CAPTURE Falls: Collaboration and Proactive Teamwork Used to Reduce Falls

描述（由申请人提供）：患者福尔斯跌倒仍然是医院中常见的、费用高昂的严重不良事件。福尔斯影响患者的生活质量，并对社会造成重大损失。因此，降低福尔斯的发生率是国家质量论坛、联邦政府、监管机构、医院质量改进计划和患者安全研究的优先事项。该项目的长期目标是减少危重病医院的住院福尔斯，危重病医院为福尔斯高风险的农村老年人提供优先服务，但缺乏大型医院的激励措施和/或资源。我们完成的风险评估表明，内布拉斯加州医院的福尔斯跌倒风险在危重病医院最高， 不要使用跨专业团队来整合来自多个学科的证据，并从以前的福尔斯中学习。本研究项目的目的是通过利用专业精神和提供来自文化的支持， 安全、团队合作和组织学习/意义建构。我们将在21家伙伴医院实施这一综合做法，其中17家是危重病医院。这一长期目标和目的与医疗保健研究和质量机构的使命一致，即提高所有美国人医疗保健的质量、安全性、效率和有效性。我们的方法来实现的理论基础是罗杰斯的组织创新过程。在组织内成功实施创新是一个五阶段的过程：（1）意识到需要，（2）将创新与需要相匹配，（3）重新发明创新以匹配组织的背景，（4）明确角色和任务，（5）将创新融入日常工作。基于这一方法，该项目有三个目标要与我们的合作医院实现：（1）制定定制的行动计划，以改善降低跌倒风险的结构和过程，考虑到每家医院的情况，（2）支持行动计划的实施，以及（3）通过重新评估结构，过程，结果，以及项目结束时降低跌倒风险的背景。这个项目是创新的，因为它试图改变跌倒风险降低的临床实践范式从一个以护理为中心的方法，以跨专业团队的方法，其中福尔斯被认为是一个指标的组织质量。该项目将通过将四种支持性做法整合到降低秋季风险中，为公共卫生做出重大贡献，这将支持这些做法的推广和采用，并在患者护理和患者安全方面发挥作用。 公共卫生相关性：这项研究项目与公共卫生有关，因为它旨在降低在危重病医院接受治疗的老年人的福尔斯风险。所提出的方法将有助于实施安全实践干预措施的证据基础，改变目前的临床范式，从以护理为中心的目标，通过安全文化，团队合作和意义的组织目标实现的跌倒风险降低。

DESCRIPTION (provided by applicant): In patient falls remain a common, costly, and serious adverse event in hospitals. Falls impact patients' quality of life and represent a significant costto society. Thus, decreasing the incidence of falls is a priority of the National Quality Forum, the federal government, regulatory agencies, hospital quality improvement programs, and patient safety research. The long-range goal of this project is to reduce inpatient falls in Critical Acces Hospitals, which serve priority rural older adult populations at high risk for falls, yet lack the incentives and/or resources present in larger hospitals. Our completed risk assessment indicated that the risk of falls in Nebraska hospitals is highest in Critical Access Hospitals that do not use an interprofessional team to integrate evidence from multiple disciplines and learn from previous falls. The objective of this research project is to implement the safe practice of inpatient fall risk reduction by leveraging professionalism and providing support from a culture of safety, teamwork, and organizational learning/sensemaking. We will implement this synthesis of practices in 21 partner hospitals, 17 of which are Critical Access Hospitals. This long-range goal and objective are consistent with the mission of the Agency for Healthcare Research and Quality, which is to improve the quality, safety, efficiency, and effectiveness of healthcare for al Americans. The theoretical rationale for our approach to implementation is Rogers' organization innovation process. Successful implementation of innovations within organizations is a five-stage process: (1) awareness of a need, (2) matching an innovation to the need, (3) re-inventing the innovation to match the organization's context, (4) clarifying roles and tasks, and (5) routinizing the innovation into daily work. Based on this approach, this project has three aims to achieve with our partner hospitals: (1) develop customized action plans to improve the structure and process of fall risk reduction that account for the context of each hospital, (2) support implementation of the action plans, and (3) evaluate implementation of the action plans by re-assessing the structure, process, outcomes, and context of fall risk reduction at the end of the project. This project is innovative because it seeks to change the clinical practice paradigm of fall risk reduction from a nursing-centric approach to an interprofessional team approach in which falls are considered an indicator of organizational quality. This project will make a significant contribution to public health by integrating four supporting practices into fall risk reduction, which will support diffusion and adoption of these practices and make a difference in patient care and patient safety. PUBLIC HEALTH RELEVANCE: This research project is relevant to public health because it seeks to decrease the risk of falls for older adults treated in Critical Access Hospitals. The proposed approach will contribute to the evidence base for implementation of safe practice interventions by changing the current clinical paradigm for fall risk reduction from a nursing-centric goal to an organizational goal achieved through safety culture, teamwork, and sense making.