Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, 2113, Macquarie Park, NSW, Australia.
BMC Geriatr. 2024 Oct 24;24(1):869. doi: 10.1186/s12877-024-05462-8.
Falls remain a persistent problem in residential aged care (RAC) facilities. Fall screening and assessment tools such as the Peninsula Health Falls Risk Assessment Tool (PHFRAT) are widely used to inform falls risk and guide fall prevention interventions. However, it is unclear how it is used in practice and whether clinicians believe it supports resident care. This study aimed to measure the extent of use of PHFRAT to understand clinicians' perceptions of its value and usefulness.
This mixed method study involved an analysis of PHFRAT assessment from 25 RAC facilities in New South Wales, Australia, and interviews with seven RAC staff about how PHFRAT information is used in practice. In the quantitative component, descriptive statistics were applied to PHFRAT data to summarise how RAC staff use the PHFRAT including the completeness and content of the three parts. In the qualitative component, thematic analysis techniques were applied to interview data.
The sample included 215 RAC residents with 703 PHFRATs, of which 617 documented fall prevention interventions. Among these 617 PHFRATs, 593 (96.1%) included strategies related to staff assistance and 283 (45.9%) recorded strategies related to device provision. While nearly all residents (96.74%) received at least one PHFRAT assessment over the study period, many PHFRAT assessments were incomplete (part 1: 11.5% of information missing; part 2: 10.8%; part 3: 17.1%). There were few variations in fall interventions prescribed to individual residents by their fall risk level. Interviews with RAC staff indicated that PHFRAT assessments are the responsibility of registered nurses with limited input from other staff or residents. While the structured process was viewed positively in guiding risk assessment and intervention assessment, a lack of input from others prevented strategies from being tailored to residents' specific needs and preferences. A shortage of resources, lack of communication, and limited staff education were identified as the main barriers to PHFRAT guideline implementation.
The PHFRAT provides a useful structure for clinicians to assess falls risk factors and plan falls prevention strategies. In the future, increased multidisciplinary input into fall prevention strategy development may improve the comprehensiveness of fall prevention plans.
跌倒仍然是住宅老年护理（RAC）设施中一个持续存在的问题。跌倒筛查和评估工具，如半岛健康跌倒风险评估工具（PHFRAT），被广泛用于评估跌倒风险并指导跌倒预防干预。然而，目前尚不清楚它在实践中的使用情况，以及临床医生是否认为它支持居民护理。本研究旨在衡量 PHFRAT 的使用程度，以了解临床医生对其价值和实用性的看法。
这项混合方法研究涉及对澳大利亚新南威尔士州 25 个 RAC 设施的 PHFRAT 评估进行分析，并对 7 名 RAC 工作人员进行了访谈，了解 PHFRAT 信息在实践中的使用情况。在定量部分，对 PHFRAT 数据进行描述性统计，以总结 RAC 工作人员如何使用 PHFRAT，包括三个部分的完整性和内容。在定性部分，应用主题分析技术对访谈数据进行分析。
样本包括 215 名 RAC 居民，共进行了 703 次 PHFRAT 评估，其中 617 次记录了跌倒预防干预措施。在这 617 次 PHFRAT 评估中，593 次（96.1%）包含与员工协助相关的策略，283 次（45.9%）记录了与设备提供相关的策略。尽管研究期间几乎所有居民（96.74%）都接受了至少一次 PHFRAT 评估，但许多 PHFRAT 评估并不完整（第 1 部分：缺失 11.5%的信息；第 2 部分：缺失 10.8%；第 3 部分：缺失 17.1%）。根据跌倒风险水平为个别居民开出的跌倒干预措施几乎没有差异。对 RAC 工作人员的访谈表明，PHFRAT 评估由注册护士负责，其他工作人员或居民的参与有限。虽然结构化的流程在指导风险评估和干预评估方面被认为是积极的，但由于缺乏他人的投入，策略无法根据居民的具体需求和偏好进行定制。资源短缺、沟通不畅和有限的员工教育被确定为 PHFRAT 指南实施的主要障碍。
PHFRAT 为临床医生评估跌倒风险因素和制定跌倒预防策略提供了有用的结构。在未来，增加多学科人员对跌倒预防策略制定的投入，可能会提高跌倒预防计划的全面性。
