Clinical Practice Guidelines for Fall Prevention in Healthcare

Introduction: Falls as a Healthcare Risk

Risks for falls have been an area of concern for medical professionals, especially nurses. Statistics show that an increasing number of falls in hospital and hospice settings not only raises questions about the quality of care provided to patients and generates negative consequences for healthcare professionals, but also increases the overall cost of healthcare delivery. Various research studies have shown that following clinical practice guidelines (CPGs) can substantially reduce the number of falls; however, the effectiveness of these CPGs depends largely on the experiences of healthcare professionals and patients following falls, as well as on social factors such as community obligation, organizational resources, and individual resources.

Personal Experience and CPG Compliance

Research by Stenberg and Wann-Hansson (2011) demonstrated that, in order to comply with established CPGs, personal experience following a fall plays a decisive role. Attitudes toward fall prevention and compliance with CPGs are shaped by two variables: experiences of falls and related injuries that produce negative consequences for the healthcare professional and the patient. The research found that negative consequences increased nurses' and other healthcare professionals' acceptance of and compliance with CPGs. However, compliance was also driven by another element: the visible positive outcomes of following CPGs. Where negative consequences prompted nurses to comply with guidelines, positive outcomes resulting from fall prevention motivated them to apply CPGs consistently.

The findings emphasized the importance of directly experiencing the course of events as a precondition for CPG compliance. The implementation of CPGs depends on three factors: (1) the level of evidence available, (2) the context into which the evidence is being implemented, and (3) the method used to facilitate change (Rycroft-Malone et al., 2002). Stenberg and Wann-Hansson (2011) found that, while there is evidence that CPG implementation effectively prevents falls, difficulties arise during the implementation phase and in sustaining consistent compliance among healthcare professionals over time. This finding is consistent with the PARiHS framework, which holds that CPGs will be successfully implemented only when they reflect clinical experience and expertise and align with research-based evidence.

Social and Organizational Factors in CPG Implementation

Stenberg and Wann-Hansson (2011) also asserted that social factors play a decisive role in the successful implementation of CPGs. Their research found that unified leadership and active sponsorship of change related to CPG implementation were important drivers of success. For CPGs to be accepted and implemented, they must be clear, concise, and relevant to the specific healthcare hazard in question. Too much information not only reduces motivation for using CPGs but also increases confusion and stress among nursing staff. Successful implementation therefore requires that CPGs be regularly evaluated and re-evaluated in the context of organizational settings and the inherent risks associated with falls.

Community-related variables, such as legislative restrictions, represent another social factor with an important role in CPG implementation. When healthcare professionals face multiple community obligations — such as the simultaneous demands of preventive measures and ethical responsibilities — reluctance to follow CPGs may emerge. It is therefore important that directives be clear enough to prevent conflicts from arising. Where conflict is unavoidable, leadership must step in to resolve it. Organizational resources such as effective leadership, and individual resources such as ethics, motivation, and knowledge, are considered primary prerequisites for the successful implementation of CPGs. All of these factors have the potential to shape the behavior of nurses and other healthcare professionals with respect to fall prevention.

Conclusion: Toward Effective Fall Prevention

Risks for falls exist across all kinds of healthcare organizations, and falls carry negative consequences not only for patients but also for healthcare professionals. It is therefore essential that clear clinical practice guidelines for fall prevention be provided and that all factors capable of affecting their successful implementation be carefully considered and analyzed.

For the successful implementation of CPGs aimed at mitigating fall risks, the personal experiences of medical practitioners and the negative consequences of falls play a vital role. In addition, positive outcomes from following CPGs increase motivation for continued adherence. Beyond direct experience with falls, social factors — including community obligation, organizational resources, and individual resources — also play a vital role in successful CPG implementation. In order to ensure that CPGs are implemented with maximum efficiency and effectiveness, all of these factors and their possible outcomes must be considered and revisited throughout the implementation process.

References

Rycroft-Malone, J. (2004). The PARiHS framework: A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.

Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., & Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13, 913–924.

Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titchen, A., & Estabrooks, C. (2002). Ingredients for change: Revisiting a conceptual framework. Quality & Safety in Health Care, 11, 174–180.

Semin-Goossens, A., Van Der Helm, J. M. J., & Bossuyt, P. M. M. (2003). A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention. Journal of Nursing Care Quality, 18(3), 317–325.

Stenberg, M., & Wann-Hansson, C. (2011). Healthcare professionals' attitudes toward and experiences of clinical practice guidelines: A qualitative study. Worldviews on Evidence-Based Nursing, 8(2), 87–95.