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Table 5 Determinants of practice and their amenability for change

From: A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department

Determinant: Why it was perceived to be more/less amenable to change.
  More amenable to change:
Support from seniors Agreement amongst senior medical and nursing staff on the management of falls could be reached in effectively led meetings, laying the foundation for care throughout the emergency department; this approach can be considered to be feasible.
Education Healthcare professionals need to be familiar with the guideline in order to adhere to them; the delivery of education is potentially feasible. In order to adhere to Falls guideline, healthcare professionals need to have an awareness of what a fall is, care requirements, processes in place, and of the Falls guideline specifically.
Cross-boundary care (patient care both within and outside the boundary of the emergency department) This determinant has the potential to be addressed through healthcare professionals and commissioners considering care pathways and alternative services to be used in conjunction with emergency department treatment of falls patients.
  Less amenable to change:
Definition of a fall Categorisation of a fall at initial presentation influences patient care pathways and Falls guideline adherence.
It is less amenable to change as in order for it to have the potential to improve, seniors need to be in agreement, and providing education needs to become possible. Therefore, these determinants need to be addressed first.
Communication and team-working, patient acceptance of staff recommendations. Communication has the potential to be addressed, but it requires support from seniors, educational interventions, and/or support from cross-boundary services and the appropriate commissioning of services.
Whether or not a patient is receptive to guideline care may have an effect upon preventative techniques being recommended or employed as a method of Falls guideline adherence.
Organisational factors within department organisation, high volume activity, access to resources, availability of medical records and targets. Some organisational factors are less amendable to being addressed, because of practical issues, and because they are not under the control of the emergency department.
Staffing and consistency of care. The large numbers of staff employed within the emergency departments often meant that healthcare professionals worked with a variety of staff across shifts, and this influenced team-working. Also, individuals working together may have had different attitudes about Falls guideline care. Due to the large numbers of staff, it would not be feasible to address this determinant in ensuring consistency in teams working together.