@article{ref1,
title="When implementation fails: the case of a nursing guideline for fall prevention",
journal="Joint Commission journal on quality and patient safety",
year="2006",
author="Bossuyt, Patrick and Goossens, Astrid and van der Helm, Jelle",
volume="32",
number="3",
pages="152-160",
abstract="BACKGROUND: Implementing guidelines can be very difficult. No magic bullet or step-by-step implementation plan is available, neither is any single implementation strategy superior. At the Academic Medical Center (AMC) in Amsterdam, a nursing guideline was developed in 1993 on prevention of patient falls. Falls decreased by 30% on six wards, yet an effort to implement the guideline into daily practice throughout the hospital failed. A renewed effort was made to implement the guideline in two wards (neurology and internal medicine) in 1999. IMPLEMENTING THE GUIDELINE: Preparations were made for implementation in the two wards. Barriers to change were identified and solutions were translated into day-to-day activities in the wards. The intervention period covered 18 months (January 2000-June 2001). A mix of implementation strategies was used, including a local consensus process, educational activities, and active support and feedback to management and staff. RESULTS: In the internal medicine ward, the target incidence of 6% was met for four of the 18 months in the intervention period. In the neurology ward, the incidence target of 11% was met in five months. DISCUSSION: Barriers to change and enabling factors may only become apparent during the implementation process itself. A strongly perceived need to change daily practice, a simple guideline, the hospital board's support, an understanding of local barriers, monitoring of outcomes, a locally tailored multifaceted implementation strategy, and voluntarily cooperating nurses are no guarantees for success.<p /> <p>Language: en</p>",
language="en",
issn="1553-7250",
doi="",
url="http://dx.doi.org/"
}