In patient falls remain a common, costly, and serious adverse event in hospitals. Falls impact patients'quality of life and represent a significant costto society. Thus, decreasing the incidence of falls is a priority of the National Quality Forum, the federal government, regulatory agencies, hospital quality improvement programs, and patient safety research. The long-range goal of this project is to reduce inpatient falls in Critical Acces Hospitals, which serve priority rural older adult populations at high risk for falls, yet lack the incentives and/or resources present in larger hospitals. Our completed risk assessment indicated that the risk of falls in Nebraska hospitals is highest in Critical Access Hospitals that do not use an interprofessional team to integrate evidence from multiple disciplines and learn from previous falls. The objective of this research project is to implement the safe practice of inpatient fall risk reduction by leveraging professionalism and providing support from a culture of safety, teamwork, and organizational learning/sensemaking. We will implement this synthesis of practices in 21 partner hospitals, 17 of which are Critical Access Hospitals. This long-range goal and objective are consistent with the mission of the Agency for Healthcare Research and Quality, which is to improve the quality, safety, efficiency, and effectiveness of healthcare for al Americans. The theoretical rationale for our approach to implementation is Rogers'organization innovation process. Successful implementation of innovations within organizations is a five-stage process: (1) awareness of a need, (2) matching an innovation to the need, (3) re-inventing the innovation to match the organization's context, (4) clarifying roles and tasks, and (5) routinizing the innovation into daily work. Based on this approach, this project has three aims to achieve with our partner hospitals: (1) develop customized action plans to improve the structure and process of fall risk reduction that account for the context of each hospital, (2) support implementation of the action plans, and (3) evaluate implementation of the action plans by re-assessing the structure, process, outcomes, and context of fall risk reduction at the end of the project. This project is innovative because it seeks to change the clinical practice paradigm of fall risk reduction from a nursing-centric approach to an interprofessional team approach in which falls are considered an indicator of organizational quality. This project will make a significant contribution to public health by integrating four supporting practices into fall risk reduction, which will support diffusion and adoption of these practices and make a difference in patient care and patient safety.

Public Health Relevance

This research project is relevant to public health because it seeks to decrease the risk of falls for older adults treated in Critical Access Hospitals. The proposed approach will contribute to the evidence base for implementation of safe practice interventions by changing the current clinical paradigm for fall risk reduction from a nursing-centric goal to an organizational goal achieved through safety culture, teamwork, and sense making.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (HSQR)
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Hogan, Eileen
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University of Nebraska Medical Center
Other Health Professions
Schools of Medicine
United States
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Reiter-Palmon, Roni; Kennel, Victoria; Allen, Joseph A et al. (2015) Naturalistic Decision Making in After-Action Review Meetings: The Implementation of and Learning from Post-Fall Huddles. J Occup Organ Psychol 88:322-340