De-Implementing Fall Prevention Alarms in Hospitals

取消医院跌倒预防警报的实施

• 批准号: 10698056
• 负责人: Molly McNett
• 金额: $ 58.83万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 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/10698056
• 关键词: Address; Adverse event; Agitation; Auditory; Beds; Caring; Cessation of life; Cluster randomized trial; Custom; Databases; Deimplementation; Devices; Diagnosis; Discipline of Nursing; Dissemination and Implementation; 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; 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; Qualifying; Quality Indicator; Quality of Care; Quality of life; Reporting; Research Priority; Resources; Safety; 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; 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

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：医院取消预防跌倒警报 住院患者的福尔斯跌倒会给患者带来巨大的身体和经济负担（增加损伤 死亡率和生活质量下降）以及医疗组织（增加 住院时间、医疗费用和诉讼）。医疗保险和医疗补助中心 医疗服务中心（CMS）认为福尔斯跌倒受伤是一个“永远不会发生的事件”--医疗保健中的一个错误， 表明医疗机构的安全性和可信度存在真实的问题。医院不 住院跌倒的诊断和管理所产生的额外费用的报销时间更长- 相关伤害。因此，由于病人福尔斯是常见的，昂贵的，并解释为穷人的照顾 质量，医院高度激励，以防止他们。 报警系统的设计是为了减少福尔斯下降提醒工作人员时，病人试图离开一个 床或椅子没有帮助。我们和其他人现在有强有力的证据表明， 警报器作为医院中的跌倒预防策略是无效的。尽管如此，我们的团队 最近显示，超过三分之一的医院病人正在接受跌倒预防警报， 监测.在疗养院，CMS规范了防跌倒警报器的使用， 身体限制。护理之家调查员的说明指出，这些设备应使用 只有在医学上有必要并不断重新评估的情况下。 在明智地选择去实现框架的指导下，该项目将产生一个 使用辅导和量身定制的取消执行战略的可推广方法，以减少使用 医院里的防坠落警报器。我们将在30年内进行混合II实施研究。 来自美国非联邦医院的医疗或医疗外科单位参加国家 护理质量指标数据库。这项研究的结果也可以支持未来的试验 旨在取消在其他护理环境中使用低质量警报，已知跌倒率较高 (e.g.,中风护理、癌症护理）。高强度与低强度教练的评估 迫切需要评估量身定制战略的使用情况， 在卫生服务机构内进行辅导，这些机构拥有不同的资源， 执行努力

项目成果

Alarm with care-a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial.

• DOI: 10.1186/s13012-023-01325-9
• 发表时间: 2023-12-05
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Turner, Kea;Mcnett, Molly;Potter, Catima;Cramer, Emily;Al Taweel, Mona;Shorr, Ronald;Mion, Lorraine
• 通讯作者: Mion, Lorraine