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Practices of falls risk assessment and prevention in acute hospital settings: A realist investigation

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About the project

Patient falls are the most common type of safety incident in hospitals and can result in physical harm, e.g. hip fractures, and other negative impacts, e.g. reduced confidence. People aged 65 years or older are most likely to suffer falls and they are also more likely to be harmed.

To prevent falls in older people, it is recommended that patients receive a comprehensive falls risk assessment, drawing on the expertise of a range of healthcare professionals. The assessment should identity risk factors that can be (1) treated, (2) improved or (3) managed during a patient’s hospital stay. Examples of such risk factors could be problems with vision or continence. It is thought that a comprehensive risk assessment could significantly reduce the incidence of patient falls. However, there is variation in the extent to which this happens. This could be because delivering the recommended assessment is a complex process and there is currently no standard, accepted approach.

Project aims

The aim of this project is to determine how and in what contexts comprehensive falls risk assessment and tailored falls prevention strategies are used as intended on a routine basis in NHS hospitals. To achieve this aim, the project has three key objectives:

1. To develop explanations of how, why and in what contexts fall risk assessment leads to a reduction in patient falls. For example, it might be that in contexts where there is an established team of healthcare professionals with different expertise, who routinely assess patients’ falls risk, the team work well together so patients’ risk factors are successfully identified and addressed.

2. To refine these explanations using the life experiences of patients at risk of falls and health service professionals responsible for assessing and preventing falls in hospital.

3. To develop guidance that NHS Trusts can use to inform their falls assessment and prevention strategies.

This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (NIHR129488). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.