included local integration, empowered decision making and dependable leadership.
Conclusion: These studies highlight an array of considerations for hospital fall prevention programs. These findings informed the PROTECT Fall Prevention Program. PROTECT provides 12 inpatient wards with 21 weeks of supported implementation of tailored fall prevention interventions informed by local needs analyses. It is currently being evaluated in an effectiveness-implementation stepped-wedge trial across four hospitals (trial due for completion February 2026).
Comments
Falls Prevention in Hospital Setting
Falls in the hospital setting place a high burden to the economic public health system and to the patients as well as carer or staff.
Until now, effective hospital intervention programs on fall prevention have been very rare. The approach of this poster demonstrates the different steps which have to be taken before even an intervention is being implemented. First by the Intervention Component Analysis the search for important components and then followed up by qualitative research (interviews with staff). Based on these results, a feasibility study with the objective of implementation has been developed.
This study shows the long way of designing a high quality intervention program, which is followed by implementation research. Exactly the last step -implementation of effective fall prevention programs in the hospital setting is urgently warranted. Therefore, this study will add, valuable knowledge in this demanding research area.
MDT approach
These results highlight the importance of the MDT approach and good that it is tailored to care.