Implementatie van valpreventie in woonzorgcentra · Effectiveness of fall prevention strategies -...
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Implementatie van valpreventie in woonzorgcentra Landelijk Valsymposium 2019 Ellen Vlaeyen, RN, PhD
Transcript of Implementatie van valpreventie in woonzorgcentra · Effectiveness of fall prevention strategies -...
Implementatie van valpreventie
in woonzorgcentra
Landelijk Valsymposium 2019
Ellen Vlaeyen, RN, PhD
19 minutes: 1 older person
dies
11 seconds: 1 older person
admitted to emergency department
1 second: 1 older person
falls
Prevalence & consequences of fall incidents
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Fall risk: nursing home residents > community setting
± 1 ± 1800 ± 164
(www.cdc.gov/homeandrecreationalsafety/falls/, Tinetti et al. N Engl J
Med; 1997;337:1279)
Effectiveness of fall prevention strategies
- Systematic review & meta-analysis - 13 studies
- 22,915 nursing home residents - Follow-up period: 6 - 17 months
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
4
7 2
(Image courtesy of https://giving-evidence.com/
Vlaeyen et al. JAGS 2015;63:211)
Fall prevention strategies: multifactorial programs
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Individual profile
>1 >1
Screening Assessment Interventions Follow-up
Multidisciplinary team (Lamb et al. Trials 2011;12:125,
Vlaeyen et al. JAGS 2015;63:211)
Fall prevention strategies: multifactorial programs
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Individual profile
>1 >1
- No effect on fallers
- 33% falls
- 21% recurrent fallers (Lamb et al. Trials 2011;12:125,
Vlaeyen et al. JAGS 2015;63:211, Milisen et al. Leuven, Acco; 2012)
In theory, there is no difference between theory and practice. But in practice, there is… (Manfred Eigen)
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
(Image courtesy of https://imgur.com/gallery/)
Fall prevention behavior of staff: Integrative Model Behavioral Prediction
NORMS
SELF-EFFICACY
ATTITUDES
INTENTION
SKILLS & ABILITIES
BARRIERS
BEHAVIOR Performing fall
prevention
Individual level (n = 1896)
Ward level (n = 397)
Nursing home level (n = 165)
(Fishbein. Med Decis Making 2008;28:834,Fishbein & Ajzen. New York, Psychology Press; 2010)
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Fall prevention behavior of staff
Attitude towards fall prevention
Fall prevention
behavior
Self-efficacy
Social norms
Work hours per week
Experience in nursing home setting
compared to
(Vlaeyen et al. To be submitted)
Barriers & facilitators influencing implementation
8 studies
44 factors influencing implementation
5 3
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
(Image courtesy of https://giving-evidence.com/
Vlaeyen et al. IJNS 2017;70:110)
17 facilitators Innovation Individual professional Resident & family
- Good credibility - Promote evidence-based practice - Provide tools for implementation
- Raising awareness and interest - Understands causes of falls - Staff motivated to learn and use skills regularly
NONE
Social context Context organization Economical & political
- Good communication - Staff involvement & empowerment - Teamwork & shared responsibility - Presence of clinical leaders - Leaders who support staff
-More facility equipment - Fall prevention as priority - Better educational structures - Structure for quality improvement - Safety structure
- Corporate or state mandate
(Vlaeyen et al. IJNS 2017;70:110)
27 barriers Innovation Individual professional Resident & family
- Too difficult - Not context specific - Too long - Not user-friendly - No measurable outcome
- Feeling helpless/frustrated - Lack of knowledge & skills - Negative beliefs & attitudes - Low awareness of problem
- Conflicting expectations & goals - Noncompliance - Resident boredom
Social context Context organization Economical & political
- Poor communication - Lower buy-in - No focus on quality improvement - Taking up leadership would add to work load too much
- Lack of time or staff - Lack of equipment - Other tasks higher priority - Low attention for quality improvement - Less attention for education - Lower structural support - Workload
- Regulations restricting access to care plans - Lower reimbursement - Corporate or state mandate if initiated unexpectedly
(Vlaeyen et al. IJNS 2017;70:110)
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Implementing a fall prevention guideline
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Multifactorial & multidisciplinary Flemish guideline
1) Fall prevention at nursing home level
2) Fall prevention at individual resident level
3) Fracture prevention
4) Follow-up
Multifaceted implementation plan that takes into account the local context
(Milisen et al. Leuven, Acco; 2012, Vlaeyen et al., to be submitted)
PHASE 1
PRE-IMPLEMENATION (planning)
PHASE 2
IMPLEMENTATION (execution)
PHASE 3
POST-IMPLEMENTATION
(Evaluation & sustainability)
Implementing a fall prevention guideline
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
STAP 1
STAP 2
STAP 5
STAP 6
STAP 7
STAP 3
STAP 4
1) Implementation traject planner
Implementing a fall prevention guideline
2) KEEP – STOP – START method
Implementing a fall prevention guideline
(Movie courtesy of nursing home “Leiehome”)
3) Share success stories e.g. reduction of medication
Implementing a fall prevention guideline
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
- Implementation plan: www.valpreventie.be
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
- Implementation study: 6 NH
- Data collected at baseline & after min. 11 months follow-up
- Sample: 709 measurements in 571 subjects
PRE: n=424 measurements
POST: n=285 measurements
Adjusted for person effect
- Follow-up: 20 months (range: 11-24)
Implementing a fall prevention guideline
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Variable PRE POST P-value
Attitude 5,55 (±1,00) 5,86 (±0,89) p<0,001
Norms 4,54(±1,23) 4,76 (±1,25) p=0,008
Self-efficacy 4,70 (±1,22) 4,96 (±1,16) p=0,001
Knowledge 69,38% (±14,38%) 76,13% (±13,44%) p<0,001
Intention 5,43 (±1,32) 5,65 (±1,29) p=0,048
Barriers 1,58 (±0,55) 1,48 (±0,61) p=0,002
Behavior Reference (OR 1) OR 3,34 p<0,001
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Conclusion: insights & recommendations
Only multifactorial interventions provided by a multidisciplinary team can reduce falls and the number of recurrent fallers keeping in mind theory & practice
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Conclusion: insights & recommendations
To further optimize uptake of the guideline the complex interaction of facilitators & barriers should be taken into
account own context
INTRO PART 3
IMPLEMENTATION PART 1
EFFECTIVENESS PART 2
VIEWS & PRACTICES CONCLUSION
Acknowledgements Co-workers Centre of Expertise for falls & fracture prevention Flanders
Joris Poels
Coordinator
Julie Meurrens
Prof. dr. Koen Milisen
Chair
Sien Valy
Sara Vandervelde
Sarah Vandekerkhof
