Go Decaf!: implementing 'decaf by default' as a quality improvement intervention to reduce toileting-related falls and improve care environments in acute hospital settings.

Toileting-related falls are common among older hospital inpatients, and although reducing caffeine intake is recommended for urinary urgency, there is little evidence on how to implement this successfully within routine hospital care. Introducing decaffeinated drinks as the default option was associated with reductions in toileting-related falls during both pilot testing and subsequent organisation-wide rollout, alongside perceived improvements in sleep, agitation and ward environment. The intervention achieved spread by changing the default rather than relying on education or individual behaviour change alone. This study suggests that changing clinical defaults, supported by local ownership and peer-to-peer diffusion, may be an effective strategy for translating existing evidence into routine practice while preserving patient choice. Similar implementation approaches could be applied to other quality improvement priorities where evidence exists but has proved difficult to embed consistently in everyday care.