Fall Prevention Practices Research Articles

Patient, Nurse, and Organizational Factors That Influence Evidence-Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study.

Hospital falls remain common despite decades of studies and guidelines to reduce their rate. Research evidence alone is insufficient, and integration of patient values and preferences, clinician expertise and experiences, and organizational culture is needed to ensure sustainable practice changes. Little is known about the best strategies for integrating these constructs to sustain effective fall prevention programs. Guided by the Comprehensive Framework for Implementation Research (CFIR), this study aimed to identify patient, nursing staff, and organizational-level factors that influence effective and sustainable fall prevention strategies with the goal of identifying variables amenable to targeted interventions. A descriptive research design engaged four oncology units in a Midwestern academic medical center and included patients (N=39) and nursing staff (N=70). Questionnaire data were collected from patients with interview assistance, and nursing staff completed a demographic form and two standardized instruments adapted for the study. Data were analyzed using descriptive statistics and narrative summaries. Findings indicated two-thirds of patients did not see themselves at risk for falling, despite nearly half having a fall history. Nursing staff indicated knowledge gaps related to specific known risks and interventions, and confidence in fall prevention management was lowest for team communication about patient risks and engaging patients and families in preventing falls. Engagement of patients in fall risk assessment and management, clear and routine communication among team members, and creating a culture of true engagement with appropriate leadership and resources can potentially improve the sustainability of successful fall prevention programs. The CFIR can guide the planning of fall prevention and other evidence-based practice changes to become hardwired and sustainable over time even with the ongoing introduction of new initiatives.

How Do General Practitioners (GPs) Engage in Falls Prevention With Older People? A Pilot Survey of GPs in NHS England Suggests a Gap in Routine Practice to Address Falls Prevention.

Falls are highly prevalent amongst older people and have substantial financial and social costs for health services and the community. Prevention of falls is the key to managing this threat to older people. General practitioners can identify older people at risk of falls on their caseloads. Once identified, actions can be taken to reduce the risk of falls by referring to appropriate services available in the community, such as allied health practitioners. However, the level of engagement in evidence based falls prevention by GPs is unknown. This study aimed to explore how British general practitioners (GPs) address falls prevention with older people, and to determine if there are any gaps in practice. As a pilot study, another aim was to test the feasibility of methods to survey GPs, if a larger survey was warranted from the findings. An on-line cross-sectional survey was distributed by email to all the Clinical Commissioning Groups in NHS England (n = 213) and individual general practices listed on the NHS Choices website, supplemented by invitations distributed to CCGs through Twitter and LinkedIn sites. Thirty-seven responses were received. Most GPs were unfamiliar with the 2013 NICE guidelines on assessment and prevention of falls in older people (51.4%, n = 19), and only 29.7% (n = 11) asked older people if they had fallen during consultations. If falls risk was identified, 81.1% (n = 30) frequently made referrals to physiotherapy (PT) and 56.8% (n = 21) to occupational therapy (OT). Most GPs did not identify older people on their caseloads as being at risk of falls unless they presented with a fall, and referral rates to relevant AHPs or falls prevention programs were low. Barriers to implementation of falls prevention best practice were identified. Alternative methods are needed to capture the falls prevention practice of a wider sample of GPs.

Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals.

Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.

The Experience and Perception of Physiotherapists in Nigeria re: Fall Prevention in Recurrent-Faller Older Adults

Background: Effective fall prevention practices are essential for reducing falls among older adults. Rehabilitation professionals like physiotherapists are essential members of the fall prevention team, yet little is known about the experiences of physiotherapists practicing fall prevention in developing nations. Objective: To explore the experiences of physiotherapists in Nigeria who practice fall prevention among older adults. Method: We adopted a phenomenological approach to the traditional qualitative design in this study. We purposefully selected and conducted face-to-face interview with twelve physiotherapists who have treated at least one older adult who reported falling two or three times within last six months. Data was analyzed using thematic analysis. Results: Four themes emerged from our participants: characteristics of recurrent fallers, fall prevention practices, hindrances to fall prevention, and strategies to promote fall prevention practices. In practice, understanding the characteristics (risk factors) of older adults with a history of recurrent falls is important for effective fall prevention practices among physiotherapists. Among other characteristics, our participants believed that older adults who have patronized “traditional bone setters/healer” are at the higher risk of having multiple falls. Conclusion: This study adds to the sparse amount of literature concerning the experience of physiotherapist in fall prevention practices in the developing world. More importantly, the findings of this study will strengthen or stimulate discussion around development of fall prevention strategies specific to the developing world context.

