Abstract
Background: Falls are a major cause of Hospital Acquired Complications and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies support their use. This study uses a mixed-methods approach to triangulate quantitative data against qualitative data to identify adjustments to the implementation approach that may enhance the uptake of the Rauland Concentric Care falls prevention digital platform to inform implementation through a customised enhancement plan in two hospitals. It is anticipated that this study will provide a method to implement these types of digital workflow tools to be integrated sustainably with the hospital workforce for patient safety and quality.
Methods: A hybrid effectiveness-implementation study to evaluate falls prevention workflows delivered through digital falls prevention platform. The evaluation aims to: 1) effectiveness of the fall prevention workflows, focusing on patient outcomes and health service outcomes 2) implementation effectiveness from both subjective and objective measures 3) impact of using a theory-informed approach to improve implementation attempts. Data is collected at three key time points: 1) before implementation 2) Shortly after implementation 3) approximately six months after amending the implementation (approach informed by the initial qualitative assessments). Here we present the qualitative component using focus groups/interviews undertaken in two hospitals: 12 participants across four inpatient wards in a rural referral hospital and 10 participants across three wards in a large urban teaching hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers are mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan.
Results: Despite a similar implementation pathway, the two hospitals had different barriers and enablers. After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed as suitable for both hospitals: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations.
Discussion & future research: The ERIC strategies identified during the CFIR-ERIC mapping process were useful as a starting point to facilitate a co-design workshop that enabled the refinement, and agreement upon, an implementation enhancement plan. The enhancement plan is being tested as part of type-two hybrid-effectiveness study to determine if the enhancement plan process has improved the uptake of the falls prevention platform as reflected in clinical (rate and severity of falls) and implementation outcomes (compliance with using system).
Conclusions: Enablers and barriers identified are similar to those described in the literature. Given the close agreement between the ERIC consensus framework recommendations and evidence, the approach of codesigning the enhancement strategies for implementation with the users of the system will likely increase its adoption to assist in enhancing the implementation of the Rauland Concentric Care falls prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routine.