Implementing the Action Falls Program Into Care Homes in England (the FinCH Imp Study)

Falls for care homes residents are a major cause of morbidity, mortality, and increased health and social care costs. The Action Falls program incorporates a multifactorial falls risk assessment checklist, training, and support for care home staff, which has been shown to reduce falls in care homes by 43%. This study explores the barriers, facilitators, and feasibility of implementing the Action Falls program into daily use in care homes.

Implementation study using the normalization process theory.

Care homes were trained and supported to use Action Falls for 12 months. Care home staff were invited to complete Normalization MeAsure Development questionnaires at baseline and 9 months, and attend Action Falls Collaborative events where observational notes were taken.

Staff readiness use Action Falls, training uptake, and costs were reported. Feasibility of collecting falls data was also measured. Quantitative data were analyzed with descriptive statistics and regression models; qualitative data underwent thematic analysis.

A total of 60% of care home staff received Action Falls training across 175 sessions. A total of 660 Normalization MeAsure Development questionnaires indicated that staff trained in Action Falls reported greater confidence in adopting the program. Confidence decreased over time, and barriers to training, including staff turnover and time constraints, were evident. The integration of the Action Falls checklist into digital care records was a key barrier to implementation. The average cost of training per care home was £331.60. Data on falls were returned by 88% of participating homes, with a mean of 2.53 falls per person-year.

Care homes were engaged and motivated to use Action Falls, which can be implemented with modest cost. Results emphasize the importance of ongoing support, digital integration, and policy backing to embed the Action Falls program into care homes. Overcoming logistical and technologic challenges is critical for its success.