Title: Practices of falls risk assessment and prevention in acute hospital settings: A realist investigation
Funder: Department of Health and Social Care

Abstract: Patient falls are the most common type of safety incident in hospitals and can cause physical harm, e.g. hip fractures, and non-physical harm, e.g. reduced confidence. It is recommended that patients receive a comprehensive falls risk assessment to identity risk factors that can be (1) treated, (2) improved, or (3) managed during a patient’s hospital stay e.g. problems with vision or continence. It is thought that a comprehensive falls risk assessment combined with strategies that address a patient’s individual risk factors could significantly reduce the number of patient falls. However, there is variation in the extent to which this happens. _x000D_ _x000D_ AIMS AND OBJECTIVES:_x000D_ The aim of this project is to determine how and in what contexts comprehensive falls risk assessment and tailored falls prevention strategies are used as intended on a routine basis in NHS hospitals. To achieve this, the project has three objectives:_x000D_ 1. To develop explanations of how, why and in what contexts comprehensive falls risk assessments are undertaken and identified risks are successfully addressed. For example, it might be that in contexts where there is an established team of healthcare professionals with different expertise, who routinely assess patients’ falls risk, the team work well together so patients’ risk factors are successfully identified and addressed. _x000D_ 2. To improve the explanations using the life experiences of patients at risk of falls and healthcare professionals responsible for assessing falls risk and preventing falls._x000D_ 3. To use the findings to develop guidance for hospitals to support comprehensive falls risk assessment and prevention. _x000D_ _x000D_ METHODS:_x000D_ 1. To develop initial explanations about how comprehensive falls risk assessment and prevention work, we will review articles such as editorials, comments, and letters. We will then systematically search for research articles that support or lead to a refinement of these explanations. _x000D_ 2. We will refine the explanations developed from the literature review using information collected via observations of, and interviews with, patients and healthcare professionals across three hospitals. _x000D_ 3. We will use the findings to produce guidance materials that hospitals can use to inform their own falls risk assessment and prevention strategies._x000D_ _x000D_ PATIENT AND PUBLIC INVOLVEMENT: We have a lay member who is part of the project team. We will work with him to recruit, via Leeds Older People's Forum, a group of lay researchers (members of the public who contribute to carrying out research). The lay researchers will present their views on the explanations from the literature review, advise on what to pay attention to when observing current practice and what questions to ask in interviews, and contribute to the analysis of the interviews. We will provide training for the lay researchers and pay them for their time._x000D_ _x000D_ DISSEMINATION: We will work with our lay researchers to create a dissemination and impact strategy. We will hold presentations at the three hospitals we will work with and we will hold an event where we will share the guidance materials we have produced and seek feedback on them. We will have a project website, where reports and guidance materials can be accessed, and we will make use of social media, e.g. Twitter.

Lay abstract: BACKGROUND: Falls are the most common type of safety incident reported by acute hospitals, and can cause both physical (e.g. hip fractures) and non-physical harm (e.g. reduced confidence) to patients. NICE recommends that, to prevent falls in hospital, patients should receive a multifactorial falls risk assessment and be provided with a multifactorial intervention, tailored to address the patient's identified individual risk factors. It is estimated that this could reduce the incidence of inpatient falls by 25-30% and reduce the annual cost of falls by up to 25%. However, there is substantial unexplained variation between hospitals in adherence to the NICE guideline, in terms of levels of assessments and interventions. _x000D_ AIM: To determine how and in what contexts multifactorial falls risk assessment and tailored multifactorial falls prevention interventions are used as intended on a routine basis in acute hospitals. _x000D_ METHODS: Realist evaluation, which is concerned with understanding for whom and in what circumstances complex interventions work and involves building, testing and refining the theories of how the intervention is supposed to work, provides an overall framework for the study. Our project is comprised of three work packages (WPs):_x000D_ WP1: A realist review of the literature will be undertaken. We will first identify theories concerning how and in what contexts multifactorial falls risk assessment and the implementation of tailored falls prevention interventions lead to a reduction in patients’ falls risk. We will then test these theories systematically, using primary studies to determine whether empirical evidence supports, refutes, or suggests a revision or addition to the identified theories. As part of testing the theories, we will assess acute hospital Trust policies for adherence to the NICE guideline, to provide insight in whether the level of adherence reflects decisions made at the organisational level. _x000D_ WP2: To further refine the theories, we will undertake a multi-site case study across three acute hospital Trusts, gathering data through ethnographic observation, interviews with staff and patients, and review of patient records and other documents._x000D_ WP3: We will translate the findings into actionable guidance that Trusts can use to inform their own falls risk assessment and prevention strategies._x000D_ ANTICIPATED IMPACT: Our impact goal is to increase uptake of the NICE guideline, in order to reduce the frequency of falls in older adults. This in turn will lead to a reduction in the human suffering that inpatient falls cause and healthcare costs._x000D_ DISSEMINATION: We will work with our lay researchers and Study Steering Committee to create a dissemination and impact strategy to promote the findings. We will hold presentations at our case sites and will hold a knowledge mobilisation event where we will share the guidance we have produced and seek feedback on it. We will also present the findings at other venues where we will reach NHS staff, including: the Manchester Falls Collaborative, a multiprofessional group that includes commissioners; the annual Nursing, Midwifery and AHP Research Conferences at Manchester Foundation Trust and Leeds Teaching Hospitals NHS Trust; the Greater Manchester Chief Nurse Group; the Greater Manchester Nurse Leaders meeting. We will engage with the wider public via a project website, where resources such as publications and guidance can be accessed, and social media, e.g. Twitter.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS