Fall prevention through education and coaching trial (PROTECT)

This is a hybrid type I implementation effectiveness trial involving: a) Implementation strategies delivered by the research team to hospital ward staff to support them to implement tailored ward-based fall prevention interventions; and b) Evidence-informed intervention (tailored ward-based fall prevention interventions) implemented by ward staff within their routine workloads. Ward staff include those from nursing, allied health, medical, administrative and environmental services teams. The intervention will be delivered in 3 steps at 5-month intervals. The intervention will be sequentially introduced into 12 wards (three clusters with each cluster containing four wards) across four hospitals over 15 months. Wards will be randomised into clusters which will determine the commencement date of the intervention. There will be a one month “wash in” period between the “control” and ‘Intervention’ phases where pre implementation surveys and quick ‘yes/no’ audits will be conducted with hospital staff and patients on the participating wards. Along with analysis of trends in routinely collected local falls data, these survey results will contribute to an individual ward falls profile. The completion of this will be supported by a quality improvement and a member of the study team experienced in hospital fall prevention. The intervention/s implemented by each ward will be locally tailored informed by the ward falls profile. The improvement science-based implementation strategy will involve the following: • Attendance by minimum two ward staff at a two-day face to face Improvement Science Education course run by Sydney Education at the start of the intervention period. This course will focus on improvement science training including using diagnostic data to inform change ideas, assessing and implementing change ideas, PDSA cycles, assessing, spreading and sustaining improvement. The course will use mixed modes of education, including presentations and interactive activities. • 16 weeks of intensive improvement science support by an experienced facilitator who will train and support clinical staff on improvement science methodology, and how ward clinicians can use this approach to implement fall prevention strategies as a patient safety initiative in their clinical areas, accommodating their working environment. The fall prevention strategies a ward chooses to implement will be informed by their ward's falls profile and evidence-based hospital fall prevention guideline. Training will be based on the needs of the participants. Examples of what this may include are: using available falls data to inform and evaluate change, practical understanding of how to adapt their way of working to reflect their distinct ward/area setting, work culture, patient acuity cohort and specific local challenges, implementing and managing change, and applying the theory of improvement science to falls prevention in a real-time clinical setting. The modes of training used will depend on the ward teams needs but may include didactic lectures, bedside education and interactive activities. Facilitation sessions will be at least weekly for 30-60 minutes, and the facilitator will be available for access at other times on an as-needs basis. • Inservice’s and local education to ward staff regarding evidence- based hospital fall prevention practice, provided by SLHD study team staff with fall prevention expertise. The topic, number and timing of in-services will be based on ward staff needs and preferences. • Creation of a community of practice for participating wards to share knowledge, challenges and success related to their involvement in the program. The community of practice will be designed based on the needs of the participants. Options for what it may involve include online channels for communication (e.g., Microsoft Teams), scheduled online or face to face meetings to share progress, challenges, etc. Additional implementation strategies may be created to meet individual ward needs based on their pre implementation needs profile (e.g. staff reminders by the bedside). The SLHD Fall Prevention and Management Guidelines, World Falls Prevention Guidelines and the Australian Fall Prevention Guidelines (due for release in November 2024) may be referenced throughout the program. Adherence to the intervention will be monitored via the implementation outcomes listed in this form. This will include strategies such as session attendance lists and questions on the study-specific questionnaires.