Table 4 implementation outcomes of included studies
First author, | Implement. outcomes (Proctor 2011) [34] | Assessment | Sample size (n) | Outcome measurement and methods | Level of analysis | Results |
|---|---|---|---|---|---|---|
Bonner | Not reported | |||||
Gama | Fidelity | Pre-post evaluation of quality criteria compliance, | Facility: single-site Residents:127 | Compliance with process criteria related to fall risk assessment measurement: twice (before/after interventions): cross-sectional random samples of medical records from the 127 residents who could walk 5 m independently | Staff | Pre-intervention: generally poor; the most problematic criteria concerned “orthostatic hypotension”, “review of assistive devices” and “strength and balance”, whereas only the “recording fall characteristics” criterion achieved compliance. Post-intervention: all criteria were improved except the eyesight evaluation criterion |
Leverenz | Acceptability | Survey | Facility: single-site Staff: 8 | Staff satisfaction with the manner of collaborative training: A post-training survey | Staff | 75% were strongly satisfied with group training, less satisfied with individual training sessions, and 63% provided neutral responses to the survey item. 75% of staff strongly agreed that their active participation feedback was welcomed and encouraged |
Rask | Fidelity | Pre-post-audit of the care process | Facility: 14 NHS medical records of 137 residents | Care process documentation: audits of records concerning 10 residents who had fallen twice or more before/during the 6-month evaluation period in both IG and CC | Facilities | Except for two, all critical areas of documentation concerning the assessment and management of fall risk factors improved. Notable advancements likely to directly impact recurrent falls included better assessment of fall risk factors, interventions to reduce the risk of falling and the likelihood of injury, and correction of environmental and equipment hazards |
Jackson | Fidelity | Self-reported staff round sheets checklist | Facility: single-site Staff:10, documenting on 144 sheets a total of 454 residents | Average compliance regarding staff documentation of hourly rounding: Staff frequency and consistency noted in each unit for every two-hour rounding sheet, with a focus on the 4 Ps (potty, pain, positioning and possession) | Staff | 2H patient rounding: average compliance was 91% across the three nursing units |
Szczerbinksa | Adoption | Quantitative measurement of intervention implementation level | Facility: 3NHs Residents: TUG test: (N: A:80, B:70, C:36) POMA test: (N: A:48, B:54, C:27) Residents who were referred to a rehab programme: (N: A:9, B:25, C:22) Residents who completed a rehab programme (N: A:9, B:23, C:20) | Measurement of the application rate of two fall prevention tests (TUG test and POMA test) and rehab programme at 3 sites: ratio of residents assessed via the two tests to all residents able to be evaluated in all NHs; ratio of residents at risk of falling and participating in a rehab programme to all residents referred by physicians to the programme | Facilities | •The implementation rate of risk assessment at the first stage (using a TUG test): mean: NHA 87.9%, NHB: 86.4%, NHC: 97.3% •The implementation rate at the second stage (using a POMA test): mean: NHA:88.9%, NHB: 100%, NHC: 100% •The implementation rate at the third stage (rehabilitation programme): mean: NHA:22.5%, NHB: 75.7%, NHC: 100% |
The percentage of residents who completed the physiotherapy programme from all residents referred to it | Residents | The percentage of residents who completed the physiotherapy programme was over 90% in all NHs. Among all residents in NHs, only 9.1% in NH A, 13.3% in NH B and 38.6% in NH C were involved in the rehabilitation intervention | ||||
Colon-Emeric, A | Fidelity | Pre-post facility (self-reported) | Facility: 36 NHs | The average compliance rate of fall risk assessment: facility self-reported data with fall prevention change concepts (fall risk assessment, labelling, post-fall risk assessment, risk factor reduction) | Facilities | Self-reported compliance: •The assessment of the fall risk level increased from 86 to 100% •Labelling of high-risk residents increased from 75 to 99% •The proportion of high-risk residents reported as having multiple-risk-factor reduction completed increased from 62 to 99% •post-fall assessments improved, rising from 81 to 98% |
