Knowledge translation in action: a CDHB & BAIL collaboration
In 2018 the CDHB piloted the Safe Recovery Programme into four Burwood Hospital rehabilitation wards with the aim of reducing falls in hospitals. The programme does this by (a) providing education to patients about their risk of falls while they are in hospital and (b) undertaking a goal setting process with them where they identify the specific areas that they are most at risk, and then developing strategies to manage these risks. BAIL has been working with the CDHB to evaluate how effective the Safe Recovery Programme has been at reducing falls and injuries as a result of falls.
Key CDHB staff involved:
- Benn Dickie (physiotherapist)
- Rachel Marshall (nurse)
- Dr Sarah Hurring
- Dr Helen Skinner
- Burwood volunteers
Why was the Safe Recovery Programme piloted?
The Older Persons Health Specialist Service (OPHSS) based at Burwood Hospital has a high rate of falls with between 20-30% of all patients falling during an admission. Despite considerable effort by falls prevention groups, management and ward staff, fall rates have changed by only 10-15% over nearly 20 years. When management saw how effective the Safe Recovery Programme has been in Australia they decided that it was important to pilot it within Burwood between August and November 2018, and to then evaluate how effective it has been.
What is the Safe Recovery and how does it work?
The Safe Recovery Programme was developed in Perth, Australia, and was found to be effective at reducing the rates of falls of inpatients reducing falls by 40%, fall related injuries by 35% and numbers of fallers by 45% in eight rehabilitation units in general hospitals within Australia (Hill, McPhail, Waldron et al, 2015).
Typical falls prevention programmes focus on changing staff behaviours (e.g., more regularly checking on patients) and implementing ward risk-minimisation practices (e.g., not using bed rails). In contrast, the Safe Recovery Programme uses patient education, individualised goal-setting, and feedback to staff as key components of the ‘Safe Recovery’ programme. The programme uses a range of formats (i.e., DVD, patient workbook and 1:1 sessions) to:
- educate patients about their risk of falling, and personalising this risk
- motivating them to mitigate this risk
- getting them involved in or engaged in their own falls prevention strategies.
Staff training involves teaching them about the falls prevention strategies used within the Safe Recovery Programme, and encouraging them to positively reinforce the messages with patients. Patients also encouraged to speak up and proactively seek help from staff and encourage staff to carry out the prevention strategies.
What differences were made to the Safe Recovery Programme when it was implemented at Burwood?
Most of the key components of the original programme have stayed the same in the Burwood setting, including use of the same training and implementation resources such as videos and workbooks. However, there were some key changes in how the Safe Recovery Programme was implemented. These include:
- volunteers to deliver the educational component of the programme
- wall posters to display the patient’s own goals – visible to the patients and the staff
What did the evaluation involve?
We adopted a realist research approach to undertake this evaluation, using a mix of research methods to collect a broad range of data exploring to what extent the Safe Recovery Programme reduced falls, how it may have worked (or not), and what aspects of the Burwood context influenced the way it was delivered and how effective it was.
The evaluation aimed to:
- Determine to what extent implementation of the SRP pilot reduced the rate of falls, injuries as a result of falling and the number of fallers
- Evaluate whether the SRP worked, for whom it worked (or not), and what the key mechanisms of action were in leading to its effects, by exploring the views of patients, staff and volunteers on the experience of the falls programme.
- Make recommendations about the ongoing provision of a Safe Recovery Programme within the Older Persons Health Specialist Service at Burwood Hospital
- Contribute to the ongoing development of Safe Recovery Programme internationally through theory development and by exploring how contextual factors might impact on implementation effectiveness.
What are the results?
These are still being analysed … and will be added here as they come to hand!