Voices from the shop floor: improving fall prevention system design

Introduction

NICE Guidance 249 (2025) acknowledges that there is little evidence of the efficacy of most fall prevention methods in hospital. A recent systematic review and the world falls guidelines considered the evidence of assistive device technology in hospital fall prevention practices, reporting no significant effects on the rate of falls. A previous systematic review of interventional studies suggested wide variance in reporting making reported outcomes difficult to synthesise. This leaves clinical staff with uncertainty and limited options to prevent falls.

Method

This multicentre qualitative study used simulation and critical decision method (CDM) interview technique to investigate healthcare workers experiences of fall prevention in hospital. Three hospitals, eighteen simulations of a clinical ward scenario followed by nine focus groups with healthcare professionals were recorded and transcribed for analysis. Thematic analysis was conducted using NVIVO 15®

Results

Eight themes emerged through analysis including decision making, communication, finance, organisation of the team, the use of technology and contextual influences such as the environment and the variability of staff performance and patient status. There is a high degree of motivation to prevent falls and support for the use of fall prevention technology, if it prevents accidental falls. The measurement of falls in hospital creates fear amongst clinical workers that impacts practice.

Conclusion

The study shows commonalities in the universal experience of fall prevention by hospital staff. Addressing reporting variability could help overcome difficulties synthesising data and lead to more targeted measurement that potentiates improvement. Understanding the context of falls is crucial for safe system design.

An ethnographic study will build on these findings to determine whether technology supported fall prevention can assist situation awareness, reduce the cognitive load of nurses and provide insights to workable fall prevention system design.