Title: Developing a novel model for the implementation of falls management in a care home setting.
Funder: Department of Health and Social Care

Abstract: Introduction Care home residents are at a high risk of falling [1]. Falls are a frightening experience that can hurt, lead to serious injury and ultimately loss of life. Falls are costly to health and social care as they are one of the main reasons why older people are admitted to hospital and are estimated to cost the NHS 6 million a day [2]. There are well known factors that can increase the risk of an older person falling and best practice is to identify these factors and look at how to modify these factors to reduce the risk of falling [3]. There have however been challenges to implementing this approach into care home settings [4]. A Cochrane review [5] on the evidence for falls interventions in care homes recommended that further development is needed on models that target staff and organisational systems within a care home setting. Aim This fellowship will collaboratively develop a novel model for the implementation of falls management in a care home setting which targets staff and organisational systems. Methods The Consolidated Framework for Implementation research [6] will be used to underpin all components of this four year fellowship. The five components of work will include: 1) Identifying what content needs to be included in falls management by reviewing the existing literature and gaining agreement from experts in the management of falls. 2) Identifying what outcomes need to be included to establish if the model is successful and how these can be collected by reviewing existing literature and routinely collected healthcare data. 3) Exploring the issues of how to deliver falls management in care homes by observing care home practice in five care homes and interviewing twenty care home staff working in different roles across the home. 4) Involving care staff, residents, family members and clinicians in developing a model for delivery that includes the relevant content and overcomes the issues of a care home setting though two structured workshops with care staff, clinicians, residents and researchers at a mutually agreed location. 5) Implementing the delivery model in ten case study care homes to evaluate whether there is a change in care home practice and improvement in falls related outcomes. Outputs and Impact Using a collaborative approach this fellowship will develop a novel implementation model to support falls management in care homes. The quality of life of older care home residents will be improved through reducing injuries and hospital admission, promoting independence and supporting continued activity and participation. Findings will be disseminated throughout the fellowship and will include; peer reviewed publications in targeted clinical and implementation science journals, international and national conference presentations, clinician and care staff workshops, online resources through the React to Falls websites and summary reports to regulatory bodies and commissioners. The fellowship will support the development of an emerging leader in this field, within an experienced multi-disciplinary team who have expertise in falls, care home and implementation science research.

Lay abstract: This fellowship will develop a new way of supporting the management of falls in a care home setting. Care home residents are at a high risk of falling. Falls are frightening experience, they can lead to serious injury and ultimately loss of life. Falls are costly to health and social care and are estimated to cost the NHS 6 million a day. There are well known factors that can increase the risk of an older person falling and best practice is to proactively identify these factors and look at how these can be modified to reduce the chance of a resident falling. This proactive approach of identifying and modifying risks to prevent falls and serious injuries is challenging in care homes and there is often a reactive approach once a resident has fallen. Delivery of best practice in a care home setting is challenging due to the complexity of resident needs, the care home environment, staff knowledge and skills and the influence of wider health and social care. A recent literature review on the evidence for falls interventions in care homes recommended that further development is needed on models that target staff and organisational systems. This fellowship will develop a new model working with staff and the organisational systems to support the delivery of falls management in care homes. This four year fellowship will use the Consolidated Framework for Implementation Research (CFIR) as a way of exploring the issues of implementing falls management in care homes. This framework highlights the different factors that can influence implementation and will help to organise and analyse each stage of the work. There will be five stages of work: 1) Identifying what content needs to be included in falls management by reviewing the existing literature and gaining agreement from experts in the management of falls. 2) Identifying what outcomes need to be included to establish if the model is successful and how these can be collected by reviewing existing literature and routinely collected healthcare data. 3) Exploring the issues of how to deliver falls management in care homes by observing care home practice in five care homes and interviewing twenty care home staff working in different roles across the home. 4) Involving care staff, residents, family members and clinicians in developing a model for delivery that includes the relevant content and overcomes the issues of a care home setting though two structured workshops with care staff, clinicians, residents and researchers at a mutually agreed location. 5) Implementing the delivery model in ten case study care homes to evaluate whether there is a change in care home practice and improvement in falls related outcomes. Care homes and wider stakeholder have been included in the development of this proposal and will be included throughout the fellowship as part of the collaborator group and involved in the design, delivery and outputs of the project. The quality of life of older care home residents will be improved through reducing injuries and hospital admission, promoting independence and supporting continued activity and participation. By working collaboratively with care home staff, residents, family members and clinicians the new model will be more acceptable to care staff and appropriate to be delivered within a care home environment. The fellowship will support the development of an emerging leader in this field, within an experienced multi-disciplinary team who have expertise in falls, care home and implementation science research.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS