Implementation strategies of fall prevention interventions in hospitals: a systematic review

Abstract

Background: The effectiveness of implementing fall prevention interventions (FPI) among hospitalised adults exhibits variability. Our review explored implementation strategies for FPIs, how these strategies are operationalised and their impact on fall rates and adherence.

Methods: Databases were searched up to October 2024 for studies reporting the implementation of FPIs in hospitalised adults. Studies were eligible if they reported at least one implementation strategy, reported a fall rate per 1000 patient days and had a control group. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) taxonomy, and operationalised based on the prerequisites of Proctor.

Results: The implementation strategies from the 48 included studies could all be categorised in the existing ERIC strategies. Almost all studies (96%) used at least one implementation strategy from the 'train and educate stakeholders' domain. The second-most used domain was 'develop stakeholder relationships'. The median number of implementation strategies per study was 6 (IQR 4-9). None of the studies reported all prerequisites per individual strategy, we found a median number of prerequisites per strategy of 2 (IQR 1-3). The action was discerned for all implementation strategies, since this was how we identified the implementation strategies. The actor was identified in 47% of the strategies, while all other prerequisites were reported less frequently. After the implementation of FPIs, the median decline in fall rate was 0.9 (IQR -1.8-.3) per 1000 patient days. Across the 17 studies that measured adherence, the median adherence rate to the FPIs was 65% (IQR 29-87).

Conclusion: This review emphasises that the documented strategies for implementing FPIs do not provide adequate details in their reporting. This, in turn, hinders clinicians and researchers from optimally guiding their quality improvement projects.

Prospero registration number: CRD42018091173.

Keywords: Hospital medicine; Implementation science; Nurses; Patient safety; Quality improvement.

Figure 1. Flow diagram for identification, screening and eligibility according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6 (7): e1000097. doi:10.1371/journal.pmed1000097.

Figure 2. Number of studies that reported using at least one strategy from the ERIC implementation domains. ERIC, Expert Recommendations for Implementing Change.