FinCH Implementation Study
Research type
Research Study
Full title
Implementation of the ACTiON FALLS prevention programme (formally GtACH) into UK care homes
IRAS ID
310091
Contact name
Pip Logan
Contact email
Sponsor organisation
University of Nottingham
Clinicaltrials.gov Identifier
0000, 0000
Duration of Study in the UK
1 years, 8 months, 18 days
Research summary
Summary of Research
People who live in care homes are at great risk of falling. Falls are common, harmful, costly, and difficult to prevent. The ACTiON Falls programme (formally GtACH) trains and supports care home staff to identify the reasons why residents fall and then guides them to complete actions to reduce falls. In a large multicentre randomised controlled trial called the FinCH trial, the ACTiON falls programme was cost-effective and reduced falls by 43%. Therefore, the benefits of the ACTION FALLS programme have already been demonstrated, and the aim of this study is to examine what helps and what hinders its implementation.
We are working with four regions – East Midlands, West Midlands, South London and the North-East - to develop and research ideas about how to put the ACTiON falls programme into use nationwide.
We will find out about what helps and hinders the ACXTiON falls programme being implemented in three ways:
• ACTiON Collaboration Events (also known as Quality Improvement Collaboratives) will bring care home and healthcare staff together to develop and research ways to implement ACTiON falls.
• Site teams are implementing ACTiON falls in up to 20 care homes per region (60 in total). Data from all homes and residents (about 2000 residents) will tell us the extent to which ACTiON falls has had an impact within the homes.
• Working with care homes, we will develop materials used in the ACTiON falls programme; a ‘return on investment’ calculator, the implementation package, and a ‘how to’ guide for establishing Communities of Practice to deliver and sustain ACTiON falls use across regions.
The study is also considering the work that people do in managing falls and whether ACTiON falls becomes routine practice. To do this we are using an approach to talking to people in care homes called Normalisation Process Theory (NPT) which will help us to think about things which help or hinder the adoption of ACTiON falls.
This study has been developed in collaboration with care home managers, care home staff, NHS clinicians and our active Patient, Public, Involvement (PPI) group.Summary of Results
Older people living in care homes are more likely to fall due to frailty, mobility problems, or memory loss. Falls can cause serious injuries, distress, and loss of confidence. Preventing falls in care homes is a public health priority.
Action Falls (previously called GtACH) is a programme designed to help care-home staff reduce falls. It includes:
• Training for all staff and support from a trained falls lead
• A multicomponent checklist to identify falls risks for each individual resident
• Posters, manuals, and a guide to prevention strategies.In a previous research trial, Action Falls reduced falls by 43% and was found to be cost-effective.
About the Study (FinCH Implementation Study – FinCHimp) This study explored how care homes used Action Falls in real-world settings, outside of a trial. We wanted to understand what helps or hinders implementation and whether care homes could reliably collect falls data themselves.
We worked with 60 care homes across four regions in England. Each home received free Action Falls training and support from local healthcare professionals known as Falls Leads.
We asked homes to:
• Send staff to training sessions,
• Collect and share monthly falls data (before and after training),
• Complete surveys on confidence and readiness,
• Join local “Collaborative” meetings to share experiences.We also interviewed 54 staff from 24 homes, across various roles, to hear in depth how Action Falls worked in practice. Their experiences were analysed using a framework called Normalisation Process Theory—a tool for understanding how new ways of working become part of daily routine.
What We Found
• 57 homes completed the study.
• 1,657 staff from 50 homes took part in training (60% uptake).
• Most homes (88%) regularly submitted falls data.
• The average falls rate was around 2.5 falls per resident per year, similar to past findings.
• Staff who completed training reported higher confidence and greater engagement than those who didn’t.Staff Experiences: What Helped and What Got in the Way What Helped:
• Interactive training sessions increased staff knowledge and confidence.
• Involving all staff—care and non-care roles—encouraged shared responsibility.
• Ongoing support from Falls Leads helped keep the programme visible and active.What Got in the Way:
• Staff shortages and turnover made training access difficult.
• Some care homes had already moved to digital care systems and were reluctant to use paper Checklists or digital checklists which were separate form their integrated system.
• Staff wanted NHS or CQC endorsement to justify replacing existing tools with Action Falls.Findings from Interviews: Using Action Falls in Everyday Practice
1. Understanding the Need: Most homes already had some falls prevention processes, but Action Falls was seen as more thorough.
2. Staff Engagement: Training all staff was positively received. However, responsibility for using the Checklist varied. Support from management was crucial to maintaining focus.
3. Making It Work: Training was considered the easy part—putting it into everyday use was harder. Many staff needed more support after the training.
4. Assessing Success: Staff viewed training as successful, but the paper-based Checklist was too complex and outdated. Most homes now use digital systems.Conclusion
Care-home staff are motivated to reduce falls and found Action Falls helpful, especially the training. Most homes were able to collect data consistently and were open to using the programme.
To make Action Falls work in today’s care homes, it should:
• Be fully integrated into digital care systems,
• Be simplified and aligned with existing processes,
• Be backed by ongoing local support (e.g. from Falls Leads).
This study shows that Action Falls can be used outside of a trial, but successful implementation requires time, support, and integration with modern care-home systems.REC name
East Midlands - Derby Research Ethics Committee
REC reference
22/EM/0035
Date of REC Opinion
14 Feb 2022
REC opinion
Further Information Favourable Opinion