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dc.contributor.authorAlvarado, Natasha
dc.contributor.authorMcVey, Lynn
dc.contributor.authorWright, J.
dc.contributor.authorHealey, F.
dc.contributor.authorDowding, D.
dc.contributor.authorCheong, V.L.
dc.contributor.authorGardner, Peter H.
dc.contributor.authorHardiker, N.
dc.contributor.authorLynch, A.
dc.contributor.authorZaman, Hadar
dc.contributor.authorSmith, H.
dc.contributor.authorRandell, Rebecca
dc.date.accessioned2023-06-22T09:53:16Z
dc.date.accessioned2023-06-22T14:30:38Z
dc.date.available2023-06-22T09:53:16Z
dc.date.available2023-06-22T14:30:38Z
dc.date.issued2023-06
dc.identifier.citationAlvarado N, McVey L, Wright J et al (2023) Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review. BMC Geriatrics. 23: 381.en_US
dc.identifier.urihttp://hdl.handle.net/10454/19474
dc.descriptionYesen_US
dc.description.abstractFalls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients' individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. PROSPERO: CRD42020184458.en_US
dc.description.sponsorshipThis research is funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research (HSDR) Programme (project number NIHR129488).en_US
dc.language.isoenen_US
dc.rights© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.en_US
dc.subjectFallsen_US
dc.subjectFalls preventionen_US
dc.subjectRisk assessmenten_US
dc.subjectRealist reviewen_US
dc.subjectPatient participationen_US
dc.titleExploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist reviewen_US
dc.status.refereedYesen_US
dc.date.Accepted2023-05-16
dc.date.application2023-06-21
dc.typeArticleen_US
dc.type.versionPublished versionen_US
dc.identifier.doihttps://doi.org/10.1186/s12877-023-04045-3
dc.rights.licenseCC-BYen_US
dc.date.updated2023-06-22T09:53:28Z
refterms.dateFOA2023-06-22T14:31:07Z
dc.openaccess.statusopenAccessen_US


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