Antecedentes y Escenario Actual en Dinámica No Linear

1.7.1 Overview

Figure 1.1 provides a step-by-step overview of how to use the guidelines to prevent falls and falls injuries in older people in Australian hospitals, in the context of consumer involvement. It is split into two

linked sections:

• The bold arrows in the outer circle represent the strategic level. This is a 15-step approach in three sections – plan a falls and falls injury prevention program

– implement a falls and falls injuries prevention program – evaluate a falls and falls injuries prevention program.

• The inner circle represents interventions that can be applied at the point of care (that is, the site of patient care). A best practice approach of individualised assessment followed by targeted,

individualised interventions is presented in Parts B to D of the guidelines (Standard falls prevention strategies, Management strategies for common falls risk factors and Minimising injuries from falls).

Pa rt A In tro du cti on Invol ve the

patient and their_care rs E ns ure sta nda rdfal

ls prevention st_ra

t_e gie s a_r e _in p la ce Conduct individualised assessment

Implement targeted, individualised fall and injury prevention

interventions Review and monitor Evaluate Implement Plan

Plan

Plan for implementation

Step 1: Identify teams

Step 2: Identify, consult, analyse and engage key stakeholders

Step 3: Assess organisational readiness Step 4: Analyse falls

Plan for evaluation

Step 5: Establish a baseline

Plan for quality improvement

Step 6: Review current clinical practice

Implement

Step 7: Decide on implementation approaches Step 8: Determine process for implementation Step 9: Conduct trial

Step 10: Learn from trial

Step 11: Proceed to widespread implementation for improvement

Step 12: Sustain implementation

Evaluate

Step 13: Measure process Step 14: Measure outcomes

Pa rt A In tro du cti on

1.7.2 How the guidelines are presented

The guidelines are presented in five parts: • Part A — Introduction

• Part B — Standard falls prevention strategies

– single and multiple falls prevention interventions – falls risk screening and assessment

• Part C — Management strategies for common falls risk factors

– strategies for managing common risk factors – 11 specific assessments and interventions • Part D — Minimising injuries from falls

– hip protectors

– vitamin D and calcium supplementation – osteoporosis management

• Part E — Responding to falls.

For ease of reference, Parts C and D consider each falls risk factor and assessment or intervention

in separate chapters. However, these interventions are generally most successful when used in combination. Interventions and assessments to minimise falls risk factors are discussed first (Part C), followed

by interventions to minimise harm from falls (Part D). This does not imply importance of one chapter over another.

Health care professionals and carers should consider the advantages and risks of using injury-prevention

strategies, as outlined in Part D, to give older people in the hospital setting extra protection from falls and

related injury. These strategies can be used after a fall or applied systematically to the population at risk. Chapters on intrinsic and extrinsic risk factors in Parts C and D begin with a set of evidence based

recommendations (assessment or intervention, or both, as appropriate). The supporting information for these recommendations is presented in the remainder of the chapter, which is organised into:

• background information — contains an overview of the risk factor or intervention, and a summary

of the relevant literature on clinical trials

• principles of care — explains how to implement the intervention of interest

• special considerations — provides information relevant to specific groups (eg Indigenous and culturally

and linguistically diverse groups, rural and remote populations, people with cognitive impairment)

Pa rt A In tro du cti on

The guidelines contain text boxes for important information, as outlined below.

Evidence based recommendations

• Evidence based recommendations are presented in boxes at the start of each section,

accompanied by references. They were selected based on the best evidence and accepted by the project’s expert advisory group and external quality reviewers.

• Where possible, separate recommendations for assessment and interventions are given.

Assessment recommendations have been developed by the expert group based on current practice and a review of the literature discussed in the text of each section.

• Intervention recommendations are based on a review of the research on the use of the intervention. Each recommendation is accompanied by a reference to the highest

quality study upon which it is based, as well as a level of evidence (see Section 1.4.3 for

an explanation of levels of evidence).

Recommendations based on evidence nearer the I end of the scale should be implemented,

whereas recommendations based on evidence nearer the IV end of the scale should

be considered for implementation on a case-by-case basis, taking into account the individual

circumstances of the patient.

Good practice points

Good practice points have been developed for practice where there have not been any studies; for example, where there are no studies assessing a particular intervention, or where there are no studies specific to a particular setting. In these cases, good practice is based on clinical

experience or expert consensus.