Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study

Abstract

(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland’s Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.

Frequency of falls and contributing factors in hospitalized patients with severe mental disorders

“…24 Interventions such as assessing cognition, standing and decubitus blood pressure, medication review, nighttime medication review, among others, improve fall prevention in psychiatric care units. 25 In countries such as Mexico and other Latin American countries, the deficit of nursing staff in public hospitals is high, hence the need to implement improvement plans that include patient and staff education. In particular, staff education is associated with a reduction in the rate of falls in the hospital.…”

The OzHarvest Nourish Program: An evaluation of a hospitality-based program to support employment for young Australians

“…The Program is making progress on several United Nations’ SDGs including no poverty, zero hunger, good health and wellbeing, quality education, gender equality, decent work and economic growth and reduced inequalities [ 14 ]. Participants described significant benefits of participation, including improved food security, self-efficacy, and communication skills, reduced social isolation, and greater hope for the future [ 24 ].…”

Sounding the Alarm to Healthcare Leadership to Establish a Standardized Evidenced-based Falls Prevention Program: An Integrative Literature Review

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The dilemma for healthcare leadership is that interventions to prevent patient falls exist, but over the years it has been unclear as to which ones are the most effective and what strategies should be implemented to best support their needs (Delaforce et al, 2023). Because of the fact that national initiatives are aimed at preventing patient harm from falls, healthcare leaders have come to the conclusion that in order to be effective, a falls prevention program needs to be multi-faceted, which in turn produces a complex system.

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