Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review

Abstract

Background Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. Methods A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration PROSPERO: CRD42020184458.

Timed Up and Go test score and factors associated with a moderate-to-high risk of future falls in patients scheduled for vascular surgeries—a cross-sectional study

“…From the point of view of nursing, the knowledge of risk factors and conditions in which falls are most frequent is of basic importance because it enables the threat to be predicted and preventive measures taken. The National Institute for Health and Care Excellence in England recommends that patients of 65 and older that are hospitalized due to severe diseases, and patients of 50–64 classified in the group of an increased risk of falls should be subject to the multifactorial falls risk assessment (MFRA) and to properly tailored procedures ( 23 , 24 ), in order to solve, improve, or manage their individual fall risk during their hospitalization.…”

Interactions that support older inpatients with cognitive impairments to engage with falls prevention in hospitals: An ethnographic study

“…The study began with a realist review of falls prevention literature in hospitals (Alvarado et al, 2023). This elicited and refined stakeholders' theories, included within the literature, about how risk assessment and prevention practices work.…”

“…A recent realist review of the international literature found that patient participation in their own falls prevention was a key falls prevention strategy (Alvarado et al, 2023). Several studies in the review involved staff-patient partnerships through which risk assessments and care plans were co-produced (Dykes et al, 2020).…”

Evaluation of a concise fall risk stratification among older adults with cataracts in day surgery settings: A historically controlled study

“…On the other hand, patients are admitted and discharged on the same day, and the fast, busy, and crowded day surgery settings present challenges to comprehensive fall risk assessment (Deng et al, 2019;Jiang et al, 2020). Most fall risk assessment tools have been conducted in general inpatient settings, and there is limited availability of ophthalmic-specific assessment tools while complex ward conditions can disrupt how such tools work as facilitators (Alvarado et al, 2023;Fulbrook et al, 2023). The fall risk assessment needs to be efficient and effective in day surgery settings.…”