title: Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.
abstract: OBJECTIVE
  To identify the barriers and facilitators for fall prevention implementation in residential care facilities.
  
  
  METHODS
  Systematic review. Review registration number on PROSPERO: CRD42013004655.
  
  
  METHODS
  Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles.
  
  
  METHODS
  This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified.
  
  
  RESULTS
  We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers.
  
  
  CONCLUSIONS
  Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills. Effective fall prevention must consist of multifactorial interventions that target each resident's fall risk profile, and should be tailored to overcome context-specific barriers and put into action the identified facilitators.
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium. Electronic address: ellen.vlaeyen@kuleuven.be.
authors.forename: Ellen
authors.initials: E
authors.lastname: Vlaeyen
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Joke
authors.initials: J
authors.lastname: Stas
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Leysens
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Elisa
authors.initials: E
authors.lastname: Van der Elst
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Elise
authors.initials: E
authors.lastname: Janssens
authors.affiliation: Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Eddy
authors.initials: E
authors.lastname: Dejaeger
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
authors.affiliation: Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. Electronic address: koen.milisen@kuleuven.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*
keywords: Accidental falls; Barriers; Facilitators; Implementation; Long-term care; Prevention; Systematic review