Knowledge, Behavioral Practices, and Experiences of Outdoor Fallers: Considerations for Prevention Programs

Abstract Date Presented 4/19/2018 Using a mixed methods design, we examined knowledge of outdoor fall risks, outdoor fall experiences, and fall prevention practices among a random sample of 85 community-dwelling older adults who had sustained an outdoor fall. Results are informative for outdoor fall prevention practice. Primary Author and Speaker: Tracy Chippendale Contributing Authors: Victoria Raveis

Health Practitioners' Perceptions of Falls and Fall Prevention in Older People: A Metasynthesis.

Fall prevention has received a great deal of consideration and funding, however fall rates have not reduced accordingly. Health practitioners are key stakeholders in the process of implementing fall prevention evidence into their clinical assessment and management of older people at risk of falling. Investigating health practitioners' clinical experiences and perceptions has been identified as a means to enhance the translation of knowledge. Four databases were searched for studies exploring health practitioners' perceptions of falls and fall prevention. A metasynthesis of eight qualitative studies was conducted. The findings suggest that health practitioners face substantial barriers in the implementation of fall prevention practices. These include personal, interpersonal, and clinical barriers in addition to limitations of the research evidence. This knowledge hopes to enhance targeted dissemination of knowledge, reducing the research-practice gap and improving clinical outcomes for older people at risk of falls.

Older adult fall prevention practices among primary care providers at accountable care organizations: A pilot study.

BackgroundFalls are a serious and common problem among older adults. Low-tech, inexpensive, community-based fall prevention programs have been shown to be both effective and cost effective, however, these programs are not well-integrated into clinical practice.Research designWe surveyed primary care providers at a convenience sample of two accountable care organizations in Massachusetts to assess their beliefs, attitudes, knowledge, and practices relative to fall risk assessment and intervention for their older patients.ResultsResponse rate was 71%. Providers’ beliefs about the efficacy of fall risk assessment and intervention were mixed. Eighty-seven percent believed that they could be effective in reducing fall risk among their older adult patients. Ninety-six percent believed that all older adults should be assessed for fall risk; and, 85% believed that this assessment would identify fall risk factors that could be modified. Nonetheless, only 52% believed that they had the expertise to conduct fall risk assessment and only 68% believed that assessing older adult patients for fall risk was the prevailing standard of practice among their peer providers. Although most providers believed it likely that an evidence-based program could reduce fall risk among their patients, only 14% were aware of the Centers for Disease Control and Prevention’s fall risk assessment algorithm (STEADI Toolkit), and only 15% were familiar with Matter of Balance, the most widely disseminated community fall risk prevention program in Massachusetts.DiscussionNew strategies that more directly target providers are needed to accelerate integration of fall risk assessment and intervention into primary care practice.

Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health.

To examine the views and suggestions of healthcare professionals, patients and family members on the causes of inpatient falls and fall-prevention practices. Patient falls are one of the most prevalent medical errors in the hospitals. In order to prevent patient falls, it is necessary to identify and classify the situations causing falls in detail and preventive interventions for these situations need to be developed. The study was designed using a descriptive qualitative research method. The semi-structured interviews were conducted with four physicians, four charge nurses, 12 nurses, four support staff members, eight patients and eight family members of patients in the palliative, internal disease, surgery and orthopaedic clinics in a training and research hospital between March 2017-May 2017. Thematic analysis method was used to analyse data. The defined themes were classified based on the International Classification of Functioning, Disability and Health Core Set for Falls in Acute Rehabilitation Settings. In this research, 71 themes related to situations causing falls and 30 themes related to prevention interventions were determined. Defined themes were linked with 44 categories under five International Classification of Functioning, Disability and Health domains and organised accordingly. Among the categories included in the International Classification of Functioning, Disability and Health Core Set for Falls in Acute Rehabilitation Settings, 65% were verified, while 22 new categories that were not included in the original core set were defined. In accordance with this result, evaluating the opinions of all stakeholders on the research and development of fall-prevention programmes will increase the effectiveness of fall prevention in hospitals. The ICF model can be used to classify the causes of falls and fall-prevention interventions to create a common language about this topic. To prevent falls, more detailed and useful information can be obtained by key stakeholders (all healthcare professionals, patient and patient family). ICF Core Set For Falls can be used to systematically classify causes of falls and fall-prevention interventions.

