Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial
Abstract Background Fall prevention alarms are commonly used among US hospitals as a fall prevention strategy despite limited evidence of effectiveness. Further, fall prevention alarms are harmful to healthcare staff (e.g., alarm fatigue) and patients (e.g., sleep disturbance, mobility restriction)....
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-023-01325-9 |
| _version_ | 1797397791622823936 |
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| author | Kea Turner Molly McNett Catima Potter Emily Cramer Mona Al Taweel Ronald I. Shorr Lorraine C. Mion |
| author_facet | Kea Turner Molly McNett Catima Potter Emily Cramer Mona Al Taweel Ronald I. Shorr Lorraine C. Mion |
| author_sort | Kea Turner |
| collection | DOAJ |
| description | Abstract Background Fall prevention alarms are commonly used among US hospitals as a fall prevention strategy despite limited evidence of effectiveness. Further, fall prevention alarms are harmful to healthcare staff (e.g., alarm fatigue) and patients (e.g., sleep disturbance, mobility restriction). There is a need for research to develop and test strategies for reducing use of fall prevention alarms in US hospitals. Methods To address this gap, we propose testing the effectiveness and implementation of Alarm with Care, a de-implementation strategy to reduce fall prevention alarm use using a stepped-wedge randomized controlled trial among 30 adult medical or medical surgical units from nonfederal US acute care hospitals. Guided by the Choosing Wisely De-Implementation Framework, we will (1) identify barriers to fall prevention alarm de-implementation and develop tailored de-implementation strategies for each unit and (2) compare the implementation and effectiveness of high- versus low-intensity coaching to support site-specific de-implementation of fall prevention alarms. We will evaluate effectiveness and implementation outcomes and examine the effect of multi-level (e.g., hospital, unit, and patient) factors on effectiveness and implementation. Rate of fall prevention alarm use is the primary outcome. Balancing measures will include fall rates and fall-related injuries. Implementation outcomes will include feasibility, acceptability, appropriateness, and fidelity. Discussion Findings from this line of research could be used to support scale-up of fall prevention alarm de-implementation in other healthcare settings. Further, research generated from this proposal will advance the field of de-implementation science by determining the extent to which low-intensity coaching is an effective and feasible de-implementation strategy. Trial registration ClinicalTrials.gov identifier: NCT06089239 . Date of registration: October 17, 2023. |
| first_indexed | 2024-03-09T01:16:15Z |
| format | Article |
| id | doaj.art-0bab29bb5c3a444986e25a52a12564ad |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-03-09T01:16:15Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-0bab29bb5c3a444986e25a52a12564ad2023-12-10T12:26:57ZengBMCImplementation Science1748-59082023-12-011811910.1186/s13012-023-01325-9Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trialKea Turner0Molly McNett1Catima Potter2Emily Cramer3Mona Al Taweel4Ronald I. Shorr5Lorraine C. Mion6Department of Health Outcomes and Behavior, Moffitt Cancer CenterHelene Fuld Health Trust National Institute for Evidence-Based Practice, The Ohio State UniversityPress Ganey AssociatesDepartment of Health Outcomes and Health Services Research, Children’s Mercy Hospital and ClinicsCollege of Nursing, The Ohio State UniversityGeriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health SystemCollege of Nursing, The Ohio State UniversityAbstract Background Fall prevention alarms are commonly used among US hospitals as a fall prevention strategy despite limited evidence of effectiveness. Further, fall prevention alarms are harmful to healthcare staff (e.g., alarm fatigue) and patients (e.g., sleep disturbance, mobility restriction). There is a need for research to develop and test strategies for reducing use of fall prevention alarms in US hospitals. Methods To address this gap, we propose testing the effectiveness and implementation of Alarm with Care, a de-implementation strategy to reduce fall prevention alarm use using a stepped-wedge randomized controlled trial among 30 adult medical or medical surgical units from nonfederal US acute care hospitals. Guided by the Choosing Wisely De-Implementation Framework, we will (1) identify barriers to fall prevention alarm de-implementation and develop tailored de-implementation strategies for each unit and (2) compare the implementation and effectiveness of high- versus low-intensity coaching to support site-specific de-implementation of fall prevention alarms. We will evaluate effectiveness and implementation outcomes and examine the effect of multi-level (e.g., hospital, unit, and patient) factors on effectiveness and implementation. Rate of fall prevention alarm use is the primary outcome. Balancing measures will include fall rates and fall-related injuries. Implementation outcomes will include feasibility, acceptability, appropriateness, and fidelity. Discussion Findings from this line of research could be used to support scale-up of fall prevention alarm de-implementation in other healthcare settings. Further, research generated from this proposal will advance the field of de-implementation science by determining the extent to which low-intensity coaching is an effective and feasible de-implementation strategy. Trial registration ClinicalTrials.gov identifier: NCT06089239 . Date of registration: October 17, 2023.https://doi.org/10.1186/s13012-023-01325-9Fall preventionHospital fallsInpatient fallsDe-implementationChoosing wiselyLow-value care |
| spellingShingle | Kea Turner Molly McNett Catima Potter Emily Cramer Mona Al Taweel Ronald I. Shorr Lorraine C. Mion Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial Implementation Science Fall prevention Hospital falls Inpatient falls De-implementation Choosing wisely Low-value care |
| title | Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial |
| title_full | Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial |
| title_fullStr | Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial |
| title_full_unstemmed | Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial |
| title_short | Alarm with care—a de-implementation strategy to reduce fall prevention alarm use in US hospitals: a study protocol for a hybrid 2 effectiveness-implementation trial |
| title_sort | alarm with care a de implementation strategy to reduce fall prevention alarm use in us hospitals a study protocol for a hybrid 2 effectiveness implementation trial |
| topic | Fall prevention Hospital falls Inpatient falls De-implementation Choosing wisely Low-value care |
| url | https://doi.org/10.1186/s13012-023-01325-9 |
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