Adoption of a Patient-Tailored Fall Prevention Program in Academic Health Systems: A Qualitative Study of Barriers and Facilitators

Falls represent a persistent and costly patient safety issue. Fall TIPS (Tailored Interventions for Patient Safety) is a patient-centered and clinical decision-supported, fall prevention program that has led to fewer falls and related injuries among hospitalized patients. We aimed to identify dominant facilitators and barriers to Fall TIPS adoption. This multisite qualitative study was conducted in 11 hospitals representing three academic health systems, where Fall TIPS had been implemented for at least one year. Interviews with 50 patients and focus groups with 71 staff were analyzed using a conventional content analysis. Fall TIPS resulted in a partnership between staff and patients, in which fall prevention interventions were patient-specific and enabled by clinical decision support. We identified three facilitators to program adoption. First, staff were motivated to address falls as staff recognized fall prevention as a priority and the limitations of previous fall prevention programs. Second, patients welcomed their role in fall prevention. Third, Fall TIPS was integrated into existing staff workflows. We identified three dominant barriers to program adoption. First, poor engagement practices among staff limited patients’ active participation in fall prevention. Second, the use of residual fall prevention approaches perpetuated a ‘one-size fits all’ approach to fall prevention. Third, patient willfulness i.e., patients’ conscious deviation from fall plans challenged program fidelity. Fall TIPS changed the paradigm of fall prevention by placing an unprecedented focus on patient engagement. Actions that improve staffs’ engagement of patients and patient’s partnership in fall prevention will assist Fall TIPS adoption.