title: A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention.
abstract: BACKGROUND
  An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change.
  
  
  METHODS
  The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs).
  
  
  RESULTS
  In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6-11 and 10-15). There was a changeable pattern over time without any declining trend. The percentage filled in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department.
  
  
  CONCLUSIONS
  There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully.
authors.affiliation: Center for Clinical Practice Guidelines, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. a.semin@amc.uva.nl
authors.forename: Astrid
authors.initials: A
authors.lastname: Semin-Goossens
authors.forename: Jelle M J
authors.initials: JM
authors.lastname: van der Helm
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
mesh_terms: D000046:Academic Medical Centers; D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000592:standards*; D006757:Hospital Units / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016294:Models, Nursing; D009426:Netherlands; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management