McLennan Charlotte, Sherrington Catherine, Naganathan Vasi, Tilden Wendy, Richards Bethan, McVeigh Tamsin, Hallahan Andrew, Nayak Veethika, Jennings Matthew, Hassett Leanne, Haynes Abby
School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
Institute for Musculoskeletal Health, Sydney Local Health District, Camperdown, New South Wales, Australia.
BMJ Open Qual. 2025 Jul 7;14(3):e003313. doi: 10.1136/bmjoq-2025-003313.
Falls in hospital remain a complex patient safety issue for health systems. Multicomponent fall prevention interventions can reduce patient falls in hospitals; however, the implementation of these approaches in routine practice can be challenging and inconsistent. Quality improvement (QI) education and clinical facilitation may support the implementation of hospital fall prevention interventions. We conducted a mixed-method implementation feasibility study with a primary aim of evaluating the acceptability of QI education and clinical facilitation to support implementation of tailored, multicomponent fall prevention interventions. Secondary aims were to describe preliminary implementation impacts, and barriers and facilitators to the intervention and its implementation, to inform study feasibility.
Acute hospital wards (n=4) established a local team (2-4 staff members) to lead the implementation of multicomponent fall prevention interventions, informed by local incident data, on their ward. Education about QI (online or face-to-face) and clinical facilitation (12 weeks of weekly onsite support from a nurse manager experienced in QI) was provided to support the teams. Ward staff were invited to complete preimplementation and postimplementation surveys and postimplementation interviews. Descriptive statistics were used to analyse quantitative data. Qualitative data were analysed using inductive and deductive content analysis.
Acceptability: staff satisfaction with the strategies used to support the implementation of local fall prevention interventions had a mean score of 7.4/10 (SD=1.9, n=38). Reach: 28/38 (74%) survey respondents were aware of the multicomponent fall prevention interventions on their ward, with 24 (86%) reporting a positive impact on clinical practice post implementation. Adoption: delivery of multicomponent hospital fall prevention interventions increased 1.1/10 points between preimplementation (n=61) postimplementation (n=38) surveys. Survey (n=99) and interview (n=12) data indicated barriers and facilitators relevant to the intervention, implementation strategies, recipients and context. Examples of barriers included lack of accountability, competing priorities and staffing challenges. Examples of facilitators included local integration, empowered decision-making and dependable leadership.
QI education and clinical facilitation appeared to be acceptable and feasible strategies to support the implementation of tailored hospital fall prevention interventions. The impact of these implementation strategies when adapted to address local barriers and support enablers warrants further evaluation.
医院内的跌倒对于卫生系统而言仍然是一个复杂的患者安全问题。多组分跌倒预防干预措施可减少医院内患者的跌倒；然而，在常规实践中实施这些方法可能具有挑战性且不一致。质量改进（QI）教育和临床指导可能有助于医院跌倒预防干预措施的实施。我们开展了一项混合方法实施可行性研究，其主要目的是评估QI教育和临床指导对于支持实施量身定制的多组分跌倒预防干预措施的可接受性。次要目的是描述初步实施影响以及干预措施及其实施过程中的障碍和促进因素，以为研究的可行性提供信息。
急性病医院病房（n = 4）成立了一个本地团队（2 - 4名工作人员），根据本地事件数据在其病房领导多组分跌倒预防干预措施的实施。提供了关于QI的教育（在线或面对面）和临床指导（由一名有QI经验的护士经理提供为期12周的每周现场支持）以协助各团队。邀请病房工作人员完成实施前和实施后的调查以及实施后的访谈。使用描述性统计分析定量数据。定性数据采用归纳和演绎内容分析法进行分析。
可接受性：工作人员对用于支持本地跌倒预防干预措施实施的策略的满意度平均得分为7.4/10（标准差 = 1.9，n = 38）。覆盖范围：28/38（74%）的调查受访者知晓其病房内的多组分跌倒预防干预措施，其中24人（86%）报告实施后对临床实践有积极影响。采用情况：在实施前（n = 61）和实施后（n = 38）的调查中，多组分医院跌倒预防干预措施的实施增加了1.1/10分。调查（n = 99）和访谈（n = 12）数据表明了与干预措施、实施策略、接受者和背景相关的障碍和促进因素。障碍示例包括缺乏问责制、相互竞争的优先事项和人员配备挑战。促进因素示例包括本地整合、授权决策和可靠的领导。
QI教育和临床指导似乎是支持实施量身定制的医院跌倒预防干预措施的可接受且可行的策略。这些实施策略在适应解决本地障碍并支持促进因素时的影响值得进一步评估。
