Background <p>Evidence-based guidelines are intended to ensure quality of care and promote preventive measures. However, their sustainable implementation in acute care hospitals often fails due to structural and personnel-related barriers. The introduction of a nationwide quality agreement in Switzerland in 2024 has increased the pressure to implement guidelines, particularly in the area of fall prevention.</p> Methods <p>In a large Swiss acute care hospital, the guideline “Fall Prevention and Management” was fundamentally revised as part of the regular revision process. Both the guideline itself and its implementation strategy were developed using a participatory approach, involving both an interprofessional team and patients.</p> Results <p>The revised guideline was significantly shortened and now includes a decision algorithm in a&#xa0;traffic light system that integrates preventive, personalized, and participatory approaches. The subsequent implementation program focused on five thematic priorities. Evaluation of fall-related indicators and implementation outcomes showed positive developments. In the upcoming implementation phase, prioritized topics related to fall prevention were further developed.</p> Conclusion <p>Participatory guideline development combined with structured implementation proved to be an effective approach for promoting preventive practices in the acute care hospital. The consistent involvement of patients and staff, along with an iterative implementation process, supported sustainable behavioral changes and structural integration. The experience provides starting points for further quality preventive initiatives in acute care settings.</p>