A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an Emergency Department

McEwan, Helen and Baker, Richard and Armstrong, Natalie and Banerjee, Jay (2018) A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an Emergency Department. International Journal of Emergency Medicine, 11 (33). pp. 1-9. ISSN 1865-1372

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Background: The National Institute for Health and Care Excellence (NICE) 2004 Falls guideline was developed to
improve the assessment and management of falls and prevention of future falls. However, adherence to the
guideline can be poor. As emergency departments (EDs) are usually consulted by older adults (aged 65 and over)
who experience a fall, they provide a setting in which assessments can be conducted or referrals made to more
appropriate settings.
The objective of this study was to investigate how falls are managed in EDs, reasons why guideline
recommendations are not always followed, and what happens instead.
Methods: The study involved two EDs. We undertook 27 episodes of observation of healthcare professional
interactions with patients aged 65 or over presenting with a fall, supported by review of the clinical records
of these interactions, and subsequently, 30 interviews with healthcare professionals. The qualitative analysis
used the framework approach.
Results: Various barriers and enablers (i.e. determinants of practice) influenced adherence at both EDs, including the
following: support from senior staff; education; cross-boundary care; definition of falls; communication; organisational
factors; and staffing.
Conclusions: A variety of factors influence adherence to the Falls guideline within an ED, and it may be difficult to
address all of them simultaneously. Simple interventions such as education and pro-formas are unlikely to
have substantial effects alone. However, taking advantage of the influence of senior staff on juniors could
enhance adherence. In addition, collaborative care with other NHS services offers a potential approach for
emergency practitioners to play a part in managing and preventing falls.
Keywords: Accidental falls, Emergency care systems, Emergency departments, Guidelines, Geriatrics, Qualitative

Item Type: Article
Identification Number: https://doi.org/10.1186/s12245-018-0192-9
25 June 2018Accepted
18 July 2018Published Online
Subjects: CAH04 - psychology > CAH04-01 - psychology > CAH04-01-01 - psychology (non-specific)
Divisions: Faculty of Business, Law and Social Sciences > School of Social Sciences > Dept. Psychology
Depositing User: Silvio Aldrovandi
Date Deposited: 03 Jul 2018 11:01
Last Modified: 03 Mar 2022 15:42
URI: https://www.open-access.bcu.ac.uk/id/eprint/6086

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