De-Implementing Fall Prevention Alarms in Hospitals

取消医院跌倒预防警报的实施

基本信息

批准号：
10444704
负责人：
LORRAINE C MION
金额：
$ 61.31万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10444704
关键词：
Address Adverse event Agitation Auditory Beds Caring Cessation of life Cluster randomized trial Custom Databases Deimplementation Devices Diagnosis Discipline of Nursing Dose Economic Burden Education Effectiveness Elderly Evaluation Event Fall prevention Feedback Focus Groups Frontline worker Future Goals Health Health Services Healthcare Hospital Costs Hospital Nursing Hospital Units Hospitals Hybrids Incentives Incontinence Injury Inpatients Institution Instruction Interruption Length of Stay Litigation Medical Medical Care Costs Medical-Surgical Nursing Methods Mission Monitor Nursing Homes Operative Surgical Procedures Patients Physical Restraint Prevention strategy Quality Indicator Quality of Care Quality of life Reporting Research Priority Resources Safety Savings Science Service setting Site Sleep disturbances Stroke System Time Translational Research United States Centers for Medicare and Medicaid Services United States National Institutes of Health Work behavioral economics cancer care compare effectiveness concept mapping cost design dissemination research evidence base fall injury fall risk falls implementation efforts implementation framework implementation outcomes implementation research implementation science implementation strategy implementation study improved medically necessary care mortality patient mobility patient safety prevent research to practice restraint virtual

项目摘要

Title: De-Implementing Fall Prevention Alarms in Hospitals Inpatient falls result in significant physical and economic burdens to patients (increased injury and mortality rates and decreased quality of life) as well as to medical organizations (increased lengths of stay, medical care costs, and litigation). The Centers for Medicare & Medicaid Services (CMS) considers falls with injury a “never event”— an error in medical care that indicates a real problem in the safety and credibility of a health care institution. Hospitals are no longer reimbursed for extra costs incurred in the diagnosis and management of inpatient fall- related injuries. Thus, because patient falls are common, costly and interpreted as poor care quality, hospitals are highly incentivized to prevent them. Alarm systems are designed to reduce falls by alerting staff when patients attempt to leave a bed or chair without assistance. There is now strong evidence from our group and others that alarms are ineffective as a fall prevention maneuver in hospitals. Despite this, our group has recently shown that more than one-third of hospital patients are undergoing fall prevention alarm monitoring. In nursing homes, CMS regulates the use of fall prevention alarms as it does physical restraints. Instructions to nursing home surveyors state these devices should be used only when medically necessary and continuously reevaluated. Guided by the Choosing Wisely De-implementation Framework, this project will generate a generalizable approach using coaching and tailored de-implementation strategies to reduce use of fall prevention alarms in hospitals. We will conduct a hybrid II implementation study in 30 medical or medical-surgical units from US non-federal hospitals participating in the National Database of Nursing Quality Indicators. Findings from this study could also support future trials aimed at de-implementing low-quality alarm use in other care settings with known high fall rates (e.g., stroke care, cancer care). Evaluation of high versus low intensity coaching addresses an urgent need to evaluate use of tailored strategies and to establish effective thresholds for coaching within health service settings that have varying resources to support de- implementation efforts

标题：医院中脱颖而出的秋季预防警报住院下降会导致患者的身体和经济伯恩斯大量（伤害增加）以及对医疗组织的死亡率和改善的生活质量）（增加住院时间，医疗费用和诉讼）。医疗保险和医疗补助中心服务（CMS）认为受伤的跌倒是“永不事件” - 医疗保健错误在医疗机构的安全性和信誉中表明了一个真正的问题。医院没有在诊断和管理住院跌倒时，偿还额的额外费用。相关伤害。那，因为患者跌倒很普遍，昂贵，并且被解释为不良护理质量，医院受到高度激励以防止它们。警报系统旨在通过提醒员工来减少跌倒，当患者试图离开床或椅子没有帮助。现在有我们小组和其他人的有力证据表明警报在医院的秋季预防动作中无效。尽管如此，我们的小组有最近显示，超过三分之一的医院患者正在接受秋季预防警报监视。在护士房屋中，CMS调节了秋季预防警报的使用身体约束。护士家庭测量师的说明指出应使用这些设备仅当医学上需要并连续重新评估时。在选择明智地实现框架的指导下，该项目将产生一个使用教练和量身定制的实施策略来减少使用的可推广方法医院秋季预防警报。我们将在30个中进行混合II实施研究美国非联邦医院的医疗或医疗手术单位参加了国家护理质量指标的数据库。这项研究的发现也可以支持以后的试验旨在在其他具有已知高跌倒率的其他护理设置中脱离实力的低质量警报（例如，中风护理，癌症护理）。高强度与低强度教练的评估解决了迫切需要评估使用量身定制策略的使用并为在卫生服务环境中的教练，这些设置具有不同的资源，以支持DE- 实施工作