Clinical trial NCT06089239: Choosing Wisely: De-implementing Fall Prevention Alarms in Hospitals
Official title: De-Implementing Fall Prevention Alarms in Hospitals
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Accidental Fall
Patient Safety
Hospital Acquired Condition
Clinical Alarms
Mentoring
Lead sponsor: University of Florida
Sponsor class: OTHER
Collaborators: name: National Institute on Aging (NIA)
First posted: 2023-10-18
Enrollment: 300
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This is a Hybrid II de-implementation study to reduce use of fall prevention alarms in hospitals. The intervention consists of tailored, site-specific approaches for three core implementation strategies: education, audit/feedback and opinion leaders. Hospital units will be randomized to low-intensity or high-intensity coaching for the implementation of the tailored strategies.

Detailed description: 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 that alarms are ineffective as a fall prevention maneuver in hospitals. Despite this, 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. The investigators 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

Eligibility criteria: Inclusion Criteria:

* Stakeholders in fall prevention at up to 30 participating NDNQI hospitals

Exclusion Criteria:

-

Primary outcomes:
measure: Fall Prevention Alarm Prevalence survey
timeFrame: monthly for 30 months
measure: Patient Falls
timeFrame: monthly for 30 months
Secondary outcomes:
Other outcomes:
Locations:
city: Downey
country: United States
facility: PIH Health Downey Hospital
state: California
city: Mountain View
country: United States
facility: El Camino Health - Los Gatos
state: California
city: Sacramento
country: United States
facility: University of California Davis Medical Center
state: California
city: Lakeland
country: United States
facility: Lakeland Regional Medical Center
state: Florida
city: Alton
country: United States
facility: OSF Saint Anthony's Health Center
state: Illinois
city: Winfield
country: United States
facility: Central DuPage Hospital
state: Illinois
city: Danville
country: United States
facility: Hendricks Regional Health
state: Indiana
city: Indianapolis
country: United States
facility: IU Health North Hospital
state: Indiana
city: Southbridge
country: United States
facility: UMass Memorial Health Harrington
state: Massachusetts
city: West Bloomfield
country: United States
facility: Henry Ford Hospital West Bloomfield
state: Michigan
city: Derry
country: United States
facility: Lahey Hospital & Medical Center
state: New Hampshire
city: Flemington
country: United States
facility: Hunterdon Medical Center
state: New Jersey
city: New Brunswick
country: United States
facility: Raritan Bay Medical Center
state: New Jersey
city: River Vale
country: United States
facility: Greenwich Hospital
state: New Jersey
city: Albany
country: United States
facility: St Peter's Health Samaritan Hospital
state: New York
city: Columbus
country: United States
facility: Grant Medical Center
state: Ohio
city: Uniontown
country: United States
facility: Barberton Hospital
state: Ohio
city: Hillsboro
country: United States
facility: Kaiser Westside Medical Center
state: Oregon
city: Woodburn
country: United States
facility: Kaiser Permanente - Sunnyside Medical Center
state: Oregon
city: West Chester
country: United States
facility: Christiana Care
state: Pennsylvania
city: Warwick
country: United States
facility: Kent Hospital
state: Rhode Island
city: Irmo
country: United States
facility: Prisma Health
state: South Carolina
city: Austin
country: United States
facility: St. David's Medical Center
state: Texas
city: Lubbock
country: United States
facility: Covenant Medical Center
state: Texas
Study officials:
affiliation: University of Florida
name: Ronald I Shorr, MD
role: PRINCIPAL_INVESTIGATOR
References: