Choosing Wisely: De-implementing Fall Prevention Alarms in Hospitals

NCT ID: NCT06089239

Last Updated: 2025-07-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-01

Study Completion Date

2026-08-31

Brief Summary

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This is a Hybrid II de-implementation study to reduce use of fall prevention alarms in hospitals. The intervention consists of tailored, site-specific approaches for three core implementation strategies: education, audit/feedback and opinion leaders. Hospital units will be randomized to low-intensity or high-intensity coaching for the implementation of the tailored strategies.

Detailed Description

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Inpatient falls result in significant physical and economic burdens to patients (increased injury and mortality rates and decreased quality of life) as well as to medical organizations (increased lengths of stay, medical care costs, and litigation). The Centers for Medicare \& Medicaid Services (CMS) considers falls with injury a "never event"- an error in medical care that indicates a real problem in the safety and credibility of a health care institution. Hospitals are no longer reimbursed for extra costs incurred in the diagnosis and management of inpatient fall-related injuries. Thus, because patient falls are common, costly and interpreted as poor care quality, hospitals are highly incentivized to prevent them.

Alarm systems are designed to reduce falls by alerting staff when patients attempt to leave a bed or chair without assistance. There is now strong evidence that alarms are ineffective as a fall prevention maneuver in hospitals. Despite this, more than one-third of hospital patients are undergoing fall prevention alarm monitoring. In nursing homes, CMS regulates the use of fall prevention alarms as it does physical restraints. Instructions to nursing home surveyors state these devices should be used only when medically necessary and continuously reevaluated.

Guided by the Choosing Wisely De-implementation Framework, this project will generate a generalizable approach using coaching and tailored de-implementation strategies to reduce use of fall prevention alarms in hospitals. The investigators will conduct a hybrid II implementation study in 30 medical or medical-surgical units from US non-federal hospitals participating in the National Database of Nursing Quality Indicators. Findings from this study could also support future trials aimed at de-implementing low-quality alarm use in other care settings with known high fall rates (e.g., stroke care, cancer care). Evaluation of high versus low intensity coaching addresses an urgent need to evaluate use of tailored strategies and to establish effective thresholds for coaching within health service settings that have varying resources to support de-implementation efforts

Conditions

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Accidental Fall Patient Safety Hospital Acquired Condition Clinical Alarms Mentoring

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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High Intensity Coaching

In Quarter 1, high intensity initiation coaching will consist of a four-hour orientation session that will include:

* comprehensive information on behavior and organizational change theory,
* suggested approaches, and
* in-depth training on behavioral and organization-focused change techniques to stimulate implementation efforts.

Commencing in Quarter 2, high intensity sustainability coaching will consist of:

* weekly virtual follow up sessions for the first month, followed by private monthly coaching follow up sessions via a virtual format.
* Access to additional monthly web-based, synchronous "office hours" for group discussion on progress and customized troubleshooting to assist in navigating barriers.
* Sites will also have access to "on call" assistance with coaches to assist with navigating challenges in real time.

Group Type ACTIVE_COMPARATOR

High Intensity Coaching

Intervention Type OTHER

External coaching is a commonly used strategy to change practice, especially for multi-site collaboratives where implementation requires customization to the site. Coaches serve as skill builders who train organizational personnel in quality improvement processes and develop proficiency in the targeted practice area (i.e., fall prevention).

Low Intensity Coaching

In Quarter 1, low intensity initiation coaching will be conducted. It will consist of:

* initial two-hour orientation session with introductory content on behavior change and organizational change theory and techniques,
* an overview of implementation phases, and
* selection of tailored de-implementation strategies for that site based on readiness for change, focus group data and local resources.

Implementation coaches will provide the Fuld Toolkit for the site with suggestions for assigning strategies, local leaders, and development of timelines for de-implementation.

Coaches will instruct site Team Leaders to establish the primary mechanism for sharing baseline and trended data in real time.

Group Type SHAM_COMPARATOR

Low Intensity Coaching

Intervention Type OTHER

External coaching is a commonly used strategy to change practice, especially for multi-site collaboratives where implementation requires customization to the site. Coaches serve as skill builders who train organizational personnel in quality improvement processes and develop proficiency in the targeted practice area (i.e., fall prevention).

