title: Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial.
abstract: Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses; provision of equipment; audit, reminders and feedback; leadership and champions; and the provision of falls data is key to successful falls prevention program implementation in acute hospitals.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Darshini R
authors.initials: DR
authors.lastname: Ayton
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Barker
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Renata T
authors.initials: RT
authors.lastname: Morello
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Brand
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Talevski
authors.affiliation: Project Health, Cremorne, Victoria, Australia.
authors.forename: Fiona S
authors.initials: FS
authors.lastname: Landgren
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Mayer M
authors.initials: MM
authors.lastname: Melhem
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Bian
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Brauer
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
authors.affiliation: Epworth/Deakin Centre for Clinical Nursing Research, Deakin University, Victoria, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Livingston
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000058:Accidental Falls / Q000517:prevention & control*; D001315:Australia; D016000:Cluster Analysis; D006284:Health Plan Implementation; D006761:Hospitals; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000517:prevention & control*