A Failed Model‐Based Attempt to Implement an Evidence‐Based Nursing Guideline for Fall Prevention
A Failed Model‐Based Attempt to Implement an Evidence‐Based Nursing Guideline for Fall Prevention
复制标题
基于模型的失败预防跌倒护理指南的实施尝试
DOI：
10.1097/00001786-200307000-00008
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发表时间：
2003
影响因子：
1.2
通讯作者：
P. Bossuyt
中科院分区：
文献类型：
--
作者：
A. Semin;J. V. D. van der Helm;P. Bossuyt
背景：1993年，当地制定了一项循证护理指南，以降低跌倒发生率，降低了30%。但执行失败了。在1999年至2001年期间，该准则得到了更新。根据实施变革的模式，选择了多方面的干预措施。方法：在2个病区进行研究。Grol的五步实施模型的所有建议都得到了遵循。目标是在一年内将跌倒发生率降低30%。从护理记录和发病率报告表（IRF）中提取福尔斯数据。结果如下：在一项试点研究中，内科每天平均每1000名患者中有9名福尔斯跌倒，神经科每天平均每1000名患者中有16名跌倒。考虑到30%的预期降低，目标平均值分别为6次和11次福尔斯。在干预年期间，平均发生率为8和13次福尔斯（95% CI：6 - 11和10 - 15）。随着时间的推移，有一个变化的模式，没有任何下降的趋势。填写IRF的百分比差异很大，内科平均为52%，神经科为60%。结论：尽管使用了基于模型的程序来实施改变，但每月福尔斯的下降并没有持久的下降。我们也没有观察到在填写IRF方面有任何改善。可以质疑的是，护士自己是否经历过病人福尔斯摔倒的麻烦。但调查这一点很困难。虽然最成功的策略似乎仍然是改变护士的态度，以增加跌倒预防，没有明确的策略，如何成功地创建这一点。
Background: An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change. Method: The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs). Results: In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6–11 and 10–15). There was a changeable pattern over time without any declining trend. The percentage filled in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department. Conclusion: There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully.