Choosing Wisely: De-implementing Fall Prevention Alarms in Hospitals
- Conditions
- Hospital Acquired ConditionClinical AlarmsAccidental FallPatient SafetyMentoring
- Interventions
- Other: High Intensity CoachingOther: Low Intensity Coaching
- Registration Number
- NCT06089239
- Lead Sponsor
- University of Florida
- Brief Summary
This is a Hybrid II de-implementation study to reduce use of fall prevention alarms in hospitals. The intervention consists of tailored, site-specific approaches for three core implementation strategies: education, audit/feedback and opinion leaders. Hospital units will be randomized to low-intensity or high-intensity coaching for the implementation of the tailored strategies.
- Detailed Description
Inpatient falls result in significant physical and economic burdens to patients (increased injury and mortality rates and decreased quality of life) as well as to medical organizations (increased lengths of stay, medical care costs, and litigation). The Centers for Medicare \& Medicaid Services (CMS) considers falls with injury a "never event"- an error in medical care that indicates a real problem in the safety and credibility of a health care institution. Hospitals are no longer reimbursed for extra costs incurred in the diagnosis and management of inpatient fall-related injuries. Thus, because patient falls are common, costly and interpreted as poor care quality, hospitals are highly incentivized to prevent them.
Alarm systems are designed to reduce falls by alerting staff when patients attempt to leave a bed or chair without assistance. There is now strong evidence that alarms are ineffective as a fall prevention maneuver in hospitals. Despite this, more than one-third of hospital patients are undergoing fall prevention alarm monitoring. In nursing homes, CMS regulates the use of fall prevention alarms as it does physical restraints. Instructions to nursing home surveyors state these devices should be used only when medically necessary and continuously reevaluated.
Guided by the Choosing Wisely De-implementation Framework, this project will generate a generalizable approach using coaching and tailored de-implementation strategies to reduce use of fall prevention alarms in hospitals. The investigators will conduct a hybrid II implementation study in 30 medical or medical-surgical units from US non-federal hospitals participating in the National Database of Nursing Quality Indicators. Findings from this study could also support future trials aimed at de-implementing low-quality alarm use in other care settings with known high fall rates (e.g., stroke care, cancer care). Evaluation of high versus low intensity coaching addresses an urgent need to evaluate use of tailored strategies and to establish effective thresholds for coaching within health service settings that have varying resources to support de-implementation efforts
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 300
- Stakeholders in fall prevention at up to 30 participating NDNQI hospitals
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description High Intensity Coaching High Intensity Coaching In Quarter 1, high intensity initiation coaching will consist of a four-hour orientation session that will include: * comprehensive information on behavior and organizational change theory, * suggested approaches, and * in-depth training on behavioral and organization-focused change techniques to stimulate implementation efforts. Commencing in Quarter 2, high intensity sustainability coaching will consist of: * weekly virtual follow up sessions for the first month, followed by private monthly coaching follow up sessions via a virtual format. * Access to additional monthly web-based, synchronous "office hours" for group discussion on progress and customized troubleshooting to assist in navigating barriers. * Sites will also have access to "on call" assistance with coaches to assist with navigating challenges in real time. Low Intensity Coaching Low Intensity Coaching In Quarter 1, low intensity initiation coaching will be conducted. It will consist of: * initial two-hour orientation session with introductory content on behavior change and organizational change theory and techniques, * an overview of implementation phases, and * selection of tailored de-implementation strategies for that site based on readiness for change, focus group data and local resources. Implementation coaches will provide the Fuld Toolkit for the site with suggestions for assigning strategies, local leaders, and development of timelines for de-implementation. Coaches will instruct site Team Leaders to establish the primary mechanism for sharing baseline and trended data in real time.
- Primary Outcome Measures
Name Time Method Patient Falls monthly for 30 months Patients on participating units are monitored for falls beginning the date/time they are admitted to the date/time they are discharged from the study unit. Falls are determined using National Database of Nursing Quality Indicators (NDNQI) protocols. Patients may contribute one or more falls during their stay. This is expressed as the Number of Patients who fell/1000 bed days of care.
This measure will be recorded monthly for 30 months during both baseline and intervention periods.Fall Prevention Alarm Prevalence survey monthly for 30 months Number of Patients in a study unit with fall prevention alarm activated divided by the number of patients evaluated. This is assessed monthly and is expressed as the proportion of patients assessed with fall prevention alarm activated. This is not a time to event outcome.
This measure will be recorded monthly for 30 months during both baseline and intervention periods.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (24)
Kaiser Westside Medical Center
🇺🇸Hillsboro, Oregon, United States
Hendricks Regional Health
🇺🇸Danville, Indiana, United States
UMass Memorial Health Harrington
🇺🇸Southbridge, Massachusetts, United States
Central DuPage Hospital
🇺🇸Winfield, Illinois, United States
OSF Saint Anthony's Health Center
🇺🇸Alton, Illinois, United States
St. David's Medical Center
🇺🇸Austin, Texas, United States
Barberton Hospital
🇺🇸Uniontown, Ohio, United States
Covenant Medical Center
🇺🇸Lubbock, Texas, United States
Kent Hospital
🇺🇸Warwick, Rhode Island, United States
St Peter's Health Samaritan Hospital
🇺🇸Albany, New York, United States
Lahey Hospital & Medical Center
🇺🇸Derry, New Hampshire, United States
Kaiser Permanente - Sunnyside Medical Center
🇺🇸Woodburn, Oregon, United States
El Camino Health - Los Gatos
🇺🇸Mountain View, California, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Prisma Health
🇺🇸Irmo, South Carolina, United States
Christiana Care
🇺🇸West Chester, Pennsylvania, United States
Lakeland Regional Medical Center
🇺🇸Lakeland, Florida, United States
IU Health North Hospital
🇺🇸Indianapolis, Indiana, United States
PIH Health Downey Hospital
🇺🇸Downey, California, United States
University of California Davis Medical Center
🇺🇸Sacramento, California, United States
Henry Ford Hospital West Bloomfield
🇺🇸West Bloomfield, Michigan, United States
Raritan Bay Medical Center
🇺🇸New Brunswick, New Jersey, United States
Hunterdon Medical Center
🇺🇸Flemington, New Jersey, United States
Greenwich Hospital
🇺🇸River Vale, New Jersey, United States