Falls in Care Homes (FinCH) 

In 2002 Rushcliffe Primary Care Trust, which provided rehabilitation services across Nottinghamshire started a Falls Prevention Group which met four times a year. The group had a broad membership from Health, Social Care, Local Authorities and University of Nottingham. Alongside implementing the National Service Framework for Older People, they developed a Falls Care Pathway which provided local services with an easy mechanism for referring clients for a falls assessment and treatment programme, used by health and social care services, the fire service, ambulance service, warden aided complexes and care homes.  The group were particularly keen to build an evidence-based culture for staff and clients and recognised they were in a perfect place to complete rigorous and useful research.

In 2005 the group created a falls screening and action checklist, training programme, support structure and manual to aid this process, based on literature searches and developed with practitioners, which they called the Guide to Action to Prevent Falls (GtA). They went on to test its sensitivity, validity, reliability, and ease of use with a Trent Focus Group Research Development Support Grant. The results were presented at conferences and published in the 2010 paper Thinking Falls and Taking Action. This community dwelling version of GtA was endorsed by NHS services: staff were trained, the manual was produced, the support structure was put in place and the systematic checklist was integrated into SystmOne  (software used for electronic patient records across primary care) to aid its implementation. 

Recognising that falls prevention in care homes was lacking in research evidence and the Cochrane reviews at the time indicated that more research was needed, the group developed a care home version of the training package, manual, checklist and support structure (the Guide to Action to prevent falls in Care Homes (GtACH) published in 2012).  

The feasibility of the application of this co-created programme was proven in the 2013 study called Falls In Care Homes study (FICH) funded by the National Institute for Health Research (NIHR) through their Research for Patient Benefit (RfPB) scheme and published in The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes paper.  

In 2015, the application of GtACH was evaluated in the largest care home study in the UK in a trial with embedded process evaluation and cost effectiveness component, called the Falls in Care Homes (FinCH) funded by NIHR Health Technology Assessment scheme. This study, which finished in 2019, highlighted that use of the GtACH was both clinically and cost effective, feasible to be delivered and valued by its users and participants. A website and paper titled: Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation provide more details. 

The success of the GtACH led to the NIHR Applied Research Collaboration – East Midlands (ARC-EM) funded the Nottingham team to prepare to implement the GtACH programme outside of formal research studies, and at scale. The 2019 study was called Falls in Care Homes Implementation Study for the East Midlands (FinCH Imp EM) and over the COVID pandemic period the team completed an update of the GtACH programme co-created with care home staff and residents, incorporating new literature, new formatting, new design and a digital version of the checklist. At this point GtACH changed names and became the Action Falls programme based in the data provided by care home staff, Falls leads and service commissioners. 

The impact of Action Falls and the expertise of the team led to them being invited by the East Midlands Patient Safety Collaborative to develop a website and APP. This was part of the local care home resources under the banner of the React to resources, and they produced the React to Falls resource.  Action Falls training includes how to use the React to Falls resources. 

In 2021 the National ARC funded a study to research implementation of Action Falls across England called the Implementation of the Action Falls prevention programme (formerly GtACH) into UK care homes (FinCH Imp Nat). This project researches the implementation of Actions Falls in four UK locations across 60 care homes.

• Set up four UK study sites by establishing teams of researchers, care homeowners and staff and falls leads.

• Train falls leads in each location in the Action Falls programme. They then train care home staff to deliver the Action Falls programme in 60 care homes. 

• Establish Action Falls Collaboratives (AFC) in each location, and explore the experiences of care home staff using the Action Falls Programme with residents, and the barriers and facilitators that influence implementation.

• Collect data on implementation of the Action Falls Programme from care home staff using the NOMAD questionnaire at two time points.  

• Collect field notes and observation data at the AFC events to understand the implementation of the Action Falls programme in the care homes and to evaluate the AFC method.   

• Complete interviews and focus groups with care home staff to explore use of the Action Falls programme. 

• Complete a focus group with all falls leads to explore the barriers and facilitators to training care home staff. 

• Collect monthly falls data from each home.

• Produce case studies at an individual resident, care home and regional level, of how the Action Falls programme has impacted on outcomes.

• Produce guidance for care homes to self-monitor their falls rates. 

• Produce an Action Falls “adopt and spread” toolkit for use in additional sites.  

• Work with other stake holders explore how to drive the sustainability of the Action Falls programme in the real world.