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NURSING SCIENCE
Alarm With Care
A De-Implementation Strategy to Reduce Fall Prevention Alarm Use in US Hospitals

Article Review by Carliss Ramos, DNP, RN, EBP-C, CPHQ Nurse Scientist

Article-Review.jpg
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
Published: Implementation Science, 2023
AACN Level of Evidence: B
Falls are common, costly and serious for healthcare organizations. Due to their frequency, significance and costs to patients, payers and healthcare organizations, falls are part of key quality measures for hospitals.1 Many nationwide fall initiatives include fall mats, virtual sitters and bed alarms. Nurses often feel pressured to comply with these initiatives, frequently adding to the nursing burden and alarm fatigue.2
What was the purpose?
This study aimed to identify barriers to de-implementing fall prevention alarms in thirty Acute Care medical-surgical units within the United States.3 De-implementation is the "process of reducing or stopping practices or services that are ineffective, unproven, harmful, overused, or inappropriate".4
What population was studied?
The study will be in acute care medical-surgical units.
Was the setting comparable to Houston Methodist? Were the nurses like our nurses?
The study was registered in October 2023 with 30 sites. Since then, two study locations have been withdrawn. The remaining sites are comparable to Houston Methodist Hospital and the Houston Methodist entities.
Did they use appropriate methods?
The study used a mixed-methods approach using the de-implementation protocol. The mixed-methods research approach combines quantitative and qualitative data collection and analysis to answer a research question. This method allows researchers to use several methods, thus offering greater insight. Concept mapping and focus groups were used to identify barriers so that a focused de-implementation, inclusive of education and coaching, could be developed. Education included the state of the evidence for effective and ineffective fall prevention practices. Coaching sessions depended on unit randomization.
What were their findings?
There were no findings since the protocol is still being implemented. As a first-in-kind fall prevention alarm de-implementation initiative, this study will add to the research gap and the de-implementation science literature.
Does the protocol make sense?
Yes, there are clear interventions with measurable primary outcomes. The primary outcome is a fall prevention prevalence survey; the second is patient falls.
How is this important for nursing?
This study is important as it offers a step-by-step de-implementation approach. Falls are not unique to Houston Methodist. This project provides a valuable approach to addressing falls within our organization and other processes or practices to these problems that are ineffective, unproven, harmful, overused or inappropriate.4
Read the full article ›
References:
  1. NQF: Focus on HARM (Harmonizing Accountability in Reporting and Monitoring) - Description. (n.d.). www.qualityforum.org. Retrieved May 13, 2024, from https://www.qualityforum.org/ProjectDescription.aspx?projectID=98544
  2. King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. The Gerontologist, 58(2), 331–340. https://doi.org/10.1093/geront/gnw156
  3. Turner, K., McNett, M., Potter, C., Cramer, E., Mona Al Taweel, Shorr, R. I., & Mion, L. C. (2023). 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, 18(1). https://doi.org/10.1186/s13012-023-01325-9
  4. Prusaczyk, B., Swindle, T., & Curran, G. (2020). Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes. Implementation Science Communications, 1(1). https://doi.org/10.1186/s43058-020-00035-3