Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators

Abstract

Objectives: To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Design: Systematic review. Review registration number on PROSPERO: CRD42013004655. Data sources: Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. Review methods: This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. Results: We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Conclusion: Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills. Effective fall prevention must consist of multifactorial interventions that target each resident's fall risk profile, and should be tailored to overcome context-specific barriers and put into action the identified facilitators.© 2017 Elsevier Ltd. All rights reserved.What is already known about the topic? Multifactorial interventions, tailored to each resident's fall risk profile, can reduce the number of falls and recurrent fallers under highly controlled circumstances, but seems to be ineffective under "real-world" conditions, presumably due to poor implementation.Successful implementation of complex, multifactorial interventions in clinical practice involves a tailored, multifaceted approach based on a good understanding of barriers and facilitators for implementation. No reviews exist that comprehensively summarize the evidence on fall prevention implementation barriers and facilitators in residential care settings. What this paper addsSeventeen facilitators and 27 barriers that ...

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

“…However, several "setting specific" factors seem to affect implementation as well. For example, in a systematic review on fall prevention in residential care facilities, poor information transfer among care providers, staff, and family, and across shifts and lack of care plan communication were barriers (Vlaeyen et al, 2017). Similar barriers emerged in our review, implying that these "setting specific" factors should be taken into account in care innovations.…”

“…Similar barriers emerged in our review, implying that these "setting specific" factors should be taken into account in care innovations. As is suggested by Vlaeyen et al (2017), we also underline that a focus on modifiable barriers and facilitators such as communication is needed in implementation projects in daily practice.…”

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

“…Preventative measures such as exercise, education and vitamin D supplements have been shown to have a non- or inconclusive effect in the residential care facility population (Avenell, Mak, & O’Connell, 2014; Bunn et al, 2014; Cameron et al, 2012). Although a review of complex multifactorial intervention programs has shown a reduction of recurrent fallers (Vlaeyen et al, 2015), there are considerable barriers for implementation outside the highly controlled circumstances of a study (Vlaeyen et al, 2017). As an alternative to active interventions, compliant flooring, defined as a flooring with some level of shock absorbency, has been suggested as a potential method for reducing the risk of fall-injuries among a frail elderly population (Lachance et al, 2017).…”

Increased care demand and medical costs after falls in nursing homes: A Delphi study

“…This calls for improved implementation of evidence-based guidelines, which meet several barriers in practice, such as insufficient management support, staff time and funding (Ferlie & Shortell, 2001;Gray, Joy, Plath, & Webb, 2012;Vlaeyen et al, 2017). Therefore, insight is needed in both the costs and the potential savings of falls prevention to estimate the economic value of this approach.…”

“…This calls for improved implementation of evidence‐based guidelines, which meet several barriers in practice, such as insufficient management support, staff time and funding (Ferlie & Shortell, ; Gray, Joy, Plath, & Webb, ; Vlaeyen et al., ).…”