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A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention.

Astrid Semin-Goossens1, Jelle M J van der Helm, Patrick M M Bossuyt

  • 1Center for Clinical Practice Guidelines, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. a.semin@amc.uva.nl

Journal of Nursing Care Quality
|July 15, 2003
PubMed
Summary

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A multifaceted intervention failed to reduce patient falls or improve incident reporting, despite using a structured implementation model. Further research is needed to understand nurse perceptions and develop effective fall prevention strategies.

Area of Science:

  • Nursing
  • Patient Safety
  • Healthcare Quality Improvement

Background:

  • A 1993 evidence-based nursing guideline initially reduced fall rates by 30%, but implementation failed.
  • The guideline was updated between 1999-2001, with a multifaceted intervention designed using a change implementation model.

Purpose of the Study:

  • To implement a multifaceted intervention based on Grol's 5-step model to reduce patient fall incidence by 30% within one year.
  • To evaluate the effectiveness of the intervention in reducing fall rates and improving the completion of Incidence Report Forms (IRFs).

Main Methods:

  • The study was conducted in two hospital wards (internal medicine and neurology).
  • Grol's 5-step implementation model guided the intervention strategy.
  • Fall data were collected from nursing records and IRFs.

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Main Results:

  • Average fall incidence was 8 falls/1000 patient-days in internal medicine and 13 in neurology, failing to meet the 30% reduction target (aimed for 6 and 11 respectively).
  • No significant declining trend in fall incidence was observed over the intervention year.
  • The percentage of completed IRFs remained low and variable (52% internal medicine, 60% neurology).

Conclusions:

  • The model-based implementation strategy did not achieve a sustained reduction in monthly patient falls.
  • No improvement in the quality or completeness of incident reporting was observed.
  • The study suggests a need to investigate nurses' perceptions of patient falls and develop effective strategies for attitude change to enhance fall prevention.