Penetration | The level of facility participation crosses collaborative activities: facility self-reported data in how consistently submitted data reflecting the level of participation to the fall prevention change concepts | Facilities were classified on their level of participation across all activities •High: n = 5, participated in 66% or more of activities •Medium: n = 16, participated in 33% to 66% of activities •Low: n = 15, participated in less than 33% of activities | ||||
Fidelity | Pre-post chart abstraction documentation | Documented from 1,398 residents’ records | Compliance on documentation of the process measures of the fall prevention change concepts: chart abstraction of 832 medical records | Chart abstraction compliance: modest improvements in screening of falls (51% to 68%, p < .05), risk-factor reduction (4% to 7%, p = .30) and medication assessment (2% to 6%, p = .34); vitamin D prescription increased (40% to 48%, p = .03), and sedative-hypnotic use decreased (19% to 12%, p = .04) | ||
Wongrakpanich | Acceptability | Survey | Facility: single-site Staff: 12 Residents: 32 | Staff Satisfaction with training: A post-training survey | Staff | 11/12 (91.7%) staff strongly agreed: training sessions for checklist implementation and fall prevention knowledge were useful. All participants agreed (75%) or strongly agreed (25%) that the checklist does not interfere with routine patient care time. 7/12 and 5/12 were very satisfied and satisfied, respectively, with the STOP-FALLING project |
Adoption | The most/least common intervention used from checklist | Quantifying the most/least frequently used intervention across all staff | Teaching (patient and family education), medication review, and in-house safety evaluation were the 3 most common interventions implemented by staff (32/32 patient checklists, or 100%). Low bed application was the least common intervention implemented (2 of 32; 6.3%) | |||
Cooper | Feasibility | Process of intervention tool completion | Facility: single-site Residents: newly admitted (n = 29) | Process measure for completing fall intervention tools: In PDSA cycle 2, falls champions tested the tool as a group with new residents, who were unable to complete it | Staff | Process measures: 3 tools not completed, 6 fully completed (median duration: 22 days). Intervention tool (handover of actions) identified difficulties achieving process reliability while care assistants completed the tool. This prompted the invitation of a nurse into the improvement group and subsequent tool testing within the admission & care planning processes. 33.33% residents had completed risk/intervention tools |
Not clear | Staff | Balancing measure: The impact the project had on staff was explored. The responses were compiled into a Wordle, and the most frequently reported words included the following: "falls", "communication", "information" and "huddles" | ||||
Zubkoff | Acceptability | Survey | Facility: 26 SVHs Staff: 26 fall teams | Staff Satisfaction with educational call training: A post-training survey | Facilities | Staff satisfaction: 60 (69%) attendees described the calls as "Very or Extremely informative". 56 (66%) rated the calls as "Very or Extremely engaging". 68 (81%) would recommend the calls to a colleague |
Fidelity | Audit of report submission | Av. monthly report submission by teams: Self-reported document on delivery interventions | Facilities | Report submission: 19 out of 26 teams (73%), ranging from 65 to 85% of submissions each month | ||
Adoption | The most common intervention used out of 27 interventions | Quantifying the most frequently used intervention across all teams: Self-reported document on the delivery of 27 interventions | Facilities | 27 interventions; most commonly implemented interventions: post-fall huddles (n = 19 teams), staff education (n = 15 teams), intentional rounding (n = 13 teams) and programme evaluation interventions (meeting to review fall cases or review post-fall huddle data) (n = 12 teams). However, differentiating staff assignments, the intervention was implemented by 6 teams and not covered by the project | ||
Beasley | Fidelity | Pre-post audit of fall incidence tracking, and staff attending education | Facility: single-site Staff: 20 Residents: 20 | Av. attendance of staff members at falls education and training in the previous 12 months: audit of training records and questioning of staff regarding their attendance | Staff | The level of compliance • the education programs are available to health-care workers: pre-implementation: 2/20 (10%)/ post-implementation: 19/20 (95%) (P-value = 0.0038) |
