Falling short on implementation of fall prevention guidelines in health services: a systematic review with meta-analysis.

BACKGROUND: Falls are a serious risk for people who use health services. We aimed to evaluate the implementation of fall prevention guidelines in health services. METHODS: Databases and grey literature were searched for studies of the implementation of fall prevention guidelines in health services. Implementation outcomes were aligned with the reach, effectiveness, adoption, implementation and maintenance framework. The methodological quality of included papers was assessed using an internal validity checklist. Results were synthesised using narrative synthesis and meta-analysis. The certainty of evidence of each meta-analysis was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS: Fifty-five studies of over 115 000 patients implemented recommendations from 14 fall prevention guidelines. Methodological quality was generally poor (median of 5 of 13 internal validity criteria). Median reach of guideline implementation was 64% (range 38%-96%, five studies). Meta-analysis provided low certainty evidence that implementing guidelines did not prevent falls [falls risk ratio 1.01, 95% confidence interval (CI) = 0.81-1.26; falls rate ratio 1.06, 95% CI = 0.77-1.46]. Adoption of fall prevention recommendations by health professionals improved in 87% of recorded outcomes across 43 studies and was maintained 50% of the time. Adherence of patients to recommendations, however, varied from 7% to 73%. Two studies assessed maintenance of reduced falls percentage or rates and found that changes were sustained. CONCLUSION: Implementation of fall prevention guidelines in health services can change and sometimes sustain fall prevention behaviour of health professionals. It is uncertain whether implementation leads to reduced falls or changes in patient behaviour.