Fall prevention knowledge and practice patterns among home healthcare professionals in southern Saudi Arabia: an observational study.

ObjectivesTo determine the knowledge of falls risk factors among home healthcare (HHC) professionals and the practice patterns of HHC professionals regarding falls prevention.MethodsA modified version of a survey designed and validated for use in home healthcare settings was distributed to HHC professionals for self-completion. Responses were collected and analysed using descriptive methods.ResultsOut of 80 surveys distributed to 23 HHC centres, 52 returned surveys were included for analyses (completed by physicians, physical therapists [PTs] and nurses). In terms of practice patterns, 82.7% of participants always asked older adults if they have a history of falls, 81% always identified falls risk factors, 73% documented risk factors for falling and 71% always provided interventions to address falls risk factors. Environmental hazards were the most common risk factor identified by HHC professionals. Approximately one quarter of nurses felt they had little knowledge of falls risk factors.ConclusionOver 70% of HHC professionals acknowledged the importance of falls, and over 80% of participants displayed knowledge of falls prevention factors. As HHC professionals most likely to encounter patients requiring intervention for falls prevention, physical therapists may benefit from training programmes to help identify important falls risk factors.

Making fall prevention routine in primary care practice: perspectives of allied health professionals

BackgroundWhile there is strong evidence that fall prevention interventions can prevent falls in people aged 65 and over, translating evidence into routine practice is challenging. Research regarding how allied health professionals (AHPs) respond to this challenge is limited. As part of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) project, this study aimed to explore how AHPs were making fall prevention practice routine in primary care and the factors that influenced their fall prevention practice.MethodsIn-depth qualitative interviews were conducted with fifteen AHPs who had attended evidence-based workshops associated with the iSOLVE project. AHPs had backgrounds in physiotherapy, occupational therapy, exercise physiology and podiatry. Interviews explored how fall prevention was being incorporated into routine practice and the factors that influenced routinisation, including the project workshops. Thematic analysis was used to analyse the data.ResultsWe found fall prevention was valued in practice and recognised as complex. AHPs worked through challenges relating to clients (multi-morbidity, complex living situations, client motivation), challenges working alongside other health professionals (understanding respective roles/overlapping roles, sense of competition, communication) and challenges associated with funding systems perceived as complicated and constantly changing. Despite these challenges, AHPs were adopting strategies for integrating fall prevention routinely. The iSOLVE workshops were perceived as important in supporting existing practice and in providing strategies to enhance practice.ConclusionsPolicy makers, program managers, educators and AHPs can adopt strategies identified in this research for routinising fall prevention such as being alert that falls are common, asking every client about falls, having processes for assessing clients for fall risk, and having structured and evidence-based programs to work with clients on fall prevention. Adapting and streamlining funding systems are also important for facilitating fall prevention work.

CE: Original Research: Exploring Clinicians' Perceptions About Sustaining an Evidence-Based Fall Prevention Program.

A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center. Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis. Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention. Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.

An evaluation of the fall prevention practice of community-based occupational therapists working in primary care

Introduction Occupational therapy in primary care settings in Australia is developing. This study aimed to examine current practice in preventing falls among older people living in the community prior to attending a home safety workshop; explore the outcomes of the workshop on fall prevention practice; and investigate self-reported changes in practice 3 months after the workshop. Method The 3-hour workshop was focused on evidence-based home safety interventions and was offered to occupational therapists providing community-based services in the Sydney North Primary Health Network area. Knowledge surveys were used immediately pre and post workshop, and practice surveys were collected data at baseline and at 3-month follow-up. Results Three workshops were run in 2015–2016, with a total of 40 occupational therapists. At follow-up, a positive impact on confidence and knowledge was reported. Less impact was observed on identifying and reducing an older person’s fall risk, and on fall prevention services provided and referrals received. Changes in practice were reported by 48% ( n = 16) of the 33 participants who returned surveys at 3 months. Conclusion These findings provide support for the benefit of professional development workshops to improve confidence and knowledge, but challenges remain in facilitating change in fall prevention service delivery. Further study on screening for fall risk and collaboration between community service providers in the primary care context is recommended.

