De-Implementation of Alarms for Fall Prevention: Optimal Strategies for Reducing Routine Use

Abstract

Purpose and Background: Falls are a leading cause of injury-related deaths, yet the use of bed alarms as a fall prevention intervention does not significantly decrease fall rates in hospitals. Nonetheless, there is limited research on the de-implementation of bed alarms and effective substitutes to prevent falls. Therefore, the purpose of this sub-study is to (1) identify optimal strategies to support the de-implementation of alarms for fall prevention and (2) determine additional evidence-based fall prevention interventions to support de-implementation of routine use of fall prevention alarms. Theoretical Framework: Choosing Wisely De-Implementation Framework; Consolidated Framework for Implementation Research. Methods: A secondary data analysis collected from the Alarm With Care Study using a hybrid II effectiveness-implementation approach with a stepped-wedge cluster randomized trial. Data involving different implementation strategies were extracted on the number of strategy types that hospitals used to decrease routine use of alarms. Data was also gathered on additional fall prevention practices used to support de-implementation efforts. Finally, data were recorded on the final phase of implementation achieved by all sites. Results: All sites were required to implement the core strategies of educational meetings, auditing & feedback, and use of local champions, which were used by all sites (n=20, 100%). The most frequent additional strategies used to support de-implementation efforts included: distribute educational material (n=16, 80%), educational outreach visits (n=15, 75%), and conduct ongoing training (n=15, 75%). Low-intensity sites used more additional strategies than high-intensity sites, but it did not significantly influence the final phase of implementation achieved (ꭓ2=0.833, p=0.361). The majority of sites (n=18, 90%) included use of additional fall prevention best practices to reduce reliance on alarms. Across all sites, there were no significant changes to fall rates, and rates remained similar when compared to a national sample of hospitals not participating in the study that served as the control group. Conclusions: Decreasing alarm use for fall prevention is feasible and does not adversely affect fall rates among a national sample of hospitals. Core strategies such as education, audit and feedback, and use of local champions can support de-implementation efforts, and additional strategies are likely needed based on site resources. Ensuring that additional evidence-based fall prevention practices are in place may be an effective tool to further support de-implementation efforts and ensure sustainability of practice changes over time.