Case studies from using Action Falls
Curious about what it’s like to use the Action Falls programme? Here are three case studies from care homes that used the Action Falls programme in our Falls in Care Homes Implementation trial (FinCH Imp). Please note that to protect the privacy of our study participants, the names of the Care Homes or staff are not provided.
Implementing Action Falls
Case Study One: Central England
About the Care Home: A small independent care home with nursing provision for a maximum of 27 residents.
The home was recruited in August 2022. The recruitment was completed with the Acting Manager/Clinical Lead, who was keen to participate in the research study as they had heard ‘good things’ about it. The Falls Lead contacted the care home to arrange the Action Falls training, which took place in November 2022. This involved three training sessions with 24 staff attending and accounted for 80% of the staff members in the home, including the Acting Manager/Clinical Lead. Two top-up sessions took place in March 2023, with 11 staff attending.
The Falls Lead phoned the home each month. The Acting Manager reported that staff were more aware of falls risks since the training. The Acting Manager completed the Action Falls Checklists as care staff were anxious about recording something wrong on the documentation. By the end of the 12-month study period, the Acting Manager reported that staff had become more confident in completing the Checklist. They had not experienced many falls in the home.
The Acting Manager (nurse) was interviewed for feedback on the overall experience of the Action Falls programme. They reported that the training had been interesting and felt that it was pitched at the right level for all the staff who attended. They believed falls should be everyone’s concern and liked the inclusion of all staff in the training:
“I liked the fact that we’d arranged it so that different job roles were involved, so we included every staff member in our training, from cleaning, activities, maintenance, kitchen, everybody got involved, so everybody was involved in talking about the residents, we were talking about and, getting involved in looking at different aspects, and that was really helpful. I think everyone enjoyed thinking about things in a different way.”
The Acting Manager felt the training led her to reflect on existing falls prevention knowledge, rather than increasing her falls knowledge base. However, she felt the training increased awareness and knowledge for other staff, and gave an example of simple things, such as cleaners not leaving trailing flexes when they were working. The Acting Manager was confident in using the Checklist after the training, and as a nurse, was familiar with conducting assessments and completing documentation. They had used the Checklist with no problems, and made the Action Falls Checklist part of their morning routine, surveying each resident and room for risks:
“I go into the home in the morning, and the first thing I do is walk around my home. It’s only, it’s a small home, we’ve only got 24 residents, so it’s a smallish home, but I’ll go round every single room and check, is my resident alright, is their room looking safe, and that’s implemented in the Checklist, you know, is there anything out of place, are they in bed, are they, have they got the crash mat, have they got the PIR, is everything OK and as it should be.”
They indicated that the carers were worried about filling in the Checklist and often asked for help with completing it. They did feel that residents were getting better care because of the Action Falls Checklist, as staff were more aware of potential risks and ensuring resident safety:
“I honestly think it’s made the carers more aware, and all the other grade staff more aware of what we’re doing and why.”
In terms of going forward, they felt they had received sufficient support to use the Action Falls Checklist, but more help (over and above the monthly phone calls stipulated in the study protocol) was needed for the seniors and carers. They thought it would be helpful if somebody visited the home informally to go through completing the Checklist with real residents.
Case Study Two: Northern England
About the Care Home: A large care home with residential, nursing and dementia support for a capacity of 58 residents. There are 17 care homes in the chain.
The care home has a few residents at high risk of falls. The manager hoped that, by participating in the research study, they could reduce the number of falls. This was the first time the home had participated in any research. There were no issues recruiting this home, and the Falls Lead delivered two training sessions. This was insufficient for the number of staff working in the home, so further sessions were arranged, but each was cancelled due to a lack of staff availability.
The Deputy Manager was also the Falls Champion and was interviewed to provide feedback on the overall experience of using the Action Falls Programme. There were issues around releasing staff for training and bringing in other staff to cover the absent staff. However, the participant was positive about the training session, saying it was engaging and informative. They particularly liked the fact that staff, such as housekeeping, were invited to join the sessions. The training encouraged them to ‘think outside the box’ and look at each resident as an individual, rather than focusing on just the fall. The Deputy Manager said:
“It kind of opened, I think, a few people’s eyes to actually looking at the bigger picture of falls and the chart [Checklist] itself, that went through more of a holistic view rather than just the falling because, y’know, the mobility’s not very good.”
