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Selecting and tailoring implementation strategies for deimplementing fall prevention alarms in US hospitals: a group concept mapping study
  1. Kea Turner1,2,
  2. Mona Al Taweel3,
  3. Carrie Petrucci4,
  4. Scott Rosas4,5,
  5. Catima Potter6,
  6. Emily Cramer7,8,
  7. Ronald I. Shorr9,10,
  8. Lorraine C Mion3,
  9. Molly McNett11
  1. 1The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
  2. 2The University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
  3. 3The Ohio State University College of Nursing, Columbus, OH, USA
  4. 4Concept Systems, Inc, Ithaca, NY, USA
  5. 5Department of Public Health and Preventive Medicine, SUNY Upstate Medical University College of Medicine, Syracuse, NY, USA
  6. 6Press Ganey Associates, LLC, South Bend, IN, USA
  7. 7Department of Health Outcomes and Health Services Research, Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
  8. 8Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
  9. 9Department of Epidemiology, University of Florida College of Public Health and Health Professionals, Gainesville, FL, USA
  10. 10Geriatric Research Education and Clinical Center (GRECC); North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, FL, USA
  11. 11Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing & Healthcare, The Ohio State University College of Nursing, Columbus, OH, USA
  1. Correspondence to Professor Kea Turner; kea.turner{at}unc.edu

Abstract

Objectives Many hospitals use fall prevention alarms, despite the limited evidence of effectiveness. The objectives of this study were (1) to identify, conceptualise and select strategies to deimplement fall prevention alarms and (2) to obtain feedback from key stakeholders on tailoring selected deimplementation strategies for the local hospital context.

Methods Hospital staff working on fall prevention participated in group concept mapping (GCM) to brainstorm strategies that could be used for fall prevention alarm deimplementation, sort statements into conceptually similar categories and rate statements based on importance and current use. Hospital staff also participated in site-specific focus groups to discuss current fall prevention practices, strategies prioritised through GCM and theory-informed strategies recommended by the study team, and potential barriers/facilitators to deimplementing fall prevention alarms.

Results 90 hospital staff across 13 hospitals brainstormed, rated and sorted strategies for alarm deimplementation. Strategies that were rated as highly important but underutilised included creating/revising staff roles to support fall prevention (eg, hiring or designating mobility technicians) and revising policies and procedures to encourage tailored rather than universal fall precautions. 192 hospital staff across 22 hospitals participated in site-specific focus groups. Participants provided feedback on each strategy’s relevance for their site (eg, if site currently has a mobility technician) and local barriers or facilitators (eg, importance of having separate champions for day and night shift). Findings were used to develop a tailored implementation package for each site that included a core set of strategies (eg, external facilitation, education, audit-and-feedback, champions), a select set of site-specific strategies (eg, designating a mobility technician to support fall prevention) and guidance for how to operationalise and implement each strategy given local barriers and facilitators.

Conclusion Findings from this study can be used to inform future programmes and policies aimed at deimplementing fall prevention alarms in hospitals.

  • Implementation science
  • Qualitative research
  • Health services research
  • Hospitals

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request and may require establishment of a data use agreement.

https://doi.org/10.1136/bmjqs-2024-018391

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request and may require establishment of a data use agreement.

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    Footnotes

    • X @TurnerKea, @rshorr

    • Contributors MM and RS managed this research study. KT collected and analysed the data and drafted the manuscript. MM, MAT and LCM assisted with data and analysis, led the preparation of the implementation packages and reviewed the manuscript. CP and SR assisted with data collection and analysis, and drafting the manuscript. EC, CP and RS provided assistance with data interpretation and reviewed the manuscript. KT is the guarantor of this statement and takes full responsibility for the conduct of this work and the decision to publish.

    • Funding This study was funded by National Institute on Aging (R01 AG073408-01A1).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.