58 Chapter 3 Background Patient falls are the most reported adverse event in hospitals [1]. About 2% of hospitalized adults fall at least once during their admission. [2] Reported fall rates range from 1.4 to 18.2 falls per 1000 patient days, depending on type of hospital ward, country and patient factors [3, 4]. Falls lead to increased morbidity, mortality, and health care costs, [5] prompting health care organizations to prioritize fall prevention. [2, 6]. Most falls result from a combination of risk factors, which can be classified into two types a) intrinsic factors such as age, sex, and impaired mobility; and b) extrinsic factors such as lighting, floor surface, and teamwork [7, 8]. Fall prevention interventions (FPIs) can consist of single component interventions (e.g. exercise) or a combination of multiple interventions (e.g., exercise and medication review). Multiple interventions can be categorized into two groups: 1) multifactorial interventions, where the FPIs vary based on individual risk assessments; or 2) multiple-component interventions, where the same FPIs are provided to all patients [9]. Systematic reviews carried out in 2018 and 2022 determined that educating both patients and staff can lead to a decrease in hospital falls. Additionally, multifactorial interventions showed a tendency to lower fall rates, while the impact of exercise remains uncertain [7, 8]. Worldwide guidelines recommend performing a multifactorial fall risk assessment to choose multifactorial FPIs, [9] in addition a tailored education on fall prevention should be delivered to all hospitalized adults at risk of falling [9]. The extent of fall rate reduction is influenced not only by the effectiveness of FPIs but also by successful implementation of these strategies [10]. A previous systematic review by Hempel et al. on implementation strategies of FPIs in U.S. hospitals described a wide range of implementation strategies. Examples of the strategies used are: staff education, establishing teams, continuous quality improvement procedures. These strategies showed varying degrees of success, however, the documentation of the operationalization of these implementation strategies was limited [11] .Turner et al. conducted a cross-sectional survey study to assess the implementation of fall prevention practices in general U.S. hospitals, they recommend that future studies should prioritize assessing effectiveness of implementation strategies [12]. To thoroughly understand effectiveness of implementation strategies it is crucial to know how these strategies were operationalised. In 2013, Proctor and colleagues published recommendations for specifying and reporting implementation strategies [13]. These recommendations include seven prerequisites that should be specified for each implementation strategy: actor, action, action target, temporality, dose, implementation outcome affected, and justification. By outlining these prerequisites,
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