Table 2 Categories, subcategories and supporting quotes

Subcategory 1a

Fall prevention policy not SCI-specific

“The policy tends to be generic for a bigger audience right? … Acute care, it is so different than rehab and the purpose of acute care is different. So I think it’s finding how we fit within the policy and how to manage within it.” (A2)

“I do find it’s difficult with our clientele because I find a lot of what is in the policy and procedures seems to be based on people with cognitive deficits rather than someone with a spinal cord injury.” (A9)

Subcategory 1b Expectation of zero falls

“I don’t think we will never have any falls. I do think trying to have zero serious outcomes from a fall is a pretty good thing to work on. But given that we are rehab, the chances are we will have patients falling because they are trying to ambulate and they are trying to go back to the community.” (A3)

“A few years ago, there was a real push on zero falls … Despite our best efforts we can’t hundred percent eliminate falls but we certainly can reduce falls and prevent injuries.” (A6)

Subcategory 1c Determining contributing factors

“I think finding precise and good information is sometimes difficult because it does happen that we find the patient on the floor. So it’s more difficult to document what happens in those situations...we do include falls that occur during physiotherapy but we are questioning that because there could be falls that, there are risks within the fact that we do rehabilitation so actually we consider those falls also but we are considering to take them out.” (A7)

“The greatest challenge that we have is that we are not actually present for most of the falls … we generally find the patient on the floor as opposed to being involved in a situation where the patient then falls.” (A5)

Subcategory 1d Learning from falls

“My hope is that people look at it as a learning opportunity and preventing the likelihood of that happening to someone else. They could be more defensive or there could also be like a punitive approach rather than a learning approach.” (A4)

“I think for us it is important to try to find the root cause and then try to avoid it because we don’t want people falling and hurting themselves.” (A2)

Subcategory 1e Overall effectiveness of the fall prevention policy

“Does the screening actually result in less falls. I don’t know. Is that actually necessary?” (A2)

“Based on all of that scientific literature that is out there around falls there hasn’t been very good evidence around any interventions that truly prevent falls.” (A4)

Subcategory 2a Variable staff adherence with the organizations’ fall prevention procedures

“We can see sometimes a very glaring gap around ‘Oh the STRATIFY has not been done yet’ and then next week ‘Oh the STRATIFY has not been done yet’ and next week same thing...Why is my staff continually week after week not filling out the falls risk assessment but my patients are not falling?” (A1)

“I would probably even say 100% [adherence], [clinicians] know what their duties are in fall prevention and management.” (A8)

Subcategory 2b Inconsistent delivery of fall prevention education

“Maybe there is a gap in something we’re forgetting to tell them or teach them before they go home. So if there is some sort of linkage as to what’s actually happening in the community when somebody leaves.” (A3)

“We don’t always do the teach back around patient family education … Do our patients truly understand this undertaking when they are trying to keep mobile and do they have a harm prevention strategy?” (A4)

Subcategory 2c Integrating individualized fall risks to guide clinical practice

“Stop rubberstamping and really try to figure out how we can hone staff skills at being better at anticipating and understanding risk factors. So train them in identifying as opposed to just filling the paper that they will never look at in the chart.” (A1)

“I would say the only thing with tracking falls is when people are completing the paperwork … is it just the filling out a form or are people actually putting sort of the thought process into the root cause? So that analysis piece. But in terms of tracking of falls themselves, I think that we do fairly well with actually tracking numbers and injuries... I would say that would be one of the challenges - getting it to be more proactive about preventing falls in the first place.” (A6)

Subcategory 3a Balancing risk vs independence and rehabilitation progress

“They are working with the experts who were trained to help the person manage that. So they are always in a situation where they’re in a harness or there’s protective equipment to protect from an injury. Again, they are pushing themselves. That’s the whole point of rehabilitation. You’ve gotta push yourself outside of the limits.” (A5)

“We are not going to stop them from transferring just because we want to keep them from falling. Because like a 20-year-old, this is going to be their life so...they have to learn if they do fall what they’re going to do about it...I almost think our patients are more of an exception to the rule.” (A9)

Subcategory 3b Responsibility for fall prevention

“They should be part of it [fall prevention] so then it doesn’t necessarily necessitate any sort of transfer [of responsibility]. They need to be in it from day one if they are doing rehab. They should be told this is what I need to watch for. This is what I need to do … it’s my accountability to check the brake … It’s not the nurse doing everything for them.” (A1)

“We have to make sure our patients become experts of their own condition so they can recognize potentially risky situations for them.” (A10)

Subcategory 3c Non-preventable falls

“I think that the cause of the falls are actually related to people that don’t respect what they have been told so that is a challenge. We are not in total control of all the factors. When the client decides to not listen with what has been told, it is more difficult to control their risks or prevent falls I would say.” (A7)

“If someone is learning to do transfers and they have a spasm and they are fatigued they might fall to the floor...he’s learning to do it … he did it with two nursing staff but then his knee buckled and he went to the floor, and we had to catch him. But we are practicing techniques that are taught to him. He was well supervised. He was using the right equipment, but it was just one of those unpredictable events.” (A9)