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Modality 1: Laminated paper Fall TIPS bedside poster, on which the nurse manually documents the patient's fall risks and tailored intervention plan.
Source publication
Background:
Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process-(1) conduct fall risk assessments;...
Contexts in source publication
Context 1
... three bedside modalities are: 1) the laminated Fall TIPS poster (Figures 1 and 2) electronic Fall TIPS poster (Figures 2 and 3) the paperless patient safety bedside display (Figure 3). To assess the effectiveness of engaging patients in the three-step fall prevention process across the Fall TIPS modalities, random audits were conducted, asking: "Does the patient/family member know their fall prevention plan?" Random audits also measured protocol adherence, defined as the presence of the Fall TIPS fall prevention plan at the bedside. ...
Context 2
... three bedside modalities are: 1) the laminated Fall TIPS poster (Figures 1 and 2) electronic Fall TIPS poster (Figures 2 and 3) the paperless patient safety bedside display (Figure 3). To assess the effectiveness of engaging patients in the three-step fall prevention process across the Fall TIPS modalities, random audits were conducted, asking: "Does the patient/family member know their fall prevention plan?" Random audits also measured protocol adherence, defined as the presence of the Fall TIPS fall prevention plan at the bedside. ...
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Citations
... Fall TIPS adaptado ao contexto brasileiro (28)(29)(30)(31)(32)(33)(34) . ...
... Prevenir quedas e seus danos, em instituições de saúde, por meio de um pôster laminado para fixação à beira leito, disponível a pacientes adultos, acompanhantes e equipes assistenciais, que possibilita o preenchimento, em conjunto, de fatores de risco individuais e sua correlação com estratégias preventivas de quedas (30)(31)(32)(33)(34) . ...
... (4a) Proporcionar cuidado centrado no paciente com base nas experiências relacionadas à prevenção de quedas oriundas do programa (30)(31)(32)(33)(34) . ...
Objectives
to present the theoretical model, logic model, and the analysis and judgment matrix of the Fall TIPS Brazil Program.
Methods
a qualitative, participatory research approach, in the form of an evaluability study, encompassing the phases (1) problem analysis; (2) program design, development, and adaptation to the Brazilian context; (3) program dissemination. Data were collected through document analysis and workshops.
Results
through document analysis, workshops with stakeholders from the participating institution, and validation with key informants, it was possible to identify the program’s objectives, expected outcomes, and the target audience. This allowed the construction of theoretical and logic models and, through evaluative questions, the identification of indicators for the evaluation of the Fall TIPS Brazil Program.
Final Considerations
this study has provided insights into the Fall TIPS program, the topic of hospital fall prevention, and the proposed models and indicators can be employed in the implementation and future evaluative processes of the program.
Descriptors:
Program Evaluation; Patient Safety; Accidental Falls; Hospitals Teaching; Implementation Science
... Document review provided answers to key questions (18) regarding the theme of hospital falls and the Fall TIPS program, and the synthesis of the findings is presented in Chart 2. 2. Healthcare program created to solve the problem Fall TIPS adapted to the Brazilian context (28)(29)(30)(31)(32)(33)(34) . ...
... To prevent falls and their associated harm in healthcare institutions through a laminated poster for bedside placement, available to adult patients, caregivers, and healthcare teams. This poster allows for the collaborative identification of individual risk factors and their correlation with fall prevention strategies (30)(31)(32)(33)(34) . ...
... 4. Specific objectives of the program 4a. To provide patient-centered care based on experiences related to fall prevention from the program (30)(31)(32)(33)(34) . 4b. ...
Objectives
to present the theoretical model, logic model, and the analysis and judgment matrix of the Fall TIPS Brazil Program.
Methods
a qualitative, participatory research approach, in the form of an evaluability study, encompassing the phases (1) problem analysis; (2) program design, development, and adaptation to the Brazilian context; (3) program dissemination. Data were collected through document analysis and workshops.
