Enhancing fall risk awareness among high fall-risk inpatients: a best practice implementation project.

introductionFalls are one of the most common adverse events among inpatients. Patients' awareness of fall risk can influence patient' behaviors and potentially reduce fall incidence. Although the importance of risk awareness in falls prevention has been increasingly recognized, how to effectively enhance awareness among high fall-risk inpatients and its consequent impact on fall rates remains to be further validated.

objectiveTo develop and implement an evidence-based practice protocol to enhance fall risk awareness among high fall-risk inpatients and evaluate its effectiveness, and to clarify its unique value compared with existing fall prevention approaches.

methodsThis study constituted a nonrandomized, pre-post quasi-experimental evidence implementation project following the JBI PACES (Practical Application to Clinical Evidence System). The project was conducted in seven inpatient wards with the highest fall incidence rates over the preceding three years at a tertiary hospital in Changsha, China. A total of 420 high- risk inpatients (210 at baseline, 210 post-implementation) and 70 nurses from these wards were enrolled. Through evidence synthesis, 22 best practice recommendations were initially identified. Following FAME (feasibility, appropriateness, meaningfulness, and effectiveness) evaluation, 18 recommendations were retained, from which 20 audit criteria were developed. A baseline audit was conducted among 210 inpatients (June-July 2024) and the 70 nurses to evaluate compliance with these criteria. Barriers to best practice implementation were systematically identified through baseline audit findings using the JBI Getting Research into Practice (GRiP) framework, and a concise targeted implementation strategy was developed and applied for three months. This program employed multifaceted strategies across five dimensions: organizational support, system optimization, staff training, patient education, and electronic medical record (EMR)-integrated warning systems. A follow-up audit was then conducted (October-December 2024). Outcome measures, including audit criteria compliance rates, fall and injury incidence, patients' fall risk perception scores, patients' knowledge, attitude, and behavior regarding fall prevention and nursing staff's knowledge and attitudes, were compared pre- and post-implementation.

resultsFollowing EBP implementation, 16 of the 20 audit criteria demonstrated significant improvement (p < 0.01). Notably, nine criteria achieved 100% compliance, and seven criteria increased from 0% to 100%. The incidence of falls decreased from 0.48% (1/210) to 0% (0/210), and the injury rate decreased correspondingly from 0.48% to 0%. Patients' Fall Risk Perception Scores increased significantly post-EBP: at admission, the mean score increased from 15.5 (SD 12.93) to 20.21 (SD 13.52); at discharge, from Mean score 16.8 (SD 12.69) to Mean score 28.15 (SD 19.76). Patients' scores across the three dimensions of fall prevention knowledge, attitudes, and behaviors were significantly higher post-EBP (p < 0.01). Nursing staff demonstrated significantly improved knowledge on five fall risk awareness-related items (p < 0.01), and their attitude scores were significantly higher post-intervention (P < 0.01).

conclusionsThis evidence-based practice protocol effectively enhanced fall risk awareness among high fall-risk inpatients, improved their knowledge, attitudes, and behaviors regarding fall prevention, enhanced nursing staff's knowledge and attitudes, and improved compliance with audit criteria. These findings provide a scientific basis for integrating patient-centered risk communication into routine fall prevention programs for fall high-risk inpatient populations.

trial registrationThis evidence implementation project was retrospectively registered with the Fudan University Centre for Evidence-based Nursing-a JBI Centre of Excellence. This was not a randomized controlled trial. CLINICAL TRIAL NUMBER: ER20251072. REGISTRATION DATE: 9 January 2025.