Implementing a ‘Safe Recovery’ fall prevention program: Refining intervention theory using realist methods

Abstract

Objectives: This research aimed to explain how the Safe Recovery Programme (SRP) may best work to reduce falls in older adults undergoing rehabilitation in four wards in an older person's health and rehabilitation service. Methods: Qualitative realist methods were used, including surveys completed by patients and staff, and qualitative interviews or focus groups exploring views of patients, ward staff and SRP educators. Results: Emphasising different types of information for patients with different preexisting understandings may facilitate their responses to SRP messaging. Consistency and coherence of SRP messaging within ward routines varied in response to staff SRP training and ongoing feedback mechanisms from SRP educators. Conclusions: Tailored individualised approaches for patients with specific characteristics may lead to patients being less likely to engage in risky behaviours. Staff training and processes for facilitating ongoing feedback between patients, SRP and ward staff are required to ensure consistency and coherence of SRP messaging. K E Y W O R D S falls, inpatient, frail older adults, patient safety, qualitative research e260 | MARTIN eT Al.

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

“…A more commonly measured impact was patient knowledge. Seven studies measured patient understanding of their falls risks and care plan with varied results (23,43,53,54,61,63, 65) e.g., Radecki et al ( 54) conducted a knowledge-in-action survey which showed statistically signi cant improvements between baseline and intervention groups (P = .0007) in patient involvement in care planning. However, there was no signi cant difference in other questions, including whether the prevention plan was always followed.…”

“…The quality of interaction between patients and professionals appeared to underpin successful messaging (53,54), enabling patients to express the circumstances that constrained their participation. However, creating this interactional space appeared to rely on staff experience, skills, and timeresources that may be limited outside a study context (53,54). Furthermore, some patients are not able to remember or understand messaging due to cognitive impairment, with one study indicating potential harm to these patients (49).…”

“…One study reported a signi cant reduction in patients' use of call bells from 1277 uses per 100,000 patient hours to 523 uses (P = < 0.001) after comfort rounds (44). Two studies described the types of goal that were set during patient and professional interactions (49,53). Common goals in both studies included working more effectively with healthcare staff, identifying environmental hazards, and using appropriate aids and equipment.…”

“…The studies suggested patient attitudes, beliefs and understanding about falls risks may constrain their participation in falls prevention interventions e.g., patients may be reluctant to use the call bell for fear of disturbing busy nurses (45,53), they may not accept they are at risk of falling (53,55,56,58), and patients that have had a recent fall may be more likely to engage in falls prevention than patients who have not (51). Studies also reported intention to act e.g., asking for help using the toilet, may not be followed through if the help requested is not forthcoming and patients feel con dent to act alone (59) or are unable to wait due to urgency (58).…”

“…Radecki et al(54) and Sitzer(57) introduced tools that enabled patients to self-assess their falls risk, recognising a discrepancy between patients' and professionals' perception. Martin et al(53) evaluated the Safe Recovery Programme in which ward staff and volunteers worked with patients on one or more occasions to develop personalised goals to prevent falls. Haines et al(49) compared two approaches, one in which patients were provided with educational materials, and a 'complete programme' where materials were supplemented by one or more follow-ups with a physiotherapist for goal-setting and review.…”