Implementation and Impact of a Lifting Cushion for Care Home Residents Who Have Fallen.

Abstract

Falls are a global public health problem and the second leading cause of death from unintentional injury. Globally, approximately 30%-50% of people living in nursing or residential care homes fall each year. Falls have an impact on quality of life and morbidity. Prevention of falls is gold standard care. When falls do occur, implementation of safe strategies to help the person rise is required. Structured risk assessment and the use of a 'lifting' cushion are one such strategy. To evaluate the impact of the lifting cushion on management of falls and assess barriers and facilitators to staff use of the lifting cushion in 18 care homes. Two-phase study involving (i) capturing quantitative pre- and post-cushion implementation data along with comparison of means testing and (ii) theoretically underpinned qualitative semi-structured interviews to explore barriers and facilitators to cushion implementation with inductive and deductive data analysis. The cushion was used a total of 32 times out of 567 post-implementation recorded falls (6% of all falls). Barriers and facilitators to cushion use aligned to the Theoretical Domains Framework include knowledge, skills and confidence, emotion, beliefs about safety and decision processes, environmental context and resources and social influences. The lifting cushion was poorly adopted. Identified barriers to adoption would not be addressed using routine train and cascade processes. We identified facilitators that could be enhanced to promote uptake. Theoretically underpinned implementation strategies, tailored to assess determinants, are known to be more effective; however, this approach has rarely been used in care homes. We have demonstrated a structured approach to implementation of cushion use; this may be transferable to other care home practices. Cae home leaders should be aware that giving information alone will not change practice. Implementation or improvement strategies will be more effective.