Av. compliance for tracking the incidence and prevalence of falls in uniform resident management systems: audit of chart residents and incident forms | Staff | The level of compliance •Tracking the incidence and prevalence of falls in uniform resident management systems: pre- implementation: 19/20 (95%)/post-implementation: 20/20 (100%) (P-value = 0.0038) | ||||
Hofmann | Not reported | |||||
Theodos | Acceptability Appropriateness | Audit of resident’s non-completion of exercise program | Facility: single-site Documentation of 145 residents | Av. number who did not complete the fall exercise programme: audit of residents’ documentation of why they did not complete their recommended programmes, based on duration, frequency and level of activities. The therapist reviewed the documentation regarding the completion of the exercises | Residents | Not all residents were appropriate or agreeable to any form of exercise or activity. 8% of the residents refused to do any exercises; some were too ill, in pain, combative, experiencing contracture or in hospice services. The restorative or activities staff members were responsible for monitoring the residents’ performance of exercise interventions |
Kato | Not reported | |||||
Jensen | Not reported | |||||
Kerse | Fidelity | Chart audit of fall reported forms | Facility: 7 Residents:123 | Av. completion of fall risk assessment and implementation of the recommended intervention among residents: chart audit of fall-reporting forms | Facilities | Programme compliance rates: 5/7 IG had high compliance rates, assessing 48% to 85% of residents (noncompliant homes, assessed 0% and 35% of residents). On average, 49% of residents underwent individualised assessment (68% excluding the two non-compliant homes). After 5–7 months: 98% compliance, including the two non-compliant homes; 78% of all residents involved in the programme had fall-prevention strategies applied |
Ray | Fidelity | Pre-post administrative data abstraction | Facility: IG = 56 Residents: 4,932 | Av. facility compliance for implementing the safety programme (assessment and intervention) among residents at high risk: administrative data of mandatory minimum data set or facility records and nursing home records | Facilities | Facilities’ compliance with the programme: 52% of residents in intervention facilities complied with less than two thirds of the study programme recommendations (26% complied with less than 33% of recommendations; 26% complied with between 34% and 66; 48% complied with more than 66%) |
Meyer | Cost | Nursing care implementation cost of using the assessment tools | Facility: 11 | Economic evaluation: nursing staff of 11 nursing homes in the IG were asked how long it took on average to fill in the Downton Index | Facilities | Based on nurses' responses, there was an average of 3 min of nursing staff time per Downton Index per resident (n = 574 over an average follow-up of 10.8 months), resulting in a total of 310 h of nursing time. Fifteen minutes of nursing staff time per resident for the initial application of the Downton Index, including a full assessment of medication data, sensory deficits and mental state, were added, which means a further 143.5 h of nursing time. Overall, we estimated that the Downton Index required 475.25 h of nursing time. The calculation was based on the nurses’ gross salary of 22 euro per hour in 2006, as indicated by the finance department of a nursing home in Hamburg. Thus, using the Downton Index in this study yielded an approximate total of €10,500 ($16,170, £8,160), which was spent without a measurable clinical benefit |
Colon-Emeric,B | Adoption | Quantitative measurement of intervention components received | Facility: 12 Staff: 658 | Average intervention level received: the number of CONNECT intervention components each staff member had completed (0–10) | Facilities | Intervention dose varied across facilities (mean number of intervention components received by staff ranged 2.3–4.2 out of 10 possible |
Ward | Not reported | |||||
Bouwen | Not reported | |||||
Lomax | Not reported | |||||
Wells | Not reported | |||||
Ofosuhene, | Not reported | |||||
Hurst | Not reported | |||||
Ogundu | Not reported | |||||
Aguwa | Not reported | |||||