Table 4, Chapter 19Implementation themes highlighted in implementation studies

Author/YearLeadership SupportFrontline EngagementMultidisciplinary CommitteesPilot TestingInformation Technology SystemsAttitude ChangeEducation and TrainingResults of Intervention and Implementation
Browne et al., 200440----Falls Committee; quarterly meetingsOnce the tool was developed, it was piloted and validated. The results were presented to the MHS Falls Committee, who gave permission for automated implementation system-wide.“the redesign of an adult inpatient falls program using a computerized information system…the tool provides an accurate assessment of the fall risk of each patient. Indicators are embedded into routine assessment documentation, eliminating added chargting time. The program allows tailored interventions for specific patient risks.”--“Nurses were taught about the redesigned falls program by ‘fall and restraint fairs’ that coincided with its implementation.Successful
Capan et al., 200741A unit champion was selected to “act as a staff resource… who was respected as a mentor and passionate about patient safety”Staff involved in choosing equipment“the hospital quality council chartered a multidisciplinary falls prevention task force. The team included nurses, nursing management, a physician/geriatrician, nursing educators, a psychiatric clinical specialist , risk management staff, performance improvement/measurement staff, and representatives from physical therapy and pharmacy.”A pilot test of the new tool was conducted in “a medical/neurology unit with a high fall incidence rate.” The original plan to roll the tool out one unit at a time was modified to “an immediate hospital-wide implementation” after the success of the pilot program.--“Nurses were reluctant to impose the interventions… [but] they came to recognize the importance of each step” “As the staff began using the interventions… falls began to decline”The research team “educated the staff about falls and the importance of fall prevention,” including background information on falls and how the new tool was to be used. “95% of staff completed the education prior to the implementation of the tool.”Successful
Dempsey, 200442--Raised concern over nurses' power to induce change--A tool was developed and “tested for inter-rater reliability in a pilot study when five nurses of different experience levels assessed the same patient.” “On the basis of the results of the research project, the Falls Prevention Programme became standard practice for medical patients…”--“In the pilot study….a number of nurses expressed the belief that falls were inevitable and that there was nothing that could be done to change this. Although the study demonstrated that it was possible to reduce the rate of patient falls, the remarks of the nurses support the suggestion…that the successful reduction of patient falls lay in the attitude of the nurses themselves. ”“The Falls Prevention programme consisted of an assessment tool, an alert graphic, and education (patient and staff)” “Staff education commenced at the introduction of the study and continued intermittently though formal and informal means.”Mixed results, initial success followed by deterioration over five years.
Gutierrez, 200843Identify clinical champions; leadership on unit agreed to send a nurse to the Evidence-Based Practice Institute“project design included soliciting staff and physician feedback”--------Yes, one key component was a brief “elevator speech” for engaging and educating staffSuccessful
Kolin et al., 201044Leadership formed a team to address falls issue, team was led by a senior vice president, information was presented to leadership throughout project--“The fall team meets regularly, with in-depth analysis… at regular intervals…”Multiple tools were tested before the redesign team developed their own, which was also tested.Currently, the team is are “working on an interface to connect the system electronic medical record with the event reporting system.” The system had a combination of paper documentation and electronic record sites, which had separate program roll out.“Implementation means changing the way nurses think about falls… accepting that ‘all’ patients are at risk.”“Comprehensive nursing education was conducted”Successful
McCollam, 199545Nursing Administration involved in full implementation--“Research in Practice Committee” oversaw the projectProblems identified during the pilot included inconsistent and incomplete reassessment, identification of secondary diagnoses, and score consistencies between shifts. Adjustments were made for full implementation.--Compliance for care plans and interventions lagged behind risk assessment, which could be due to skepticism about the program. “Some nurses may question the instrument's findings or not believe the problem serious enough to address.”Training sessions were conducted for nursing; video tape was shown about tool; understanding checked using evaluationSuccessful
Neily, 200539“Senior leadership support helps remove organizational barriers to change and provides resources needed to implement change” “The four sites that reported spreading changes to other facilities also indicated that leadership was a major success factor.”--“…teamwork skills are an important component of sustained success” Interdisciplinary or multidisciplinary falls team was a core component of all four high performing sites.--------Successful
O'Connell, 200146----Team of researchers and cliniciansNo pilot test was conducted.--Risk assessment tool difficulties may have undermined staff confidence and the program “may have lost some of its significance.” Staff felt that they were already doing everything they could, and this program did not add anything--Unsuccessful
Rauch et al., 200947Leadership hired a consulting team. All levels of leadership were engaged and accepted ownership of the project. A champion was identified in each unit.“It is imperative to obtain frontline staff input and feedback to ensure that successful change management occurs in the clinical arena” “If there are any words of advice here, they would be: never change a program without directly involving and getting buy-in from those it immediately affects.”“The Fall Team, multidisciplinary in nature and inclusive of managers and frontline staff [were involved in all phases of the project]” Weekly teleconferences during implementation; monthly fall team meetings after implementationDuring the 30 day pilot, “staff were routinely questioned and encouraged to provide feedback on elements working well and elements that were failing… Changes were made as needed…the pilot was extended…to ensure a solid process before total hospital roll-out.”----“…educational needs were identified and sessions were scheduled… [including] an introduction of the assessment tool and proper utilization”Successful
Semin-Goossens, 200348Attempt to involve medical chiefs and nurse managers could have promoted implementation “In our case, efforts to reach and involve the people higher in the hierarchy such as the Medical Chiefs and nursing managers were not successful.”“We did not believe in a top-down strategy and so we involved the nurses in rewriting and implementing the guideline.” Authors would have tried to get more buy-in from floor nurses if given another try, but they did receive feedback and modify the intervention accordingly.A project team was formed consisting of 9 nurses in various positions, a clinical epidemiologist, and a consultant for quality improvement projects.After a 3 month pilot, the guidelines were finalized.--“Nurses…frequently stated that it was simply impossible to prevent patients from falling. Falling was recurrently considered to be an inevitable part of aging, hospitalization, and illness, and therefore seen as an unavoidable accident, rather than something predictable and often preventable.”Dissemination of the guideline, including large posters.Unsuccessful
Weinberg et al., 201149Hospital leadership initiated effort and prioritized fall prevention--Committee was formed by leadership and attendance was mandated; monthly fall reviews were attended by unit managers, staff involved in patient care, and fall prevention initiative co-chairsThe Fall Prevention Initiative was rolled out incrementally, using continuous quality improvement methods--Transforming the culture was integral to implementation; emphasis placed on building a “just culture” and having a “constructive, nonpunitive forum” for discussionYesSuccessful

From: Chapter 19, Preventing In-Facility Falls

Cover of Making Health Care Safer II
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 211.

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