TY - JOUR
T1 - A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention
AU - Semin-Goossens, Astrid
AU - van der Helm, Jelle M. J.
AU - Bossuyt, Patrick M. M.
PY - 2003
Y1 - 2003
N2 - Background: An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change. Method: The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs). Results: In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6-11 and 10-15). There was a changeable pattern over time without any declining trend. The percentage fined in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department. Conclusion: There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully
AB - Background: An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change. Method: The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs). Results: In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6-11 and 10-15). There was a changeable pattern over time without any declining trend. The percentage fined in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department. Conclusion: There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully
U2 - https://doi.org/10.1097/00001786-200307000-00008
DO - https://doi.org/10.1097/00001786-200307000-00008
M3 - Article
C2 - 12856906
SN - 1057-3631
VL - 18
SP - 217
EP - 225
JO - Journal of nursing care quality
JF - Journal of nursing care quality
IS - 3
ER -