Alarm with care-a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial.
Alarm with care-a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial.
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谨慎使用警报——一种减少美国医院跌倒预防警报使用的去实施策略：一项混合2型效果 - 实施试验的研究方案
DOI：
10.1186/s13012-023-01325-9
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发表时间：
2023-12-05
影响因子：
7.2
通讯作者：
Mion, Lorraine
中科院分区：
文献类型：
--
作者：
Turner, Kea;Mcnett, Molly;Potter, Catima;Cramer, Emily;Al Taweel, Mona;Shorr, Ronald;Mion, Lorraine
关键词：
跌倒预防警报器通常在美国医院中用作跌倒预防策略，尽管有效性的证据有限。此外，防坠落警报对医护人员是有害的（例如，警报疲劳）和患者（例如，睡眠障碍、活动受限）。有必要进行研究，以开发和测试减少美国医院使用跌倒预防报警器的策略。为了解决这一差距，我们建议测试的有效性和实施的报警与护理，去实施策略，以减少跌倒预防报警的使用，使用一个阶梯楔形随机对照试验中的30个成人医疗或医疗外科单位从非联邦美国急性护理医院。在“明智选择取消实施框架”的指导下，我们将（1）识别跌倒预防警报取消实施的障碍，并为每个单位制定量身定制的取消实施策略，（2）比较高强度与低强度辅导的实施和有效性，以支持跌倒预防警报的特定地点取消实施。我们将评估成效和实施成果，并审查多层次（例如，医院、单位和患者）因素对有效性和实施的影响。跌倒预防报警器的使用率是主要结局。平衡措施将包括跌倒率和与跌倒有关的伤害。实施结果将包括可行性、可接受性、适当性和忠实性。这一系列研究的结果可用于支持在其他医疗保健环境中扩大跌倒预防警报的实施。此外，从这一建议产生的研究将通过确定低强度教练在多大程度上是一个有效和可行的去执行战略，推进去执行科学领域。ClinicalTrials.gov标识符：NCT 06089239。报名时间：2023年10月17日。
Fall prevention alarms are commonly used among US hospitals as a fall prevention strategy despite limited evidence of effectiveness. Further, fall prevention alarms are harmful to healthcare staff (e.g., alarm fatigue) and patients (e.g., sleep disturbance, mobility restriction). There is a need for research to develop and test strategies for reducing use of fall prevention alarms in US hospitals. To address this gap, we propose testing the effectiveness and implementation of Alarm with Care, a de-implementation strategy to reduce fall prevention alarm use using a stepped-wedge randomized controlled trial among 30 adult medical or medical surgical units from nonfederal US acute care hospitals. Guided by the Choosing Wisely De-Implementation Framework, we will (1) identify barriers to fall prevention alarm de-implementation and develop tailored de-implementation strategies for each unit and (2) compare the implementation and effectiveness of high- versus low-intensity coaching to support site-specific de-implementation of fall prevention alarms. We will evaluate effectiveness and implementation outcomes and examine the effect of multi-level (e.g., hospital, unit, and patient) factors on effectiveness and implementation. Rate of fall prevention alarm use is the primary outcome. Balancing measures will include fall rates and fall-related injuries. Implementation outcomes will include feasibility, acceptability, appropriateness, and fidelity. Findings from this line of research could be used to support scale-up of fall prevention alarm de-implementation in other healthcare settings. Further, research generated from this proposal will advance the field of de-implementation science by determining the extent to which low-intensity coaching is an effective and feasible de-implementation strategy. ClinicalTrials.gov identifier: NCT06089239. Date of registration: October 17, 2023.
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