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Objectives Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based fall prevention program that led to a 25% reduction in falls in hospitalized adults. Because it would be helpful to assess nurses' perceptions of burdens imposed on them by using Fall TIPS or other fall prevention program, we conducted a study to learn benefits and burdens. Methods A 3-phase mixed-method study was conducted at 3 hospitals in Massachusetts and 3 in New York: (1) initial qualitative, elicited and categorized nurses' views of time spent implementing Fall TIPS; (2) second qualitative, used nurses' quotes to develop items, research team inputs for refinement and organization, and clinical nurses' evaluation and suggestions to develop the prototype scale; and (3) quantitative, evaluated psychometric properties. Results Four "time" themes emerged: (1) efficiency, (2) inefficiency, (3) balances out, and (4) valued. A 20-item prototype Fall Prevention Efficiency Scale was developed, administered to 383 clinical nurses, and reduced to 13 items. Individual items demonstrated robust stability with Pearson correlations of 0.349 to 0.550 and paired t tests of 0.155 to 1.636. Four factors explained 74.3% variance and provided empirical support for the scale's conceptual basis. The scale achieved excellent internal consistency values (0.82-0.92) when examined with the test, validation, and paired (both test and retest) samples. Conclusions This new scale assess nurses' perceptions of how a fall prevention program affects their efficiency, which impacts the likelihood of use. Learning nurses' beliefs about time wasted when implementing new programs allows hospitals to correct problems that squander time.

Falls represent a persistent and costly patient safety issue. Fall TIPS (Tailored Interventions for Patient Safety) is a patient-centered and clinical decision-supported, fall prevention program that has led to fewer falls and related injuries among hospitalized patients. We aimed to identify dominant facilitators and barriers to Fall TIPS adoption. This multisite qualitative study was conducted in 11 hospitals representing three academic health systems, where Fall TIPS had been implemented for at least one year. Interviews with 50 patients and focus groups with 71 staff were analyzed using a conventional content analysis. Fall TIPS resulted in a partnership between staff and patients, in which fall prevention interventions were patient-specific and enabled by clinical decision support. We identified three facilitators to program adoption. First, staff were motivated to address falls as staff recognized fall prevention as a priority and the limitations of previous fall prevention programs. Second, patients welcomed their role in fall prevention. Third, Fall TIPS was integrated into existing staff workflows. We identified three dominant barriers to program adoption. First, poor engagement practices among staff limited patients’ active participation in fall prevention. Second, the use of residual fall prevention approaches perpetuated a ‘one-size fits all’ approach to fall prevention. Third, patient willfulness i.e., patients’ conscious deviation from fall plans challenged program fidelity. Fall TIPS changed the paradigm of fall prevention by placing an unprecedented focus on patient engagement. Actions that improve staffs’ engagement of patients and patient’s partnership in fall prevention will assist Fall TIPS adoption.

This article describes how nurse leaders in one organization led an interdisciplinary team to develop an evidence-based fall prevention program, Fall TIPS (Tailoring Interventions for Patient Safety), that is now used in hospitals across the country. A common barrier to fall prevention is developing new programs rather than adopting and using evidence-based approaches. The Fall TIPS program overcomes this barrier by providing a comprehensive suite of tools that nurse leaders can use to promote adoption and spread of evidence-based fall prevention best practices in their organization. This article is a call to action to inform nurse leaders about the decade of evidence behind the Fall TIPS program, how they can join the Fall TIPS Collaborative, and how they can access Fall TIPS resources to support implementation at their hospitals.

Background/objectives To assess nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. Design Survey research. Setting Seven adult acute-care hospitals in 2 hospital centers located in Boston and NYC. Participants A total of 298 medical-surgical nurses on 14 randomly selected units. Intervention Three-step FallTIPS fall prevention program that had been in use as a clinical program for a minimum of 2 years in each hospital. Measurements Fall Prevention Efficiency Scale (FPES), range 13-52; four-factorilly derived subscales: valued, efficiency, balances out and inefficiency; and 13 psychometrically validated individual items. Results Nurses perceived the FallTIPS fall prevention program to be efficacious. The FPES mean score of 38.55 (SD = 5.05) and median of 39 were well above the lowest possible score of 13 and scale midpoint of 32.5. Most nurses (N = 270, 90.6%) scored above 33. There were no differences in FPES scores between nurses who had only used FallTIPS and nurses who had previously used a different fall prevention program. Conclusion The nurses who used FallTIPS perceived that efficiencies in patient care compensated for the time spent on FallTIPS. Nurses valued the program and findings confirmed the importance of patient and family engagement with staff in the fall prevention process. Regardless of the fall prevention program used, organizations should examine staff perceptions of their fall prevention program because programs that are not perceived as being useful, efficient, and valuable will lead to nonadherence over time and then will not reduce falls and injuries. The recently developed FPES used in this study is a brief tool available for organizations to assess nurses' perceptions of the efficacy of their fall prevention program. Additional FPES research is needed with larger and more diverse samples.

Falls are a major problem in hospitals. The fall prevention program Fall TIPS (Tailoring Interventions for Patient Safety) has been shown to be effective in preventing inpatient falls and related injuries. The purpose of this study was to examine the impact of the Fall TIPS program on patient activation related to fall prevention.Patient activation was measured by surveying a random sample of adult patients before and after implementation of Fall TIPS at three health care systems. Researchers used the short form Patient Activation Measure (PAM-13) adapted for fall prevention. This 13-item survey assesses a patient's knowledge, skill, and confidence in managing his or her fall prevention. Patients (N = 343) were surveyed on medical units at Brigham and Women's Hospital (BWH), Montefiore Medical Center (MMC), and New York-Presbyterian (NYP) Hospital. Statistical analysis using the robust t-test was done to compare patient activation in the preintervention and postintervention groups.Patient activation improved from preintervention to postintervention at all sites (BWH, p0.0001; NYP, p = 0.0373; MMC, p0.0001). Overall, the mean PAM score improved from 63.82 (standard deviation [SD] ± 17.35) to 80.88 (SD ± 17.48), p0.0001.Patients with access to the Fall TIPS program are more activated and engaged in their fall prevention plan. Members of the care team should engage patients in their fall prevention plan to increase their knowledge, skill, and confidence.

Background Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. Strategies were needed to integrate this evidence into clinical practice. Methods The Institute for Healthcare Improvement's Framework for Spread is the conceptual model for pilot implementation of Fall TIPS at Brigham and Women's Hospital (BWH; Boston) and Montefiore Medical Center (MMC; Bronx, New York). The key to translating the evidence into practice was engaging stakeholders by leveraging existing shared governance structures, identifying unit champions, holding training sessions for all staff, and implementing auditing to assess and provide feedback on protocol adherence and patient outcomes. Results BWH unit compliance with using Fall TIPS averaged 82%, the mean fall rate decreased from 3.28 to 2.80 falls per 1,000 patient-days from January through June 2015 versus 2016, and the mean fall with injury rate for these periods decreased from 1.00 to 0.54 per 1,000 patient-days. At MMC, compliance averaged 91%, but the mean fall rate increased marginally from 3.04 to 3.10, while the mean fall with injury rate decreased from 0.47 to 0.31 per 1,000 patient-days. Patient knowledge survey results show improvement in knowledge of the risks for falls and the ways to prevent falls. Conclusion Engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. Barriers to adoption of the protocol have been addressed and detailed to provide guidance for spread to other institutions.