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Falls among older inpatients are frequent and have negative consequences. In this study, the effectiveness of a fall prevention programme in reducing falls and fall injuries in an acute hospital was studied.
Retrospective audit.
The Northern Hospital, an acute, metropolitan, hospital in Australia.
A multi-factorial fall prevention programme that in...
Citations
... A total of six studies were included in the meta-analysis. Two studies examined multimodal interventions, 16,17 three studies examined bed/ chair exit alarms, 30,31,33 while one study examined monitoring intervention. 23 Standardized mean difference was utilized as there was high heterogeneity (Q-value = 61.89, ...
... Firstly, overreliance on technological fall prevention strategies might create a false sense of security 36 and reduce nurses' innate surveillance of patients to prevent falls. Secondly, during the research study, increased staff alertness about falls might have heightened reporting, 16 resulting in a statistically non-significant intervention effect. Thirdly, poor adherence to the fall prevention interventions might attribute to the statistically non-significant findings. ...
Introduction:
Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality.
Aims:
The study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls.
Methods:
The meta-analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords.
Results:
A total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures.
Conclusion:
A comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.
... The fall prevention efficacy was as expected to differ from high-risk groups, such as hospitalized or institutionalized adults [30,31]. Our recent comparison of health and social information between participants and non-participants of the KFPS trial showed that the women attending were better off for physical and mental well-being, functional capability and sociodemographic status than women on average in this region [32]. ...
Background:
Communal exercise interventions may help prevent falls and injuries. However, pragmatic trials demonstrating the effectiveness of such strategies are sparse.
Methods:
We determined whether a cost-free 12-month admission to the city's recreational sports facilities including initial 6 months of supervised weekly gym and Tai Chi sessions decreases the number of falls and related injuries. The mean (SD) follow-up time was 22·6 (4.8) months in 2016-19. A total of 914 women from a population-based sample with a mean age of 76.5 (SD 3.3, range 71.1-84.8) years were randomized into exercise intervention (n = 457) and control (n = 457) groups. Fall information was collected through biweekly short message (SMS) queries and fall diaries. Altogether 1,380 falls were recorded for the intention-to-treat analysis, with 1,281 (92.8%) being verified by telephone.
Results:
A 14.3% fall rate reduction was detected in the exercise group (Incidence rate ratio (IRR) = 0.86; CI 95% 0.77-0.95) compared with the control group. Approximately half of the falls caused moderate (n = 678, 52.8%) or severe (n = 61, 4.8%) injury. In total, 13.2% (n = 166) of falls (including 73 fractures) required medical consultation with a 38% lower fracture rate in the exercise group (IRR = 0.62; CI 95% 0.39-0.99). Overall, the greatest reduction of 41% (IRR = 0.59; CI 95% 0.36-0.99) was observed in falls with severe injury and pain.
Conclusions:
A community-based approach for a 6-month exercise period combined with a 12-month free use of sports premises can reduce falls, fractures and other fall-related injuries in aging women.
... L'analisi dei diversi quadri di riferimento, applicati alle realtà organizzative, suggeriscono l'introduzione di strumenti di valutazione del rischio, partendo dalle esperienze organizzative documentate in letteratura (Dolan & Taylor-Piliae, 2019) e per alcuni adattando gli strumenti validati alle realtà ospedaliere (Walsh et al., 2011). Tuttavia per quest'ultima soluzione, vi è una limitata evidenza di effetti benefici sui tassi di caduta quando si utilizza l'adattamento locale di uno strumento validato (Barker et al., 2009). Lo strumento di valutazione del rischio di caduta deve identificare la popolazione a rischio di caduta (Oliver, 2008). ...
RIASSUNTO Introduzione La caduta è l'evento avverso più comune tra i pazienti ricoverati in ospedale. La valutazione del rischio caduta attraverso uno strumento adeguato e adattabile alla popolazione ricoverata costituisce una sfida per le organizzazioni. La Regione Emilia Romagna ha messo in campo delle azioni di intervento attraverso strumenti per il monitoraggio, analisi degli eventi e attività di reporting, prima e dopo l'implementazione di corsi di formazione online e l'elaborazione di specifiche linee di indirizzo sulla prevenzione delle cadute. Il nostro studio valuta gli interventi di prevenzione e gestione caduta delle Aziende prima (T0) e dopo gli interventi regionali (T1). Materiali e metodi È stato condotto uno studio osservazionale retrospettivo su cartelle cliniche in Aziende pubbliche e private della Regione Emilia Romagna nel periodo 2016-2018, prima e dopo l'emanazione delle linee guida e la conseguente formazione. Risultati Sono state coinvolte 46 Aziende, 14 pubbliche e 32 private (2400 cartelle). Lo strumento utilizzato ha registrato una buona consistenza interna (α=,834). In T1 si sono evidenziati significativi risultati nella frequenza ai corsi FAD, nella valutazione ambientale, multifattoriale, interventi singoli e registrazioni nelle cartelle. Rimane insoddisfacente la fisioterapia addizionale, la valutazione farmacologica, l'adozione dei sistemi di riconoscimento e i dispositivi di protezione per i pazienti a rischio. Conclusioni Continuare l'impegno con la formazione, consolidare la valutazione multi professionale, educare e creare alleanze con familiari e caregivers, favorire la mobilizzazione dei pazienti, evitare le barriere architettoniche, favorire gli audit, creare e utilizzare linee guida basate sulle evidenze, sono interventi raccomandati.