Community service provider perceptions of implementing older adult fall prevention in Ontario, Canada: a qualitative study

BackgroundDespite evidence for effective fall prevention interventions, measurable reductions in older adult (≥ 65 years) fall rates remain unrealized. This study aimed to describe the perceived barriers to and effective strategies for the implementation of evidence-based fall prevention practices within and across diverse community organizations.This study is unique in that it included community service providers who are not generally thought to provide fall prevention services to older adults, such as retail business, community support, volunteer services, community foundations, recreation centres, and various emergency services.MethodsInterviews and focus groups were conducted with a purposive sampling of providers (n = 84) in varied roles within diverse community-based organizations across disparate geographical settings.ResultsCommunity service providers experience significant multi-level barriers to fall prevention within and across organizations and settings. The overall challenge of serving dispersed populations in adverse environmental conditions was heightened in northern rural areas. Barriers across the system, within organizations and among providers themselves emerged along themes of Limited Coordination of Communication, Restrictive Organizational Mandates and Policies, Insufficient Resources, and Beliefs about Aging and Falls. Participants perceived that Educating Providers, Working Together, and Changing Policies and Legislation were strategies that have worked or would work well in implementing fall prevention. An unintentional observation was made that several participants in this extremely varied sample identified expanded roles in fall prevention for themselves during the interview process.ConclusionsCommunity service providers experience disabling contexts for implementing fall prevention on many levels: their specific geography, their service systems, their organizations and themselves. A systemic lack of fit between the older adult and fall prevention services limits access, making fall prevention inaccessible, unaccommodating, unavailable, unaffordable, and unacceptable. Educating Providers, Working Together, and Changing Policies and Legislation offers promise to create more enabling contexts for community stakeholders, including those who do not initially see their work as preventing falls.

Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach

BackgroundFalls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice.MethodsA convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.).ResultsStaff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management.ConclusionsInterdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.

Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns.

Background and ObjectivesIn October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints.Research Design and MethodsUsing electronic medical record data collected from four hospitals between 2005 and 2010, this secondary observational analysis examined the associations between the CMS no-pay policy and nursing interventions and medical orders related to fall prevention. Multivariable generalized linear mixed models with logit link function and accommodation for matching was used to assess the associations between the CMS no-pay policy and nursing interventions and medical orders.ResultsAfter the CMS policy change, nurses were more likely to perform one or more fall-related interventions (adjusted odds ratio (aOR): 1.667; 95% confidence interval (CI): 1.097–2.534). Of the four prevention practices, the use of bed alarms (aOR: 2.343; 95% CI: 1.409–3.897) increased significantly after the CMS policy change.Discussion and ImplicationsThe CMS no-pay policy increased utilization of fall prevention strategies despite little evidence that these measures prevent falls.

An exploration of fall-related, psychosocial variables in people with multiple sclerosis who have fallen

Introduction Psychosocial contributors to fall risk for people with multiple sclerosis are often overlooked in falls prevention practice. This study explored several fall-related, psychosocial variables and their association with falls self-efficacy in a sample of people with multiple sclerosis reporting a fall. Method A cross-sectional, structured telephone survey was employed. The survey explored socio-demographics, multiple sclerosis characteristics, and fall-related psychosocial variables. Multiple linear regression was employed to investigate associations with Falls Efficacy Scale – International scores. Results The mean Falls Efficacy Scale – International score for 140 participants was 38.14(SD = 10.16), and the mean Falls Control Scale score was 5.38(SD = 2.22). Fear of falling was expressed by 129 (92%) participants, with 111 (79%) reporting associated activity curtailment. A regression model including six predictors explained 47% of the variance in the Falls Efficacy Scale – International scores. Results of the multiple linear regression showed that fear of falling, associated activity curtailment, balance interference, falls control, and health status were associated with falls self-efficacy. Conclusion Fear of falling and associated activity curtailment, low falls self-efficacy, and compromised falls control are common among people with multiple sclerosis who have fallen. These fall-related psychosocial variables are distinct and each warrants attention during assessment. Findings suggest that falls self-efficacy among people with multiple sclerosis who have fallen is a complex construct associated with physical and psychosocial factors.

