Supported implementation of tailored multicomponent fall prevention interventions in hospital: a feasibility study

Abstract

Background Falls in hospital remain a complex patient safety issue for health systems. Multicomponent fall prevention interventions can reduce patient falls in hospitals; however, the implementation of these approaches in routine practice can be challenging and inconsistent. Quality improvement (QI) education and clinical facilitation may support the implementation of hospital fall prevention interventions. We conducted a mixed-method implementation feasibility study with a primary aim of evaluating the acceptability of QI education and clinical facilitation to support implementation of tailored, multicomponent fall prevention interventions. Secondary aims were to describe preliminary implementation impacts, and barriers and facilitators to the intervention and its implementation, to inform study feasibility. Methods Acute hospital wards (n=4) established a local team (2-4 staff members) to lead the implementation of multicomponent fall prevention interventions, informed by local incident data, on their ward. Education about QI (online or face-to-face) and clinical facilitation (12 weeks of weekly onsite support from a nurse manager experienced in QI) was provided to support the teams. Ward staff were invited to complete preimplementation and postimplementation surveys and postimplementation interviews. Descriptive statistics were used to analyse quantitative data. Qualitative data were analysed using inductive and deductive content analysis. Results Acceptability: staff satisfaction with the strategies used to support the implementation of local fall prevention interventions had a mean score of 7.4/10 (SD=1.9, n=38). Reach: 28/38 (74%) survey respondents were aware of the multicomponent fall prevention interventions on their ward, with 24 (86%) reporting a positive impact on clinical practice post implementation. Adoption: delivery of multicomponent hospital fall prevention interventions increased 1.1/10 points between preimplementation (n=61) postimplementation (n=38) surveys. Survey (n=99) and interview (n=12) data indicated barriers and facilitators relevant to the intervention, implementation strategies, recipients and context. Examples of barriers included lack of accountability, competing priorities and staffing challenges. Examples of facilitators included local integration, empowered decision-making and dependable leadership. Conclusion QI education and clinical facilitation appeared to be acceptable and feasible strategies to support the implementation of tailored hospital fall prevention interventions. The impact of these implementation strategies when adapted to address local barriers and support enablers warrants further evaluation.