Reducing Fall Prevention Alarms in Hospitals

Recruiting in Palo Alto (17 mi)

+19 other locations

Overseen by Ronald I Shorr, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Florida

No Placebo Group

Trial Summary

What is the purpose of this trial?

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.

Do I need to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment High Intensity Coaching, Tailored De-implementation Strategies, and Low Intensity Coaching in reducing fall prevention alarms in hospitals?

Research shows that a multi-pronged approach, including staff education and focusing on high-risk patients, can significantly reduce falls in hospitals. Additionally, comprehensive fall-prevention programs that assess fall risks and provide targeted interventions have been effective in reducing both falls and related injuries. ^{1 2 3 4 5}

Is reducing fall prevention alarms in hospitals safe for humans?

The research does not provide specific safety data for reducing fall prevention alarms, but it highlights that current alarm use can have unintended negative consequences, suggesting a need for careful implementation of any changes. ^{5 6 7 8 9}

How does the treatment for reducing fall prevention alarms in hospitals differ from other treatments?

This treatment focuses on reducing the use of fall prevention alarms in hospitals, which are often ineffective and can cause issues like alarm fatigue and sleep disturbances. Unlike traditional methods that rely on alarms, this approach aims to minimize their use and instead encourages strategies that promote patient mobility and safety without the negative side effects of constant alarms. ^{1 2 5 10 11}

Research Team

Ronald I Shorr, MD

Principal Investigator

University of Florida

Eligibility Criteria

This trial is for stakeholders involved in fall prevention at up to 30 hospitals participating in the NDNQI program. It's designed for those who are directly engaged with patient safety and want to explore alternative methods to prevent falls without relying on alarms.

Inclusion Criteria

You are a stakeholder in fall prevention at up to 30 NDNQI hospitals.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline

Baseline data collection on fall prevention alarm prevalence and patient falls

4 weeks

Monthly data collection

Intervention

Implementation of tailored de-implementation strategies with high or low intensity coaching

30 months

Weekly virtual sessions initially, then monthly follow-ups

Follow-up

Participants are monitored for safety and effectiveness after intervention

4 weeks

Treatment Details

Interventions

• High Intensity Coaching (Behavioural Intervention)
• Low Intensity Coaching (Behavioural Intervention)

Trial Overview The study tests two levels of coaching intensity (low and high) aimed at reducing reliance on fall prevention alarms. Hospitals will be randomly assigned to receive either low-intensity or high-intensity coaching, which includes education, audit/feedback, and guidance from opinion leaders.

Participant Groups

Group I: High Intensity Coaching Active Control 1 Intervention

In Quarter 1, high intensity initiation coaching will consist of a four-hour orientation session that will include: * comprehensive information on behavior and organizational change theory, * suggested approaches, and * in-depth training on behavioral and organization-focused change techniques to stimulate implementation efforts. Commencing in Quarter 2, high intensity sustainability coaching will consist of: * weekly virtual follow up sessions for the first month, followed by private monthly coaching follow up sessions via a virtual format. * Access to additional monthly web-based, synchronous "office hours" for group discussion on progress and customized troubleshooting to assist in navigating barriers. * Sites will also have access to "on call" assistance with coaches to assist with navigating challenges in real time.

Group II: Low Intensity Coaching Placebo Group 1 Intervention

In Quarter 1, low intensity initiation coaching will be conducted. It will consist of: * initial two-hour orientation session with introductory content on behavior change and organizational change theory and techniques, * an overview of implementation phases, and * selection of tailored de-implementation strategies for that site based on readiness for change, focus group data and local resources. Implementation coaches will provide the Fuld Toolkit for the site with suggestions for assigning strategies, local leaders, and development of timelines for de-implementation. Coaches will instruct site Team Leaders to establish the primary mechanism for sharing baseline and trended data in real time.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

Kent Hospital Warwick, RI

El Camino Health - Los Gatos Mountain View, CA

Lahey Hospital & Medical Center Derry, NH

IU Health North Hospital Indianapolis, IN

More Trial Locations

Who Is Running the Clinical Trial?

University of Florida

Lead Sponsor

Trials

1428

Patients Recruited

987,000+

National Institute on Aging (NIA)

Collaborator

Trials

1841

Patients Recruited

28,150,000+

Findings from Research

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nurses' experiences with bed exit alarms may lead to ambivalence about their effectiveness. Hubbartt, B., Davis, SG., Kautz, DD.[2019]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fall prevention in hospitals: an integrative review. Spoelstra, SL., Given, BA., Given, CW.[2012]

A systematic review of 59 studies on fall prevention in U.S. acute care hospitals found that while many interventions included multiple components, only 45% of studies with concurrent controls provided sufficient data to compare fall rates, indicating a need for better reporting.

The pooled analysis showed a postintervention incidence rate ratio (IRR) of 0.77, suggesting a potential reduction in falls, but the lack of systematic associations between implementation strategies and effectiveness highlights the need for improved adherence and detailed reporting in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Hempel, S., Newberry, S., Wang, Z., et al.[2022]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Team approach to fall reduction in paediatric ward of national referral hospital, Thimphu, Bhutan: a quality improvement initiative. Chhetri, K., Rinchen, U., Lamichaney, G., et al.[2022]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unit-level variation in bed alarm use in US hospitals. Staggs, VS., Turner, K., Potter, C., et al.[2021]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Hill, AM., McPhail, SM., Waldron, N., et al.[2022]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Validating Fall Prevention Icons to Support Patient-Centered Education. Leung, WY., Adelman, J., Bates, DW., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of implementing a practice guideline for fall prevention on geriatric wards: a multicentre study. Milisen, K., Coussement, J., Arnout, H., et al.[2013]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How feasible was a bed-height alert system? Tzeng, HM., Prakash, A., Brehob, M., et al.[2021]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Turner, K., McNett, M., Potter, C., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals. Gray-Miceli, D., Mazzia, L., Crane, G.[2017]

References

1. United States pubmed.ncbi.nlm.nih.gov

Nurses' experiences with bed exit alarms may lead to ambivalence about their effectiveness. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Fall prevention in hospitals: an integrative review. [2012]

3. United States pubmed.ncbi.nlm.nih.gov

Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Team approach to fall reduction in paediatric ward of national referral hospital, Thimphu, Bhutan: a quality improvement initiative. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Unit-level variation in bed alarm use in US hospitals. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Validating Fall Prevention Icons to Support Patient-Centered Education. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Feasibility of implementing a practice guideline for fall prevention on geriatric wards: a multicentre study. [2013]

9. United States pubmed.ncbi.nlm.nih.gov

How feasible was a bed-height alert system? [2021]

10. England pubmed.ncbi.nlm.nih.gov

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. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals. [2017]