Developing Post-falls Management Principles in Care Homes

Nottingham University Hospitals NHS Trust138 enrolled

Overview

Falls are common among older people living in care homes and can cause serious injuries. After a fall, older people require post-falls management. This involves timely risk assessment and immediate action to manage potential injuries and reduce risk of further falls. Residents may need support from several organisations. However, coordinating post-falls management can be challenging. Organisations may have different ways of working. There may be differences in opinions about the best course of action. Care home residents, relatives, staff and health professionals have highlighted that post-falls management guidance is needed. This research aims to develop principles for post-falls management for older people in care homes. The principles are intended to support a consistent approach and shared understanding across health and social care organisations. The first component (an online national survey) is already underway to map current post-falls management organisational processes for older people who fall in care homes and is not included in this protocol. This protocol includes the final three components of the research: 1) patient journey mapping to understand decision making process after a fall, 2) semi-structured interviews to explore different perspectives on factors affecting post falls decision-making and key areas for inclusion in the principles, and 3) an online modified Delphi to develop a consensus on key principles for consistent post-falls management in care homes. The research follows an implementation science approach and the Behaviour Change Wheel will be used to structure the work.

A mixed methods, sequential exploratory design will be used to co-develop principles. This study includes 3 components: * Retrospective patient journey mapping * Semi-structured interviews * Online modified Delphi method using cross-sectional surveys at 3 time points.

Study Type

OBSERVATIONAL

Enrollment

138

Conditions

Fall Fall Accident

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Patient journey mapping: * Resident living in a care home in Nottinghamshire or Lincolnshire * Aged 65 or over * Has experienced a fall in the last six months * Has not fallen within the last two weeks * Is capable of providing written or verbal informed consent as assessed by the researcher in line with the Mental Capacity Act or has a diagnosis of dementia and has a personal or nominated consultee who can advise on the person's feelings and wishes Interviews: * Resident or relative of a resident taking part in the patient journey mapping * Care home staff in England with experience of post falls management with older people in care homes * Healthcare staff in England working in primary, community, emergency and acute settings with experience of post falls management with older people in care homes * Ability to communicate verbally Delphi: * Care home staff in any role or healthcare staff in any role working in a primary, community, emergency and acute settings * Work in a care home or healthcare setting in England * Has any previous experience in supporting older people immediately after a fall in a care home as part of their role * Aged 18 years or over Exclusion Criteria: Patient journey mapping: * Outside of stated location * Outside of stated age range * No falls in the last six months * Fallen within the last two weeks * Unable to provide written or verbal informed consent and a personal or nominated consultee cannot be identified for residents with a diagnosis of dementia Interviews: * Residents or relatives who did not take part in the patient journey mapping * Care home and healthcare staff outside of England * Staff working outside of stated settings * Care home and healthcare staff with no experience of post falls management with older people in care homes * Residents who do not have mental capacity to provide informed consent (written or verbal) and do not have a personal consultee who can advise on the person's feelings or wishes. * Unable to communicate verbally Delphi: * Care home and healthcare staff working outside of England * Staff working outside of stated settings * No experience in supporting older people immediately after a fall in a care home as part of their role * Under 18 years of age

Outcomes

Primary Outcomes

Identification of principles for consistent post-falls management with older people in care homes using the Behaviour Change Wheel.

Principles will be classified to the relevant level of the Behaviour Change Wheel: sources of behaviour, intervention functions, policy categories. The classification of principles will be recorded.

Time frame: 18 months