The Fall TIPS Toolkit was developed using an iterative approach with toolkit requirements coming directly from end-users including professional and paraprofessional caregivers, patients and family members. Since implementation of the Fall TIPS Toolkit on experimental units, feedback from end-users is positive. However, even well designed innovations which are successful in one location, may fail in different organizations or settings. [7
] Due to the complex, fast paced work flows that exist in acute care hospitals, adoption and spread of new innovations is often challenging for even well designed systems. The Fall TIPS toolkit was implemented on experimental units in four acute care hospitals, each with unique communication and information systems. A key challenge was to identify a framework for implementation that would facilitate spread and adoption across diverse sites.
The IHI Framework for Spread provided an organized approach to implementation and a multifaceted Fall TIPS Toolkit adoption strategy that promotes engagement across all levels of the organization. Key components of the Framework for Spread including an expectation for adoption communicated by PHS leaders, chief nursing officers, and unit leadership set the tone for successful diffusion. Involvement of unit-based “peer champions” in usability and pilot testing supported the “set-up for spread” efforts by communicating and demonstrating the advantages of using the Fall TIPS toolkit in the context of typical patient care workflows. Regular measurement and consistent feedback to end-users about performance serves as a means to reinforce effective fall prevention practices and further integrate the Fall TIPS Toolkit into the workflow.
As with all new innovations, there are challenges associated with implementing the Fall TIPS Toolkit. Changing behavior and practice is difficult, even when the rationale and methods for change are embraced by caregivers. Nurses and other caregivers in acute care hospitals are busy. The patients are sick and the workflows are complex. In addition to the Fall TIPS toolkit, professional and paraprofessional caregivers are continuously barraged with new policies, systems and innovations that they are pressured to implement. This type of environment demands that if innovations are to be adopted, they must be thoughtfully introduced using a framework that provides the communication, peer support, feedback and time needed to assure an effective transition to adoption, culture change and sustained improvement.
There are several limitations associated with this work. While the “Framework for Spread” Fall TIPS Adoption Measure results suggest that the toolkit is being used, it has been in place for a relatively short period of time and is currently on experimental units only. Once the randomized evaluation of the Fall TIPS Toolkit is complete, it will be made available across all PHS hospitals. It is unknown whether the same techniques will have similar results with a larger implementation over a long period of time.