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Title: Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial.
Epworth Authors: Livingston, Patricia
Botti, Mari
Other Authors: Ayton, Darshini
Barker, Anna
Morello, Renata
Brand, Caroline
Talevski, Jason
Landgren, Fiona
Melhem, Mayer
Bian, Evelyn
Brauer, Sandra
Hill, Keith
Keywords: Falls
Falls Prevention
Prevention Interventions
6-PACK Falls Prevention Program
Acute Wards
Motivation Barriers
Motivation Enablers
Successful Implementation
Epworth/Deakin Centre for Clinical Nursing Research, Deakin University, Melbourne, Australia.
Issue Date: Feb-2017
Publisher: Public Library of Science
Citation: PLoS One. 2017 Feb 16;12(2):e0171932
Abstract: Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses; provision of equipment; audit, reminders and feedback; leadership and champions; and the provision of falls data is key to successful falls prevention program implementation in acute hospitals.
DOI: 10.1371/journal.pone.0171932
PubMed URL:
ISSN: 1932-6203
Journal Title: PLoS One
Type: Journal Article
Affiliated Organisations: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
Type of Clinical Study or Trial: Multicentre Studies
Appears in Collections:Health Administration

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