Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit
Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit
复制标题
DOI：
10.1016/j.jcjq.2017.05.002
复制
发表时间：
2017-08-01
影响因子：
2.3
通讯作者：
Scanlan, Maureen
中科院分区：
文献类型：
--
作者：
Dykes, Patricia C.;Duckworth, Megan;Scanlan, Maureen
背景：患者在急性住院期间跌倒会导致受伤、活动能力下降和费用增加。层压纸 Fall TIPS Toolkit (Fall TIPS) 通过将每位患者的跌倒风险评估与循证干预措施联系起来，在床边提供临床决策支持。需要采取策略将这些证据整合到临床实践中。方法：医疗保健改进研究所的传播框架是在布莱根妇女医院（BWH；波士顿）和蒙蒂菲奥里医疗中心（MMC；纽约布朗克斯）试点实施 Fall TIPS 的概念模型。将证据转化为实践的关键是通过利用现有的共享治理结构、确定单位冠军、为所有员工举办培训课程以及实施审核来评估协议遵守情况和患者结果并提供反馈来吸引利益相关者参与。结果：与 2016 年相比，BWH 单位对使用 Fall TIPS 的平均遵守率为 82%，从 2015 年 1 月到 6 月，平均跌倒率从每 1,000 个患者日 3.28 次下降到 2.80 次，平均跌倒率这些时期的伤害率从每 1,000 个患者日 1.00 人下降到 0.54 人。在 MMC，平均依从性为 91%，但平均跌倒率略有上升，从 3.04 次增加到 3.10 次，而平均跌倒受伤率从每 1000 个患者日 0.47 次下降到 0.31 次。患者知识调查结果显示，患者对跌倒风险和预防跌倒方法的了解有所提高。结论：医院和临床领导层的参与对于将循证护理转化为临床实践至关重要。该协议采用的障碍已得到解决和详细说明，以便为向其他机构的推广提供指导。
Background: Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. Strategies were needed to integrate this evidence into clinical practice.Methods: The Institute for Healthcare Improvement's Framework for Spread is the conceptual model for pilot implementation of Fall TIPS at Brigham and Women's Hospital (BWH; Boston) and Montefiore Medical Center (MMC; Bronx, New York). The key to translating the evidence into practice was engaging stakeholders by leveraging existing shared governance structures, identifying unit champions, holding training sessions for all staff, and implementing auditing to assess and provide feedback on protocol adherence and patient outcomes.Results: BWH unit compliance with using Fall TIPS averaged 82%, the mean fall rate decreased from 3.28 to 2.80 falls per 1,000 patient-days from January through June 2015 versus 2016, and the mean fall with injury rate for these periods decreased from 1.00 to 0.54 per 1,000 patient-days. At MMC, compliance averaged 91%, but the mean fall rate increased marginally from 3.04 to 3.10, while the mean fall with injury rate decreased from 0.47 to 0.31 per 1,000 patient-days. Patient knowledge survey results show improvement in knowledge of the risks for falls and the ways to prevent falls.Conclusion: Engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. Barriers to adoption of the protocol have been addressed and detailed to provide guidance for spread to other institutions.