Results
through document analysis, workshops with stakeholders from the participating institution, and validation with key informants, it was possible to identify the program’s objectives, expected outcomes, and the target audience. This allowed the construction of theoretical and logic models and, through evaluative questions, the identification of indicators for the evaluation of the Fall TIPS Brazil Program.
Final Considerations
this study has provided insights into the Fall TIPS program, the topic of hospital fall prevention, and the proposed models and indicators can be employed in the implementation and future evaluative processes of the program.
Descriptors:
Program Evaluation; Patient Safety; Accidental Falls; Hospitals Teaching; Implementation Science
... Moreover, in order to determine the sample size, power analysis was performed by using the g power program, as explained in the study carried out by Duckworth et al. (2019) 33 . Accordingly, it was determined that there should be 220 observations in the sample with a statistical power level of 80% and a significance level of 5% for the (d=0.19) ...
... Moreover, in order to determine the sample size, power analysis was performed by using the g power program, as explained in the study carried out by Duckworth et al. (2019) 33 . Accordingly, it was determined that there should be 220 observations in the sample with a statistical power level of 80% and a significance level of 5% for the (d=0.19) ...
Purpose: This study aims to test the Turkish validity and reliability of the Fall Prevention Knowledge Test assessing the knowledge level of nurses in the clinical setting regarding fall prevention. Materials and Methods: This study was carried out with nurses working at a university hospital between 16 February and 31 March 2022. The study group consisted of 250 nurses, who had been working as nurses for at least six months and voluntarily agreed to participate in the study. The study data was collected by using The Nurse Information Form and Fall Prevention Knowledge Test. Content validity, item difficulty and item discrimination indices, KR-20 coefficient, and intra-class correlation coefficient were used in the data analyses. Results: It was determined that 75.2% of the nurses participating in the study were female, 50.8% were married, and 75.6% had a bachelor’s degree. The mean age of the nurses participating in the present study was 29.22±6.55 years, the mean work experience was 6.84±6.60 years, and the mean weekly working hours were 44.10±6.76 hours. It was found that 96.8% of the nurses knew about the risk of fall, and 96.0% knew about fall prevention practices. The content validity index of the test was found to be 0.836 and the KR-20 reliability coefficient for the scale was calculated to be 0.713. Conclusions: The Fall Prevention Knowledge Test (11 items) is a valid and reliable test for measuring the knowledge level of nurses working in hospitals in Türkiye.
... This finding may imply in the reductions of fall during service, since, many times the patient takes unnecessary risks, such as getting out of bed and go to the bathroom unassisted. Consequently, the patient can get involved and embrace the prevention strategies after acknowledging the importance of changing their practices via positive transformation (Duckworth et al., 2019). ...
Background: Falls are responsible for a significant morbimortality related to the assistance in the hospitals and healthcare facilities. Among the prevention strategies, it is the worth emphasizing improvement in the patient’s perception about the risks of falling, since such perception has a direct impact in the adhesion to the preventive guidelines. Therefore, we aimed to analyse the impact of educational intervention in the perception of hospitalised patients about the risk of falling and associated factors. Methods: This study used the quasi‐experimental, pretest‐posttest design and results were presented according to the Transparent Reporting of Evaluations with Nonrandomised Design guidelines. This study was conducted in a Brazilian public hospital with 157 patients admitted to a medical clinic. The data were collected before and after educational intervention mediated by a booklet on fall prevention. It was identified the nursing diagnosis Risk of fall, and applied an adaptation of the Falls Risk Awareness Questionnaire scale. Results: The findings were presented according to the number of risk factors of the participants, and to define the groups, with lower and higher risk, a median of the analyzed risk factors was used, represented by five. Therefore, this value was used to dichotomize the data. The results showed positive effects of the educational intervention mediated by booklet in the perception of fall risks. The questions about advanced age, hearing problems, insecurity and fear of falling presented significant associations with perception improvement in both groups. Conclusions: educational intervention mediated by booklet is effective to promote improvement in the perception of risks of falling patients in hospital admission. Health education about fall preventions is effective for involving patients in the care process. Therefore, this evidence may support the planning of strategies to prevent falls inside hospital environments.
