Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study.
Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study.
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DOI：
10.1136/bmjqs-2019-010642
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发表时间：
2020-12
影响因子：
5.4
通讯作者：
Mion LC
中科院分区：
文献类型：
--
作者：
Turner K;Staggs V;Potter C;Cramer E;Shorr R;Mion LC
为了指导预防跌倒的工作，美国的组织，如联合委员会和卫生保健研究和质量局，建议组织一级的实施战略：领导支持，跨学科的福尔斯委员会，电子健康记录工具，工作人员，家庭和病人的教育。目前还不清楚医院是否坚持这些战略，或者这些战略是如何运作的。确定并描述特定医院跌倒预防实施策略的流行情况。2017年，我们调查了80家参与国家护理质量指标数据库的美国医院，这些医院自愿参加了这项研究。我们通过计算分类变量的百分比和计数变量的中位数和IQR进行描述性统计。共有60/80（75%）的医院完成了调查。大多数医院是非营利（98%）和城市（90%）;一半以上是磁铁（53%），小型（53%）和教学（52%）。医院更有可能使用领导策略，例如在过去3年中更新秋季政策（98%），但不太可能奖励员工（40%）。医院通常使用跨学科福尔斯委员会（83%），但成员很少包括医生。医院缺乏电子健康记录工具，如高风险药物警告（27%）。教育策略是常用的; 100%的医院提供秋季教育，在工作人员的方向，但只有22%的教育所有员工（不只是护理人员）。据我们所知，我们的研究是第一次研究正在使用哪些专家建议的实施策略以及它们如何在美国医院中实施。未来的研究需要详细记录跌倒预防实施策略，并测试哪些实施策略在减少福尔斯方面最有效。此外，需要进行研究以评估跌倒预防干预措施的实施质量（例如，保真度）。
To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised. To identify and describe the prevalence of specific hospital fall prevention implementation strategies. In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables. A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff). Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.
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