CAPTURE Falls: Collaboration and Proactive Teamwork Used to Reduce Falls

描述(由申请人提供)：在医院中，跌倒仍然是一种常见的、昂贵的和严重的不良事件。跌倒影响患者的生活质量，并给社会带来巨大的代价。因此，减少跌倒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Acce危重医院的住院患者跌倒，这些医院为重点农村老年人口提供服务，这些人群有较高的跌倒风险，但缺乏大型医院现有的激励措施和/或资源。我们完成的风险评估表明，内布拉斯加州医院跌倒的风险最高的关键通道医院 不要使用跨专业团队来整合来自多个学科的证据，并从之前的跌倒中吸取教训。这项研究项目的目标是通过利用专业精神和提供支持的文化来实施住院患者降低跌倒风险的安全做法 安全、团队合作和组织学习/感官创造。我们将在21家合作医院实施这一综合实践，其中17家是关键通道医院。这一长期目标和目标与医疗研究和质量机构的使命是一致的，即提高美国人的医疗保健的质量、安全、效率和有效性。我们实施方法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个阶段的过程：(1)意识到需求，(2)将创新与需求相匹配，(3)根据组织的背景重新发明创新，(4)明确角色和任务，(5)将创新例行化到日常工作中。基于这种方法，该项目与我们的合作医院有三个目标：(1)制定定制的行动计划，以改进针对每家医院的背景的减少跌倒风险的结构和流程，(2)支持行动计划的实施，以及(3)通过在项目结束时重新评估减少跌倒风险的结构、过程、结果和背景来评估行动计划的实施情况。这个项目具有创新性，因为它试图将降低跌倒风险的临床实践范式从以护理为中心的方法转变为跨专业团队方法，在这种方法中，跌倒被视为组织质量的指标。该项目将通过将四种支持做法整合到降低跌倒风险中，为公共卫生做出重大贡献，这将支持这些做法的传播和采用，并在患者护理和患者安全方面产生影响。 与公共健康相关：这项研究项目与公共健康相关，因为它寻求降低在关键通道医院接受治疗的老年人跌倒的风险。建议的方法将有助于通过改变当前降低跌倒风险的临床范例，从以护理为中心的目标转变为通过安全文化、团队合作和理性创造实现的组织目标，从而为实施安全实践干预提供证据基础。

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.