A Sustainability Oriented and Mentored Approach to Implementing a Fall Prevention Guideline in Acute Care Over 2 Years

Implementation strategies of fall prevention interventions in hospitals: a systematic review

BACKGROUND

The effectiveness of implementing fall prevention interventions (FPI) among hospitalised adults exhibits variability. Our review explored implementation strategies for FPIs, how these strategies are operationalised and their impact on fall rates and adherence.

METHODS

Databases were searched up to October 2024 for studies reporting the implementation of FPIs in hospitalised adults. Studies were eligible if they reported at least one implementation strategy, reported a fall rate per 1000 patient days and had a control group. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) taxonomy, and operationalised based on the prerequisites of Proctor.

RESULTS

The implementation strategies from the 48 included studies could all be categorised in the existing ERIC strategies. Almost all studies (96%) used at least one implementation strategy from the 'train and educate stakeholders' domain. The second-most used domain was 'develop stakeholder relationships'. The median number of implementation strategies per study was 6 (IQR 4-9). None of the studies reported all prerequisites per individual strategy, we found a median number of prerequisites per strategy of 2 (IQR 1-3). The action was discerned for all implementation strategies, since this was how we identified the implementation strategies. The actor was identified in 47% of the strategies, while all other prerequisites were reported less frequently. After the implementation of FPIs, the median decline in fall rate was 0.9 (IQR -1.8-.3) per 1000 patient days. Across the 17 studies that measured adherence, the median adherence rate to the FPIs was 65% (IQR 29-87).

CONCLUSION

This review emphasises that the documented strategies for implementing FPIs do not provide adequate details in their reporting. This, in turn, hinders clinicians and researchers from optimally guiding their quality improvement projects.

PROSPERO REGISTRATION NUMBER

CRD42018091173.

Implementation and sustainability of best practice guidelines: a tale of three hospitals

OBJECTIVE

This study explores factors that affect the sustainable implementation of best practice guidelines (BPGs) and provides a basis for developing corresponding action strategies to promote project sustainability.

METHODS

Using the NHS (National Health Service) questionnaire scoring system, surveys were conducted among nurses who implemented BPGs in three hospitals in China. Data were analyzed using statistical analysis. We adhered to the STROBE guidelines for cross-sectional studies.

RESULTS

The average total score was 85.18/100, while the average scores of the process dimension, staff dimension, and organization dimension were 25.85, 45.88, and 13.45, respectively. The average score of the three dimensions was 83.12%, 87.56%, and 81.52%, respectively. This means that the three dimensions of the NHS SM had high scores and the implemented BPGs had a high likelihood of being sustained. The sustainable implementation of guidelines involves three factors: project characteristics, staff dimensions, and organizational environment.

CONCLUSION

Important factors that influence project sustainability include the clinical value of the project, a supportive environment provided by human resources and project infrastructure, and the degree of cooperation between interprofessional teams.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A305.

Talking about falls: a qualitative exploration of spoken communication of patients' fall risks in hospitals and implications for multifactorial approaches to fall prevention

BACKGROUND

Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients' levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice.

METHODS

Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach.

FINDINGS

We observed staff engaging in 'multifactorial talk' to address patients' modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with 'categorisation talk', which focused on patients' levels of fall risk and allocating nursing supervision to 'high risk' patients. Staff negotiated tensions between these different approaches through frequent 'hybrid talk', where, as well as categorising risks, they also discussed how to modify them.

CONCLUSION

To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients' individual risk factors and actions to address them (a 'why?' rather than a 'who' approach); (2) where not possible to avoid 'high risk' categorisations, employing 'hybrid' communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines to participate.

Child and adolescent mental health services in a devolved healthcare system: a qualitative exploration of sustainable practices

BACKGROUND

The transference of research evidence into routine healthcare practice remains poorly understood. This includes understanding the prerequisites of longer-term viability. The present study investigated the sustainable practices of GM i-THRIVE, a programme which reconceptualizes mental health services for children and young people (CYP) in Greater Manchester, United Kingdom. We aimed to establish whether a sustainable future was likely, and to identify areas of focus to improve that likelihood.

METHODS

The NHS Sustainability Model, typically completed as a questionnaire measure, was converted into interview questions. The responses of nine professionals, from a variety of roles across the CYP mental health workforce, were explored using inductive thematic framework analysis. Selected participants completed the original questionnaire.

RESULTS

Five themes (communication; support; barriers to implementation; past, present, and future: the implementation journey; and the nuances of GM i-THRIVE) and 21 subthemes formed the final thematic framework. Relationships with senior leaders and with colleagues across the workforce were seen as important. Leaders' roles in providing meaning and fit were emphasized. Whilst training delivered the programme's aims well, monitoring its dissemination was challenging. Widespread issues with dedicating sufficient time to implementation were raised. The flexibility of the programme, which can be applied in multiple ways, was discussed positively. This flexibility links to the idea of GM i-THRIVE as a mindset change, and the uniqueness of this style of intervention was discussed. To varying degrees, themes were supported by responses to the quantitative measure, although several limitations to the use of the questionnaire were discovered. Consequently, they were used to infer conclusions to a lesser degree than originally intended.

CONCLUSIONS

Professionals involved with GM i-THRIVE reported many elements that indicate a positive future for the programme. However, they suggested that more attention should be given to embedding the core concepts of the model at the current stage of implementation. Limitations relating to its use within our study are discussed, but we conclude that the NHS Sustainability Model is a suitable way of guiding qualitative implementation research. It is especially valuable for localized interventions. The constraints of our small sample size on transferability are considered.

Influence of participation in a quality improvement collaborative on staff perceptions of organizational sustainability

BACKGROUND

Sustainability capacity (SC), which is an organization's ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention - the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200).

METHODS

A mixed linear model repeated measures analysis was applied to matched staff members (n = 908, representing 2329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III).

RESULTS

For Model I, staff perceptions of total SC increased throughout most of the study (t1,4 = - 6.74, p < .0001; t2,4 = - 3.100, p < .036; t3,4 = - 0.23, p = ns). Model II did not change Model I's overall Time effect, but combined NIATx200 services (t = - 2.23, p = .026), staff job function (t = - 3.27, p = .001), and organizational administrators (t = - 3.50, p = .001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t = - 3.09, p < .002) and being in a free-standing clinic (t = - 2.06, p < .04) on staff perceptions of total SC.

CONCLUSION

Although staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization's SC significantly differed over time. However, an organization's participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors' influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT00934141 . Registered July 6, 2009. Retrospectively registered.