Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
BMJ Qual Saf. 2020 Dec;29(12):1000-1007. doi: 10.1136/bmjqs-2019-010642. Epub 2020 Mar 18.
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.
为了指导防跌倒工作，美国的一些组织，如联合委员会和医疗保健研究与质量机构，建议采用组织层面的实施策略：领导层支持、跨学科跌倒委员会、电子健康记录工具，以及对员工、家属和患者进行教育。目前尚不清楚医院是否遵守这些策略，也不清楚这些策略是如何运作的。
确定和描述特定医院防跌倒实施策略的流行情况。
2017 年，我们调查了参与国家护理质量指标数据库的 80 家美国医院，这些医院自愿参与了这项研究。我们通过计算分类变量的百分比、计数变量的中位数和四分位距来进行描述性统计。
共有 60/80（75%）家医院完成了调查。大多数医院为非营利性（98%）和城市医院（90%）；超过一半的医院为磁疗（53%）、规模较小（53%）和教学医院（52%）。医院更有可能采用领导力策略，例如在过去 3 年内更新跌倒政策（98%），但不太可能奖励员工（40%）。医院经常使用跨学科跌倒委员会（83%），但成员很少包括医生。医院缺乏电子健康记录工具，如高危药物警示（27%）。教育策略被广泛使用；100%的医院在员工入职培训时提供跌倒教育，但只有 22%的医院对所有员工（不仅仅是护理人员）进行教育。
我们的研究首次调查了美国医院正在使用哪些专家推荐的实施策略，以及这些策略是如何运作的。未来的研究需要详细记录防跌倒实施策略，并测试哪些实施策略最能有效减少跌倒。此外，还需要研究评估防跌倒干预措施的实施质量（例如，保真度）。
