Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study
BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record...
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Published in | BMJ quality & safety Vol. 29; no. 12; pp. 1000 - 1007 |
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Format | Journal Article |
Language | English |
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BMJ Publishing Group LTD
01.12.2020
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Abstract | BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.ObjectiveTo identify and describe the prevalence of specific hospital fall prevention implementation strategies.MethodsIn 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.ResultsA total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).ConclusionsOur study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions. |
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AbstractList | BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.ObjectiveTo identify and describe the prevalence of specific hospital fall prevention implementation strategies.MethodsIn 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.ResultsA total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).ConclusionsOur study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions. To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.BACKGROUNDTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.To identify and describe the prevalence of specific hospital fall prevention implementation strategies.OBJECTIVETo identify and describe the prevalence of specific hospital fall prevention implementation strategies.In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.METHODSIn 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).RESULTSA total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.CONCLUSIONSOur study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions. To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised. To identify and describe the prevalence of specific hospital fall prevention implementation strategies. In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables. A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff). Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions. Background To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised. Objective To identify and describe the prevalence of specific hospital fall prevention implementation strategies. Methods In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables. Results A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff). Conclusions Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions. |
Author | Staggs, Vincent Potter, Catima Shorr, Ronald Turner, Kea Cramer, Emily Mion, Lorraine C |
AuthorAffiliation | 7 Ohio State University College of Nursing, Columbus, Ohio, USA 6 Department of Epidemiology, University of Florida, Gainesville, Florida, USA 4 School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA 5 GRECC , Malcom Randall VAMC, Gainesville, Florida, USA 2 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA 3 Press Ganey Associates Inc, South Bend, Indiana, USA 1 Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA |
AuthorAffiliation_xml | – name: 2 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA – name: 7 Ohio State University College of Nursing, Columbus, Ohio, USA – name: 5 GRECC , Malcom Randall VAMC, Gainesville, Florida, USA – name: 4 School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA – name: 1 Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA – name: 6 Department of Epidemiology, University of Florida, Gainesville, Florida, USA – name: 3 Press Ganey Associates Inc, South Bend, Indiana, USA |
Author_xml | – sequence: 1 givenname: Kea orcidid: 0000-0002-7885-0879 surname: Turner fullname: Turner, Kea email: kea.turner@gmail.com organization: Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA – sequence: 2 givenname: Vincent orcidid: 0000-0002-6232-9149 surname: Staggs fullname: Staggs, Vincent email: kea.turner@gmail.com organization: Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA – sequence: 3 givenname: Catima surname: Potter fullname: Potter, Catima email: kea.turner@gmail.com organization: Press Ganey Associates Inc, South Bend, Indiana, USA – sequence: 4 givenname: Emily surname: Cramer fullname: Cramer, Emily email: kea.turner@gmail.com organization: School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA – sequence: 5 givenname: Ronald surname: Shorr fullname: Shorr, Ronald email: kea.turner@gmail.com organization: Department of Epidemiology, University of Florida, Gainesville, Florida, USA – sequence: 6 givenname: Lorraine C surname: Mion fullname: Mion, Lorraine C email: kea.turner@gmail.com organization: Ohio State University College of Nursing, Columbus, Ohio, USA |
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Keywords | hospital falls implementation strategies Fall prevention |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Contributors KT drafted the manuscript and conducted the analyses. VS, CP and EC provided guidance on the data analyses and reviewed drafts of the manuscript. LCM and RS oversaw the data collection and analyses process, reviewed the manuscript and provided overall guidance on the study. |
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Snippet | BackgroundTo guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have... To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have... Background To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have... |
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SubjectTerms | Advanced practice nurses Committees Drug stores Education Falls Geriatrics Hospitals Injury prevention Interdisciplinary aspects Intervention Nursing Patients Prevention Quality management Risk assessment Variables Workforce planning |
Title | Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study |
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