4 Selecting Interventions
Learn how to select individualized clinical interventions, weigh benefits and risks, and evaluate and adapt the plan based on the person’s response.
Purpose and place in clinical judgment
Choosing an intervention means selecting an action that addresses the , is appropriate for the person and situation, and is likely to do more good than harm. In clinical judgment, this follows recognizing and analyzing cues and prioritizing hypotheses. After acting, the clinician evaluates the response and revises the plan as needed.
These steps are connected and iterative, not a one-time checklist. Reassessment can show that the original hypothesis or intervention is not working, requiring a change in the plan.
Match the action to the problem
Begin with the prioritized problem, not simply the most noticeable cue. Clarify what needs to change by stating the problem and a measurable desired result, then select an action that addresses a likely cause or reduces an important risk.
Assess urgency. Potential threats to life or rapid deterioration take priority. If the person is unstable or the cause is uncertain, promptly reassess and escalate to the appropriate clinician or emergency response. Do not delay urgent care while pursuing a routine intervention.
Consider whether the action is appropriate for this person by taking account of current findings, history, preferences, culture, abilities, other conditions, medications, and care setting. Follow applicable protocols and work within professional scope and authorized orders.
Interventions may be independent, prescribed or protocol-based, or collaborative with the care team. The appropriate category depends on the action and practice setting.
Use evidence and weigh trade-offs
combines the best available research with clinical expertise and the person’s circumstances and preferences. Prefer established guidance and interventions supported by relevant evidence, while checking whether the evidence applies to the person and setting. Evidence does not eliminate judgment: barriers, uncertain benefits, and unintended effects may still matter.
Before acting, compare options by considering:
Expected benefit: What change should occur, and how soon?
Potential harm: What side effects, complications, or new risks could result?
Fit and feasibility: Can the person tolerate and access the intervention? Can the team carry it out consistently?
Alternatives: Could a less burdensome or lower-risk option achieve the goal?
Monitoring: What findings would show improvement, lack of effect, or harm, and when will they be checked?
Fall prevention should be tailored to a person’s specific risks rather than applied as a generic bundle. The Fall TIPS approach connects risk assessment to an individualized plan and consistent communication with the care team and patient.
Apply the approach to fall prevention
A hospitalized patient is unsteady when standing and recently received a medication that may contribute to dizziness. The priority is to reduce the immediate risk of a fall while preserving safe mobility.
Possible actions include assisting with transfers and walking, keeping the call bell and needed items within reach, explaining how to request help, and reporting the dizziness for review of possible contributing factors, including medication. Expected effects include fewer unassisted transfers and safer mobility.
Consider trade-offs: excessive restrictions may limit activity and independence, while additional assistance requires coordination and may not be reliably available unless planned. Evaluate the plan by reassessing dizziness and steadiness, observing transfers, confirming the patient knows how to request help, and monitoring for falls or near-falls. If the patient worsens or a fall occurs, reassess promptly and escalate as indicated.
A safety intervention is not successful merely because it was ordered or documented. Its effects and unintended consequences matter, and the plan should change if reassessment shows the original hypothesis or intervention is not working.
Evaluate and adapt the plan
Set an before intervention. Then compare follow-up findings with the person’s baseline and the goal. Evaluate outcomes, such as symptom change or injury avoided, and, when relevant, : whether the plan was delivered as intended.
Look for adverse effects and new cues as well as signs of benefit. If the response is inadequate, reconsider the problem, contributing factors, and alternatives. Communicate and document actions and findings according to local practice, and revise or escalate the plan when findings warrant it.