Every time an older person falls in a care home, a patchwork of different organisations—care home staff, ambulance crews, GPs, and urgent care teams—must decide what happens next, often with no consistent national guidance to follow. This matters because falls are the most common reason older care home residents are admitted to hospital, yet the decision-making process immediately after a fall is fragmented. Organisational policies and cultures differ across the ambulance service, primary care, and acute providers, creating inconsistent care and unnecessary hospital visits. There is currently no agreed set of principles to guide post-falls management across these groups. If this research succeeds, it will produce the first consensus-based principles for post-falls management in care homes. These principles could reduce avoidable hospital admissions and improve the immediate care experience for residents and their relatives. The project also builds research capacity among Allied Health Professionals, who will co-design the work. The researchers will map current processes, analyse care records from 15 residents, interview up to 20 stakeholders, and use a Delphi method to reach agreement on what the principles should contain.
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Research question What should be included in principles for post-falls management for older people who fall in care homes? Background Falls are common and distressing for older people living in care homes. They are costly for health and social care systems as a common reason for hospital admissions from care homes. Numerous organisations across the Integrated Care System (ICS) are involved in post-falls management in care homes including care home staff, urgent care response teams, primary care teams, ambulance services and acute providers. Our previous research suggests that differences in organisational policies and cultures across settings affects collaborative post-falls decision-making and creates challenges to delivering a consistent approach. There is a lack of consistent national guidance on post-falls management in care home settings. This exploratory phase seeks to develop principles as a first step towards investigating whether consistent principles of post-falls management reduce hospital admissions and improve care experiences immediately after an older person falls in a care home. Aims and Objectives Aim: to develop principles to support consistent post-falls management immediately following a fall for older people in care homes Objectives: To map current post-falls management processes for older people who fall in care homes To explore factors affecting cross-organisational decision-making immediately after a fall in a care home To develop a consensus on principles for consistent post-falls management in care homes. Methods Mixed methods approach using a sequential exploratory design. Four work packages, underpinned by the Behaviour Change Wheel as a theoretical framework, are included: Online national survey to map post-falls management processes and identify barriers and facilitators to cross-organisational decision-making. Individuals employed by care homes and health and social care organisations across England will be recruited using existing networks and contacts. Retrospective patient journey mapping to understand decision-making processes immediately after care home residents fall. Data will be collected from care records of 15 residents in 4 Nottinghamshire care homes to produce a summary patient journey. Semi-structured interviews with up to 20 stakeholders involved in post-falls management to explore different perspectives on factors affecting post-falls decision-making and key areas for inclusion in the principles. Stakeholders will include residents, relatives, care home staff and professionals from health organisations Online Delphi method to develop a consensus on principles for post-falls management in care home settings. Recruitment will include five areas of expertise (care home staff and professionals from primary, community, emergency, and acute settings in England). Timelines for delivery Duration: 24 months Anticipated Impact and Dissemination The principles will support availability of consistent guidance and awareness of post-falls management across organisations. We will use our findings to plan and conduct a study to evaluate whether implementation of the principles reduces hospital admissions and improves resident or relative experiences of care. The research will build research capacity by developing the experience and skills of Allied Health Professionals (AHPs) as co-applicants. The principles will be disseminated in a range of formats for different audiences. Findings will be disseminated by journal publications and presentation at international research conferences and local events.
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