Paper: Fall Prevention at Acute Care Hospitals in Singapore: A Strategy for Implementation of Clinical Practice Guidelines (19th International Nursing Research Congress Focusing on Evidence-Based Practice)

Tuesday, 8 July 2008: 1:55 PM

Serena Siew Lin Koh, BSc, (Hons), Adv, Dip, (Midwifery), RN , Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore

Elizabeth Manias, RN, MPharm, PhD , School of Nursing, The University of Melbourne, Carlton Victoria 3053, Australia

Alison M. Hutchinson, PhD , School of Nursing, The University of Melbourne, Melbourne, Australia

Linda Johnston, PhD, BSc, Dip, N, RN , School of Nursing, University of Melbourne, Carlton, Australia

Learning Objective 1: understand the strategy for the implementation of the fall prevention clinical practice guidelines at acute care hospitals in Singapore

Learning Objective 2: apply this strategy for implementation of other nursing clinical practice guidelines at acute care hospitals

INTRODUCTION: This study sought to develop and evaluate the effectiveness of a tailored, multifaceted strategy with targeted interventions to support the implementation of a Fall Prevention Clinical Practice Guideline (CPG), as measured by a reduction in falls incidence and increased application of fall prevention practices in the five acute care hospitals in Singapore.

METHODS: This ‘controlled before-and-after' study was conducted in four phases – a retrospective baseline audit on falls incidence and fall prevention practices; followed by administration of a questionnaire to elicit perceived barriers to implementation in five acute care hospitals; the conduct of a comparative study to evaluate the implementation strategy in a control hospital and intervention hospital; and a repeat follow-up audit on falls incidence and fall prevention practices at five acute care hospitals in Singapore.

RESULTS: Mean post-knowledge test scores at 6 months post intervention were statistically significantly higher [t(516) = -3.33, p<0.01] at the intervention hospital (10.3±2.3) compared to the control hospital (9.8±1.8). Following implementation of the Fall Prevention CPG, there was no significant reduction in fall rate (0.67 – 1.36 per 1000 patient days), across the five hospitals.

Findings indicated no significant difference between the intervention and the other hospitals in fall risk assessment practices following the multifaceted strategy with tailored interventions for the implementation of the CPG. There was approximately 99% compliance across the five hospitals on the documentation of fall risk assessment after implementation of CPG.

CONCLUSION: An implementation strategy involving targeted multifaceted interventions for the implementation of the fall prevention CPG increased nurses' knowledge in fall prevention strategies and, though not statistically significant, was associated with a reduction in the incidence of falls. Additionally, following the implementation of the CPG, change in nurses fall prevention practice was evident across the five acute care hospitals in Singapore.

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