... The odds of placental abruption significantly increase because of a fall and a small increase in foetal death rate has been observed (Schiff 2008). While the detrimental potential consequences of a fall during pregnancy have been documented, reducing fall rates during pregnancy will depend on delivering targeted recommendations and interventions (Maki et al. 2011;Spano-Szekely et al. 2019;Duckworth et al. 2019), which can only be accomplished with an accurate portrait of fall rate change throughout the nine months of pregnancy. ...
... physical stress on the foetus) and time constraints (i.e. an additional time burden) are noted as the most common barriers for pregnant individuals participating in fall prevention exercise (Brewin and Naninni 2014). However, fall prevention methods can improve when the method options are robust, and the application has a specific target (Maki et al. 2011;Spano-Szekely et al. 2019;Duckworth et al. 2019). Having an accurate understanding of causes and timing for increased fall rates during pregnancy could improve clinical fall prevention efforts. ...
All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.
... In total 1,491 citations and abstracts and 467 full texts were screened, resulting in the inclusion of 28 manuscripts for Facilitation and 24 manuscripts for Patient Participation [23,25,, see Fig. 2 for PRISMA diagram. The studies were conducted in a range of countries and encompassed a range of methods, many were quality improvement projects describing examples from practice, see Appendix iii for summary of study details. ...
... Ten studies described use of published tools such as the Morse Fall Scale [16,18,[23][24][25]32], the Memorial Emergency Department Fall Risk Assessment Tool (MED-FRAT) [33], the Fall Risk for Older People (FROP) [37] and KINDER 1 [19,41]. Seven studies described locally developed tools e.g., developed through review of the falls literature and/or identifying common risk factors on a particular unit [17,21,26,28,[34][35][36]. In nine studies, it was unclear whether the assessment tool was publicly available or locally developed [15,20,22,27,29,31,37,40,42]. ...
... Three studies measured adherence displaying a bed side poster generated from Fall TIPS [23][24][25], a HIT intervention that aimed to involve patients, with their families and carers, in the assessment and care planning process to overcome patient non-adherence to falls prevention strategies. ...
Background
Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals.
Methods
A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers.
Results
Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging.
Conclusions
Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate.
Trial registration
PROSPERO: CRD42020184458.
... Of the 1,445 articles located, 19 were established as the body of analysis, most of which were published in 2017 (12)(13)(14)(15)(16)(17)(18) and 2018 (19)(20)(21)(22) (58%), in the United States (14,15,(17)(18)(19)(23)(24)(25)(26) (47.4%), Australia, (12,13) Germany, (27,28) Brazil (21,22) and Japan (16,20) (10.5%) and United Kingdom (29) and Singapore (30) (5.3%). ...
... Australia, (12,13) Germany, (27,28) Brazil (21,22) and Japan (16,20) (10.5%) and United Kingdom (29) and Singapore (30) (5.3%). We identified 14 usability and product presentation studies, (13)(14)(15)(16)18,19,(21)(22)(23)(24)(25)(26)(27)(28)31) two control case studies, (17,20) a comparative retrospective study, (30) a randomized controlled study (29) and a comparative prospective. (12) Most articles were published in journals specialized in nursing, (17,19,20,21,25,26,28,30) (8/42.1%), ...
... We identified 14 usability and product presentation studies, (13)(14)(15)(16)18,19,(21)(22)(23)(24)(25)(26)(27)(28)31) two control case studies, (17,20) a comparative retrospective study, (30) a randomized controlled study (29) and a comparative prospective. (12) Most articles were published in journals specialized in nursing, (17,19,20,21,25,26,28,30) (8/42.1%), followed by gerontology and geriatrics (12,14,23,24) (4/22.1%) ...
