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：取消医院跌倒预防警报的实施住院患者跌倒会给患者带来重大的身体和经济负担（增加伤害）和死亡率和生活质量下降）以及医疗机构（增加住院时间、医疗费用和诉讼）。服务 (CMS) 认为跌倒受伤是“绝不会发生的事件”，即医疗护理中的错误，表明医疗机构的安全性和可信度确实存在问题。住院病人跌倒的诊断和处理所产生的额外费用得到更长的报销- 因此，由于患者跌倒很常见、成本高昂并且被解释为护理不善。质量，医院有很大的动力去预防它们。警报系统旨在通过在患者试图离开时向工作人员发出警报来减少跌倒。我们的团队和其他人现在有强有力的证据表明，在没有帮助的情况下，可以在床上或椅子上移动。尽管如此，警报作为医院预防跌倒的措施还是无效的。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在疗养院中，CMS 监管跌倒预防警报的使用。给疗养院测量员的说明指出应使用这些设备。仅在医学上必要且不断重新评估时才进行。在“明智地选择取消实施框架”的指导下，该项目将生成一个使用指导和定制的取消实施策略来减少使用的通用方法我们将在 30 年内进行混合 II 实施研究。参与全国计划的美国非联邦医院的医疗或医疗外科单位这项研究的结果也可以支持未来的试验。旨在杜绝在已知跌倒率较高的其他护理环境中使用低质量警报的情况（例如，中风护理、癌症护理）。迫切需要评估定制策略的使用情况并建立有效的阈值在拥有不同资源的卫生服务机构内进行辅导，以支持实施工作