Mapping the organisation of post falls management in care homes. What is missing?

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F Hallam-Bowles 1,2; P Smith 3; N Gray 1,2; J Darby 1,2; L Rees 4; G Squires 5; E Cox 2; P Logan 2,6; K Robinson 2

1. Nottingham University Hospitals NHS Trust; 2. University of Nottingham; 3. Patient and Public Involvement and Engagement (PPIE) Co-applicant; 4. Avery Healthcare Group; 5. East Midlands Ambulance Service NHS Trust; 6. University of Queensland

Scientific Research

SP - Falls (Falls, fracture & trauma)

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Abstract

Introduction: Falls are common among care home residents and can have serious physical and psychological consequences. Effective post-falls management is essential to identify injuries and prevent further falls, often requiring multi-agency collaboration. However, there is no national care home-specific guidance, with approaches typically developed locally. This study maps organisational post-falls management processes in English care homes and explores challenges to delivery.

Method: An online mixed methods survey was completed by care home and healthcare staff with experience of post-falls management with older adults (aged 65 years and older) living in care homes in England. Convenience sampling, with an emphasis on national coverage, was undertaken. Quantitative data was analysed using descriptive statistics. Qualitative data from open-ended questions was analysed independently by two researchers using thematic analysis and mapped to the behaviour change wheel to explore barriers and facilitators.

Results: Survey responses from 178 participants across 11 English regions showed that post-falls management was guided by multiple policies and guidelines. These included falls management policies (n=151, 85%), moving and handling policies (n=126, 70%), risk assessment documents (n=122, 69%) and National Institute for Health and Care Excellence (NICE) guidelines (n=141, 79%). Policies and guidelines were rarely specific to care home residents (n=69, 38%), especially those used by healthcare staff (n=17, 20%). Responses differed between care home and healthcare staff. Five themes emerged: policy inconsistency, communication of policies and falls information, access to external support, understanding of procedures, and resource availability.

Conclusions: This mapping study highlights the lack of consistent guidance in supporting residents following a fall and the complexity of delivering multi-organisational care. Survey results will be explored in more depth through interviews with residents, relatives and staff.