THE 6-PACK PROGRAM TO DECREASE FALL INJURIES IN HOSPITALS: THE WORLDS LARGEST FALLS PREVENTION TRIAL

The nurse-led 6-PACK falls prevention program includes a fall-risk tool and individualised use of ‘falls alert’ signs; supervising patients in the bathroom; ensuring walking aids are within reach; a toileting regime; low-low beds; and bed/chair alarms. This RCT evaluated the effect of the 6-PACK on falls and fall injuries in 24 acute wards from six Australian hospitals compared to usual care over 12-months. Positive changes in falls prevention practice occurred following the introduction of the 6-PACK. During the RCT, there were 46,245 patient admissions, 1831 falls and 613 fall injuries. The rate of falls (IRR=1.04, 95% CI, 0.78 to 1.37) and fall injuries (IRR=0.96, 95% CI, 0.72 to 1.27) were similar in intervention and control wards. The findings are in accordance with previous studies, which together provide increasing evidence of no effect for falls prevention interventions in acute wards. Novel solutions to the issue of in-hospital falls are required.

Knowledge, behavioral practices, and experiences of outdoor fallers: Implications for prevention programs

ObjectiveAlthough the epidemiology and prevention of falls has been well studied, the focus has been on indoor rather than outdoor falls. Older adults’ knowledge of outdoor risk factors and their outdoor fall prevention practices have not been examined. To fill this gap, and to inform the development of a prevention program, we sought to explore the experiences and fall prevention knowledge and practices of older adults who had sustained an outdoor fall. MethodsA cross-sectional study using random digit telephone dialing was used to survey community dwelling seniors (N=120) across the five boroughs of New York City. We used the Outdoor Falls Questionnaire (OFQ), a valid and reliable tool as the survey instrument. Perceived outdoor fall risks, strategies used for prevention, and outdoor fall experiences were examined. SPSS version 21 was used for descriptive analysis of participant characteristics and to determine frequencies of perceived outdoor fall risks and strategies used for prevention. Phenomenological analysis was used with the qualitative data. Qualitative and quantitative data were analyzed separately and a mixed methods matrix was used to interpret and integrate the findings. ResultsAnalysis revealed diverse unmet education and training needs including the importance of using single vision glasses, understanding the fall risks associated with recreational areas and parking lots, safe outdoor walking strategies, safe carrying of items on level and uneven surfaces, as well as when walking up and down stairs, and safety in opening/closing doors. ConclusionsStudy findings are informative for outdoor fall prevention programs as well as practice.

Study of Individualization and Bias in Nursing Home Fall Prevention Practices.

Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias. Randomized factorial clinical vignette survey. Sixteen nursing homes in North Carolina. Nursing, rehabilitation, and social services staff (n = 433). Vignettes describing hypothetical residents were generated from a matrix of clinical and demographic characteristics. Resident age, race and gender were suggested by a photo. Participants completed up to four randomly assigned vignettes (n = 1615), rating the likelihood that 12 fall prevention activities would be used for the resident. Fixed and random effects mixed model analysis examined the impact of vignette resident characteristics and staff characteristics on four intervention categories. Staff reported a higher likelihood of fall prevention activities in all four categories for residents with a prior fall (0.2-0.5 points higher, 10 point scale, P < 0.05), but other risk factors did not affect scores. There was little evidence of individualization; only dementia increased the reported likelihood of environmental modification (0.3, P < 0.001, 95% CI 0.2-0.5). Individualization did not vary with staff licensure category or clinical experience. Registered nurses consistently reported higher likelihoods of all fall prevention activities than did licensed practical nurses, unlicensed staff and other professional staff (1.0-2.7 points, P < 0.001 to 0.005). There was a small degree of implicit racial bias; staff indicated that environmental modification would be less likely to occur in otherwise identical vignettes including a photo of a black rather than a white resident (-0.2 points, 95% CI -0.3 to -0.1). Nursing home staff report a standardized approach to fall prevention without individualization. We found a small impact from implicit racial bias that should be further explored.

Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design

BackgroundDespite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention.Methods/designThis protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates.DiscussionThe design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery.Trial registrationAustralian New Zealand Clinial Trials Registry ACTRN12615000401550