TY - JOUR
T1 - Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions
T2 - a realist review
AU - Alvarado, Natasha
AU - McVey, Lynn
AU - Wright, Judy
AU - Healey, Frances
AU - Dowding, Dawn
AU - Cheong, V. Lin
AU - Gardner, Peter
AU - Hardiker, Nick
AU - Lynch, Alison
AU - Zaman, Hadar
AU - Smith, Heather
AU - Randell, Rebecca
N1 - Funding Information:
This research is funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research (HSDR) Programme (project number NIHR129488). The views and opinions expressed are those of the presenters and do not necessarily reflect those of the HSDR Programme, NIHR, NHS or the Department of Health and Social Care.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/6/21
Y1 - 2023/6/21
N2 - Background: Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. Methods: A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results: Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions: Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration: PROSPERO: CRD42020184458.
AB - Background: Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. Methods: A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results: Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions: Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration: PROSPERO: CRD42020184458.
KW - Falls
KW - Falls prevention
KW - Patient participation
KW - Realist review
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85162866162&partnerID=8YFLogxK
U2 - 10.1186/s12877-023-04045-3
DO - 10.1186/s12877-023-04045-3
M3 - Review article
C2 - 37344760
AN - SCOPUS:85162866162
VL - 23
JO - BMC Geriatrics
JF - BMC Geriatrics
SN - 1471-2318
IS - 1
M1 - 381
ER -