Interventions

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High Intensity Coaching

External coaching is a commonly used strategy to change practice, especially for multi-site collaboratives where implementation requires customization to the site. Coaches serve as skill builders who train organizational personnel in quality improvement processes and develop proficiency in the targeted practice area (i.e., fall prevention).

Intervention Type OTHER

Low Intensity Coaching

External coaching is a commonly used strategy to change practice, especially for multi-site collaboratives where implementation requires customization to the site. Coaches serve as skill builders who train organizational personnel in quality improvement processes and develop proficiency in the targeted practice area (i.e., fall prevention).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Stakeholders in fall prevention at up to 30 participating NDNQI hospitals

Exclusion Criteria

\-
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

University of Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ronald I Shorr, MD

Role: PRINCIPAL_INVESTIGATOR

University of Florida

Locations

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PIH Health Downey Hospital

Downey, California, United States

Site Status RECRUITING

El Camino Health - Los Gatos

Mountain View, California, United States

Site Status RECRUITING

University of California Davis Medical Center

Sacramento, California, United States

Site Status RECRUITING

Lakeland Regional Medical Center

Lakeland, Florida, United States

Site Status WITHDRAWN

OSF Saint Anthony's Health Center

Alton, Illinois, United States

Site Status WITHDRAWN

Central DuPage Hospital

Winfield, Illinois, United States

Site Status RECRUITING

Hendricks Regional Health

Danville, Indiana, United States

Site Status RECRUITING

IU Health North Hospital

Indianapolis, Indiana, United States

Site Status RECRUITING

UMass Memorial Health Harrington

Southbridge, Massachusetts, United States

Site Status RECRUITING

Henry Ford Hospital West Bloomfield

West Bloomfield, Michigan, United States

Site Status RECRUITING

Lahey Hospital & Medical Center

Derry, New Hampshire, United States

Site Status RECRUITING

Hunterdon Medical Center

Flemington, New Jersey, United States

Site Status RECRUITING

Raritan Bay Medical Center

New Brunswick, New Jersey, United States

Site Status RECRUITING

Greenwich Hospital

River Vale, New Jersey, United States

Site Status WITHDRAWN

St Peter's Health Samaritan Hospital

Albany, New York, United States

Site Status RECRUITING

Grant Medical Center

Columbus, Ohio, United States

Site Status RECRUITING

Barberton Hospital

Uniontown, Ohio, United States

Site Status RECRUITING

Kaiser Westside Medical Center

Hillsboro, Oregon, United States

Site Status RECRUITING

Kaiser Permanente - Sunnyside Medical Center

Woodburn, Oregon, United States

Site Status RECRUITING

Christiana Care

West Chester, Pennsylvania, United States

Site Status WITHDRAWN

Kent Hospital

Warwick, Rhode Island, United States

Site Status RECRUITING

Prisma Health

Irmo, South Carolina, United States

Site Status RECRUITING

St. David's Medical Center

Austin, Texas, United States

Site Status RECRUITING

Covenant Medical Center

Lubbock, Texas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Ronald I Shorr, MD, MS

Role: CONTACT

352-271-5001

Facility Contacts

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Silvia Hernandez

Role: primary

Ann Aquino

Role: primary

Stacy Henever

Role: primary

Mary Fran Oskvarek

Role: primary

Hannah Wyneken

Role: primary

Amy Leach

Role: primary

William Heckendorf

Role: primary

Kyle Bartley

Role: primary

Danielle Ferreira

Role: primary

Marianne Sweeney

Role: primary

Kathy Taylor

Role: primary

Carole Wickham

Role: primary

Logan Griffith

Role: primary

Jenny Morgan

Role: primary

Audra Pfund

Role: primary

Branden Shepitka

Role: primary

Julie Fierro

Role: primary

Whitney Smith

Role: primary

Breanna Compian

Role: primary

Crystal Johnston

Role: primary

References

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Turner K, McNett M, Potter C, Cramer E, Al Taweel M, Shorr RI, Mion LC. 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. Implement Sci. 2023 Dec 5;18(1):70. doi: 10.1186/s13012-023-01325-9.

Reference Type DERIVED
PMID: 38053114 (View on PubMed)

Other Identifiers

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R01AG073408-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CED000000718

Identifier Type: -

Identifier Source: org_study_id

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