De-Implementing Fall Prevention Alarms in Hospitals

标题：医院取消实施预防跌倒警报器 住院患者跌倒会给患者带来巨大的身体和经济负担(增加伤害 以及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 服务机构(CMS)认为跌倒并受伤是一件“从未发生过的事情”--这是医疗护理中的一个错误 表明卫生保健机构的安全和可信度存在真正的问题。医院不是 为诊断和处理住院跌倒而产生的额外费用不再报销- 相关伤害。因此，因为患者跌倒很常见，成本很高，而且被解释为护理不善 为了保证质量，医院受到高度激励，以防止它们。 警报系统的设计是为了减少跌倒，方法是在患者试图离开房间时提醒工作人员 没有帮助的床或椅子。现在有来自我们小组和其他人的强有力的证据 在医院里，警报器作为预防跌倒的动作是无效的。尽管如此，我们小组还是 最近显示，超过三分之一的医院患者正在接受预防跌倒的警报 监控。在疗养院，CMS规范了跌倒警报器的使用 身体上的束缚。养老院测量师的说明中指出，这些设备应该使用 只有在医学上有必要并不断重新评估的情况下。 在选择明智的取消实施框架的指导下，该项目将生成一个 使用指导和量身定制的取消实施策略来减少使用的通用方法 医院里的防摔报警器。我们将在30年内进行一项混合II实施研究 来自美国非联邦医院的医疗或外科单位参加国家 护理质量指标数据库。这项研究的发现也可能支持未来的试验 旨在取消在具有已知高坠落率的其他护理环境中使用低质量警报 (例如，中风护理、癌症护理)。高强度和低强度教练的评估解决了 迫切需要评估量身定制战略的使用情况并确定有效的阈值 在卫生服务环境中进行指导，这些环境有不同的资源来支持去中心化 执行工作

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