ABSTRACT Introduction Fall is the most common adverse event among hospitalized patients. Falling risk assessment through an appropriate and adaptable tool for the hospitalized population constitutes a challenge for organizations. The Emilia Romagna Region has implemented intervention actions through tools for monitoring, event analysis and reporting activities, before and after the implementation of online training courses and the development of specific guidelines on the prevention of falls. Our study evaluates the fall prevention and management interventions of the Companies before (T0) and after the regional interventions (T1). Methods A retrospective observational study was conducted on medical records in public and private companies of the Emilia Romagna Region between 2016-2018, before and after the issue of the guidelines and the consequent training. Results 46 companies were involved, 14 public and 32 private (2400 folders). The instrument used recorded a good internal consistency (α =, 834). T1 showed significant results in attending FAD courses, in environmental, in multifactorial evaluation, in individual interventions and recordings in the files. Remain unsatisfying the additional physiotherapy, the pharmacological evaluation and the use of identifying systems and protecting devices for patients at risk. Conclusions Continuing the commitment with training, consolidating multi-professional assessment, educating and creating alliances with family members and caregivers, encouraging patient mobilization, avoiding architectural barriers, promoting audits, creating and using evidence-based guidelines, are recommended interventions.
... 25 Effective team functioning is one of the Institute of Medicine's five principles for implementing health care safety systems that seek high reliability. 26 Empirical studies [27][28][29][30][31] and systematic reviews 14,32 of inpatient fall-risk-reduction programs have established that an interprofessional team is more effective than a nursing-centric structure to sustain decreases in fall rates. A team is two or more people with complementary skills and specific roles who interact to achieve a collective goal. ...
... 35 Effective coordination among component teams within an MTS achieves system goals by planning, standardizing, and adjusting processes in real time. 36 These three elements of effective coordination-planning, standardizing, and adjusting-ensure accountability when roles and responsibilities are clarified, predictability when the actions and needs of others are anticipated, and a shared mental model of how coordinated component team processes achieve a collective goal 37 While it is established that an interprofessional team can reduce fall risk, 14,[27][28][29][30][31][32] little is known about the coordination of processes across diverse professionals and teams that may be needed to adaptively manage the complexity of inpatient fall-risk-reduction. The purpose of this study is to evaluate the implementation of evidence-based fall-risk-reduction processes and their impact on fall-related outcomes when those processes are implemented using an MTS structure. ...
Objective:
To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure.
Data sources/study setting:
Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement.
Study design:
A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system.
Data collection:
Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study.
Principal findings:
The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes.
Conclusions:
Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
... Multicomponent interventions with different combinations of fall prevention strategies have been effective in hospitals with different sizes, locations, and teaching status. 24,27,29,[36][37][38][39][40][41][42] Although the components of these fall intervention program vary, the success of these multicomponent programs suggests that an effective fall prevention program should include the following components: fall risk assessment, fall alert signs, staff education, patient education, movement alarms, and hourly rounding especially assessing patients' need for toileting. 29,[36][37][38][39][40][41][42] In addition to these interventions, an individualized fall prevention plan needs to be developed by considering different patient populations in various hospital units. ...
... 24,27,29,[36][37][38][39][40][41][42] Although the components of these fall intervention program vary, the success of these multicomponent programs suggests that an effective fall prevention program should include the following components: fall risk assessment, fall alert signs, staff education, patient education, movement alarms, and hourly rounding especially assessing patients' need for toileting. 29,[36][37][38][39][40][41][42] In addition to these interventions, an individualized fall prevention plan needs to be developed by considering different patient populations in various hospital units. For example, research suggests that surgical units have more injurious falls among inpatient falls compared with medical, medical-surgical, and step-down units. ...
Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.
... Generalized additive modeling (GAM) allows for rather flexible specification of variables and has the advantage of being nonparametric regarding the statistical distribution of the data [18][19][20][21]. GAMs have been widely applied in environmental monitoring [22], ecology [16,23,24] and medicine [25] but have not been used to optimize the conditions for culturing microalgae. ...
Background
Organic carbon sources have been reported to simultaneously increase the growth and lipid accumulation in microalgae. However, there have been no studies of the mixotrophic growth of Porphyridium purpureum in organic carbon media. In this study, three organic carbon sources, glucose, sodium acetate, and glycerol were used as substrates for the mixotrophic growth of P. purpureum. Moreover, a novel trait-based approach combined with Generalized Additive Modeling was conducted to determine the dosage of each organic carbon source that optimized the concentration of cell biomass or fatty acid.
