JMIR Publications

ABSTRACT

Background:

Falls, a severe threat to the health and well-being of older adults, is the most common adverse event reported in hospital. Although multifactorial interventions are effective for in-hospital fall prevention, the interventions’ content vary widely and evidence for specific components is, thus, weak. Although fall prevention for in-hospital patients is a complex phenomenon, technology-based in-hospital fall prevention has mainly focused on technologies to detect falls. New knowledge is needed regarding when and how new technologies may support fall prevention among in-hospital patients from a systemic perspective is needed.

Objective:

This study aimed to explore and describe the fall preventive clinical practice in an acute hospital ward from a systemic perspective as well as to capture needs and possibilities for further support in fall preventive clinical practice.

Methods:

This qualitative study followed principles of human-centered design, combining focused ethnography and workshop. Health professionals (N=8) representing different staff categories in an acute hospital ward of an orthopedic clinic were observed in their clinical practice or participated in on-site interviews. Data from these events was subjected to qualitative content analysis to describe the observed fall preventive clinical practice in terms of people, activities, context and tools. In a workshop, a wider group of the clinic’s personnel gave their views on fall prevention, the description of observed activities and tools to prevent falls, as well as on needs for further support.

Results:

This study identified that health personnel considered fall prevention and assesses fall risk in all their interactions with patients. Staff categories had complementary roles in the wide range of fall preventive activities that they performed around a patient. The observed interactions between patients and personnel were goal-oriented, responsive, and patient-centered. In these meetings, the staff – as human individuals possessing a broad range of skills and functions – often served as key “tools” in assessment, communication, and coaching. Even though the personnel strived for fall prevention both in the hospital setting and after hospital discharge, they emphasized that it was much more difficult for them to address long-term prevention in their clinical practice. Therefore, they expressed a need for more home-like environments in the hospital. The lack of home-like physical elements in the ward was confirmed in the observations.

Conclusions:

The view on technology-based in-hospital fall prevention can be widened to not mainly include monitor- and alarm systems, but to also support activities performed by health personnel to engage patients in fall prevention. For example, tools to enable training of daily activities and mobility in more home-like and yet safe clinical contexts. Clinical Trial: Not Applicable, this study was not a Randomized Controlled Trial.