为美国医院取消跌倒预防警报选择并定制实施策略：一项群体概念映射研究

Selecting and tailoring implementation strategies for deimplementing fall prevention alarms in US hospitals: a group concept mapping study.

作者信息

Turner Kea, Al Taweel Mona, Petrucci Carrie, Rosas Scott, Potter Catima, Cramer Emily, Shorr Ronald I, Mion Lorraine C, McNett Molly

机构信息

The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA

The University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.

出版信息

BMJ Qual Saf. 2025 Mar 26. doi: 10.1136/bmjqs-2024-018391.

DOI:10.1136/bmjqs-2024-018391

PMID:40139778

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12309417/

Abstract

OBJECTIVES

Many hospitals use fall prevention alarms, despite the limited evidence of effectiveness. The objectives of this study were (1) to identify, conceptualise and select strategies to deimplement fall prevention alarms and (2) to obtain feedback from key stakeholders on tailoring selected deimplementation strategies for the local hospital context.

METHODS

Hospital staff working on fall prevention participated in group concept mapping (GCM) to brainstorm strategies that could be used for fall prevention alarm deimplementation, sort statements into conceptually similar categories and rate statements based on importance and current use. Hospital staff also participated in site-specific focus groups to discuss current fall prevention practices, strategies prioritised through GCM and theory-informed strategies recommended by the study team, and potential barriers/facilitators to deimplementing fall prevention alarms.

RESULTS

90 hospital staff across 13 hospitals brainstormed, rated and sorted strategies for alarm deimplementation. Strategies that were rated as highly important but underutilised included creating/revising staff roles to support fall prevention (eg, hiring or designating mobility technicians) and revising policies and procedures to encourage tailored rather than universal fall precautions. 192 hospital staff across 22 hospitals participated in site-specific focus groups. Participants provided feedback on each strategy's relevance for their site (eg, if site currently has a mobility technician) and local barriers or facilitators (eg, importance of having separate champions for day and night shift). Findings were used to develop a tailored implementation package for each site that included a core set of strategies (eg, external facilitation, education, audit-and-feedback, champions), a select set of site-specific strategies (eg, designating a mobility technician to support fall prevention) and guidance for how to operationalise and implement each strategy given local barriers and facilitators.

CONCLUSION

Findings from this study can be used to inform future programmes and policies aimed at deimplementing fall prevention alarms in hospitals.

摘要

目的

尽管预防跌倒警报的有效性证据有限，但许多医院仍在使用。本研究的目的是：（1）识别、概念化并选择停用预防跌倒警报的策略；（2）从关键利益相关者那里获取反馈，以便根据当地医院的情况调整所选的停用策略。

方法

从事预防跌倒工作的医院工作人员参与了小组概念图绘制（GCM），以集思广益可用于停用预防跌倒警报的策略，将陈述分类为概念上相似的类别，并根据重要性和当前使用情况对陈述进行评分。医院工作人员还参加了针对特定地点的焦点小组，讨论当前的预防跌倒措施、通过GCM确定优先级的策略以及研究团队推荐的基于理论的策略，以及停用预防跌倒警报的潜在障碍/促进因素。

结果

来自13家医院的90名医院工作人员对停用警报的策略进行了头脑风暴、评分和分类。被评为非常重要但未充分利用的策略包括创建/修订员工角色以支持预防跌倒（例如，招聘或指定行动辅助技术人员）以及修订政策和程序以鼓励采取量身定制而非通用的预防跌倒措施。来自22家医院的192名医院工作人员参加了针对特定地点的焦点小组。参与者就每种策略与他们所在地点的相关性（例如，该地点目前是否有行动辅助技术人员）以及当地的障碍或促进因素（例如，为日班和夜班分别设立负责人的重要性）提供了反馈。研究结果被用于为每个地点制定量身定制的实施方案，其中包括一组核心策略（例如，外部促进、教育、审核与反馈、负责人）、一组选定的针对特定地点的策略（例如，指定一名行动辅助技术人员来支持预防跌倒）以及关于如何根据当地的障碍和促进因素实施和执行每种策略的指导。