The practical part of the training session, the case study, was viewed positively and seen as a means of encouraging staff to think about falls in relation to their residents.
They liked the Action Falls Checklist and felt it was more in-depth than the home’s existing falls assessment. They
were enthusiastic about the basic ethos of the programme involving all staff in falls prevention, rather than just being the responsibility of the nurses and carers.
Once the training was completed, they were left to implement the Checklist. However, the care home was busy, so the Checklist was pushed to the bottom of the priority list. The Deputy Manager said:
“I really thought it was good, and I thought that it would, you know, potentially help reduce certain falls in certain people. But to do it for everybody, it just wasn’t relevant for everybody, and it was too, it was too long-winded to go through everything of actually looking at their medication every time, looking at their eyesight every time, do they need this, do they need that, you know. Personally, when we’re full, we’re a 57, 58-bedded home, to do it for everybody, it was just unrealistic”.
Their thoughts on going forward were to only use the Checklist with high-risk fallers (in addition to using the home’s existing falls documentation), rather than using it with all residents. They wished to meet the ethos of the programme, adopting a whole team approach, and envisaged achieving this by assembling a group of staff at all levels, with an interest in falls. This group could then meet each month to discuss the Action Falls Checklist in relation to high-risk fallers. They recommended that the Checklist be integrated into their digital system, rather than being used as a separate, standalone document.
Case Study Three: Southern England
About the Care Home: A medium-sized care home with nursing provision for a maximum of 42 residents. There are five care homes in the chain.
The Care Home Liaison Nurse was instrumental in recruiting this home and forwarded the home’s details to the research team. There was a delay in recruitment as the home manager left, but once the new manager was in place, the home was recruited with no problems. The manager and Clinical Lead nurses were very supportive of the ActionFalls Programme.
The Falls Lead completed three training sessions at the home, accounting for 72% of the staff in the home. However, no checklists had been completed when the Falls Lead made a review visit. The visit was therefore used to go through the e-version of the Checklist with the manager and Clinical Lead for one of the residents in the care home. They felt the Checklist was more comprehensive than their existing documentation and saw the benefit of the suggested actions. They subsequently replaced their existing falls assessment with the Action Falls Checklist.
A top-up training session was conducted focusing on their residents, discussing common problems, and suggesting actions.
A joint interview took place with the manager and one of the Clinical Lead nurses to get feedback on the overall experience. They explained that they had taken part in the research due to the high number of falls in the home. They wanted to see what else they could do to prevent falls and were interested in how they could adapt the care home environment. They also liked the fact that anyone could attend the training and that falls prevention was not restricted to the carers.
Training sessions were arranged over different days to accommodate staff on duty. The sessions took place at 7.30 am so that night staff could also attend. The nurse liked the fact that a target was set around the number of staff in the home who should be trained:
“Because when you are trying to share with them, maybe let’s say for example during meetings etc. the larger the number of staff members that would have attended, you know, it makes it easier forpeople to understand and sort of like take on board, if at all there’s any changes that you are trying to, you know, sort of like implement as a result of the training.”
The training greatly increased the knowledge of these two senior staff members. They stated their knowledge was enhanced by the training and felt the training was at a suitable level for the carers:
“So that even our carers who attended that training, they said that it’s quite understandable and it’s clear, because each step is clear. They can understand and they can put it into action also.”
The practical case study in the training was perceived positively, and it was felt that this encouraged staff to think outside the box in relation to their own residents.
The nurses completed the electronic version of the Action Falls Checklist. They had no difficulties filling it in, found it helpful, and did not find it time-consuming. The home had a nurse doing supernumerary shifts who normally completed the Checklist. They staggered and spaced out, completing the Action Falls Checklist across the residents.
When asked if the Action Falls programme had changed anything for the home. The nurse replied:
“Oh yeah, definitely. Because once we’ve got that knowledge, you know, there were a lot of other things that we’re looking into, including medication reviews, you know, although yes, the medications were being reviewed, but, you know, one, once you, you, you sort of like have this awareness, you do it proactively, you know.”
Going forward, they suggested that the electronic version of the Action Falls Checklist should be developed so that once the Checklist is generated, it can pre-populate without refilling it in.