Results
A 0.50% (w/v) dosage of glucose was optimum for the enhancement of the cell growth of P. purpureum, whereas sodium acetate performed well in enhancing cell growth, arachidonic acid (ARA) and eicosapentaenoic acid (EPA) content, and glycerol was characterized by its best performance in promoting both cell growth and ARA/EPA ratio. The optimum dosages of sodium acetate and glycerol for the ARA concentration were 0.25% (w/v) and 0.38% (v/v), respectively. An ARA concentration of 211.47 mg L⁻¹ was obtained at the optimum dosage of glycerol, which is the highest ever reported.
Conclusions
The results suggested that a comprehensive consider of several traits offers an effective strategy to select an optimum dosage for economic and safe microalgae cultivation. This study represents the first attempt of mixotrophic growth of P. purpureum and proved that both biomass and ARA accumulation could be enhanced under supplements of organic carbon sources, which brightens the commercial cultivation of microalgae for ARA production.
... Interdisciplinary teams are suggested as one possible way to reduce medical errors and increase the quality of patient care (Rosen & Callaly, 2005). In the context of decreasing patient fall risk, actual fall rates were reduced when hospitals used interdisciplinary teams to coordinate and implement their FRR program (e.g., Barker, Kamar, Morton, & Berlowitz, 2009;Gowdy & Godfrey, 2003;Szumlas, Groszek, Kitt, Payson, & Stack, 2004;von Renteln-Kruse & Krause, 2007). ...
... Interdisciplinary teams are suggested as one possible way to reduce medical errors and increase the quality of patient care (Rosen & Callaly, 2005). In the context of decreasing patient fall risk, actual fall rates were reduced when hospitals used interdisciplinary teams to coordinate and implement their fall risk reduction program (e.g., Barker, Kamar, Morton, & Berlowitz, 2009;Gowdy & Godfrey, 2003;Szumlas, Groszek, Kitt, Payson, & Stack, 2004;von Renteln-Kruse & Krause, 2007). ...
Interdisciplinary teams play an important role implementing innovations that facilitate the quality and safety of patient care. This article examined the role of reflexivity in team innovation implementation and its association with an objective patient safety outcome, inpatient fall rates (a fall is an unintended downward displacement of a patient’s body to the ground or other object). In this study, we implemented, supported, and evaluated interdisciplinary teams intended to decrease fall risk in 16 small rural hospitals. These hospitals were part of a collaborative that sought to increase knowledge and facilitate reflexivity about fall event reporting and fall risk reduction structures and processes. We assessed team reflexivity at the start and at the end of the 2-year intervention and innovation implementation at the end of the intervention. The 16 hospitals reported objective fall event data and patient days throughout the project, which we used to calculate comparative rates for assisted, unassisted, and injurious falls. The results suggest that teams benefited from the intervention, increasing reflexivity from the start of the project to the end, which was related to innovation implementation and decreases in fall rates. Theoretical and practical applications of the results are discussed.
... In Barker et al.,52 the lack of effect from the intervention protocol was attributed to the specific interventions included in their program, including the use of lowlow beds and chair and bed alarms. Although the 6-PACK program had originally been designed based on a quality improvement project assessing interventions that had been components of usual care, 57 these components had been found to be ineffective in prior studies. [58][59][60] Lack of communication and understanding of patients fall risk status among team members may also contribute to patient falls. ...
... Nursing staff play a major role in the success of any fall prevention program, therefore, paramount to this success is staff buy-in of the prevention program. 57 The authors further noted that successful fall prevention programs are ones that could be easily incorporated in the normal workflow of nursing units and processes that facilitated continued evaluation of the fall prevention programs. 54 Barker et al. 52 also recognized the importance of adherence and adoption of fall prevention programs in reducing the number of falls and fall rates. ...
EXECUTIVE SUMMARY
Background
Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions.
Objectives
To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting.
Inclusion criteria Types of participants
All adult patients admitted to medical or surgical acute care units for any condition or illness.
Types of intervention(s)
Patient-centered intervention strategies to reduce falls compared to usual care.
Types of studies
Randomized control trials.
Types of outcomes
Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries.
Search strategy
A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository.
Methodological quality
Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute.
Data extraction
Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute.
Data synthesis
Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form.
Results
Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients’ fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5).
Conclusions
Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.
... 9 Actual fall rates are likely to even be higher as there is no universal definition for a fall, and falls incidents tend to be under-reported. 10 Hospital falls tend to cause serious complications, with 44-60% resulting in harm, 11,12 especially among older persons. 13 The 6-PACK trial (2011)(2012)(2013) in six Australian hospitals demonstrated that hospital falls increased length of stay (LOS) by 8 days [95% confidence interval (CI) 5.8-10.4, ...
Aim:
To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital.
Methods:
This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (post-trial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P ≤ 0.05).
Results:
Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or effectively preventing hospital falls (odds ratio 0.12). Clinicians' recommendations resulted in subsequent technological refinement of the tool, and provision of an additional iPad device for more efficient use.
Conclusion:
This study adds to the limited pool of knowledge about clinicians' attitudes toward health technology use in falls avoidance. Clinicians were willing to use the HIT tool, and their concerns about its usability were addressed in ongoing tool improvement. Including end-users in the development and refinement processes, as well as having high staff uptake of new technologies, is important in improving their acceptance and usage, and in maximizing beneficial feedback to further inform tool development.