... Of the 1,445 articles located, 19 were established as the body of analysis, most of which were published in 2017 (12)(13)(14)(15)(16)(17)(18) and 2018 (19)(20)(21)(22) (58%), in the United States (14,15,(17)(18)(19)(23)(24)(25)(26) (47.4%), Australia, (12,13) Germany, (27,28) Brazil (21,22) and Japan (16,20) (10.5%) and United Kingdom (29) and Singapore (30) (5.3%). ...
... Australia, (12,13) Germany, (27,28) Brazil (21,22) and Japan (16,20) (10.5%) and United Kingdom (29) and Singapore (30) (5.3%). We identified 14 usability and product presentation studies, (13)(14)(15)(16)18,19,(21)(22)(23)(24)(25)(26)(27)(28)31) two control case studies, (17,20) a comparative retrospective study, (30) a randomized controlled study (29) and a comparative prospective. (12) Most articles were published in journals specialized in nursing, (17,19,20,21,25,26,28,30) (8/42.1%), ...
... We identified 14 usability and product presentation studies, (13)(14)(15)(16)18,19,(21)(22)(23)(24)(25)(26)(27)(28)31) two control case studies, (17,20) a comparative retrospective study, (30) a randomized controlled study (29) and a comparative prospective. (12) Most articles were published in journals specialized in nursing, (17,19,20,21,25,26,28,30) (8/42.1%), followed by gerontology and geriatrics (12,14,23,24) (4/22.1%) ...
Resumo Objetivo Identificar o conhecimento produzido sobre estratégias tecnológicas voltadas para prevenção de quedas de adultos no ambiente hospitalar. Métodos Revisão integrativa da literatura realizada nas bases de dados Medical Literature Analysis and Retrieval System Online/National Library of Medicine (MEDLINE/ PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus e Web of Science publicados no período de 2017 a 2022. Resultados Foram incluídos 19 artigos, a maioria publicado em revistas de Enfermagem (42%). Os temas que emergiram da análise foram: tipos de estratégias tecnológicas, custos, privacidade do paciente e relevância dos profissionais de enfermagem no desenvolvimento, avaliação e utilização dos dispositivos. Conclusão A pesquisa revelou uma gama de recursos tecnológicos voltados para prevenção de quedas disponíveis no mercado que podem ser incorporados nas práticas assistenciais. Cabe aos hospitais definirem qual estratégia aplica-se de forma mais adequada à sua realidade.
... Environmental factors and errors in patient judgment cause these types of falls. Prevention of these types of falls is geared at keeping the environment free from hazards and proper education for the patient/family regarding the environment and use of various devices (Duckworth et al., 2019). ...
... Lack of communication of the falls prevention plan between different professional groups and availability of physical resources, e.g., non-skid socks, may constrain delivery of interventions suggested by tools (21,33,34,40). Furthermore, hospital IT infrastructure dictated what HIT was available to staff at the ward level e.g., whether automation was available or not (23). ...
... (43) introduced an agreement that patients signed to con rm that they had been educated on fall risk prevention strategies, acknowledged falling could cause serious injuries and therefore agreed to ask for help to prevent falls. Five studies examined Fall TIPS (23,25,46,63), an intervention in which staff, patients and their carers worked in partnership throughout the assessment and care planning processes to prevent falls. However, how patients and carers interacted with staff during these processes was not explained. ...
... Similarly, one study suggested nurses with more experience (de ned as two or more years) moved the risk assessment process from 'task mode' to a vehicle to enhance communication and partnership that authors linked to falls reduction (54). Based on previous experience, effectively communicating the care plan to patients was emphasised as a key component of Fall TIPS, with studies evidencing a reduction in fall rates and improvements in patient activation (23,46,63). ...
Background
Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions.
Methods
A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOc’s, and (3) following prioritisation of CMOc’s, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers.
Results
Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging.
Conclusions
Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate.
Trial registration
PROSPERO: CRD42020184458
