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Gupta E, Tennison JM, Shin KY, Fu JB, Rozman de Moraes A, Naqvi SMA, Fellman B, Bruera E. Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit. JCO Oncol Pract 2023; 19:741-749. [PMID: 37339393 PMCID: PMC10538936 DOI: 10.1200/op.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. METHODS A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. RESULTS There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). CONCLUSION The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.
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Affiliation(s)
- Ekta Gupta
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jegy M. Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ki Y. Shin
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aline Rozman de Moraes
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Bryan Fellman
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, Kiegaldie D, Slade S, Jazayeri D, Heng H, Shorr R, Carey L, Barker A, Cameron I. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing 2022; 51:6581612. [PMID: 35524748 PMCID: PMC9078046 DOI: 10.1093/ageing/afac077] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. DESIGN Systematic review and meta-analysis. PARTICIPANTS Hospitalised adults. INTERVENTION Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. OUTCOME MEASURES Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). RESULTS There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. CONCLUSION Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
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Affiliation(s)
- Meg E Morris
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia,The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia,Address correspondence to: Meg E. Morris, La Trobe University, Bundoora, Victoria 3186, Australia.
| | - Kate Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cathy Jones
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Monash University, Melbourne, Victoria, Australia
| | - Susan Slade
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Dana Jazayeri
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Hazel Heng
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Leeanne Carey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia,Silver Chain, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia
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Cooke M, de la Fuente M, Stringfield C, Sullivan K, Brassil R, Thompson J, Allen DH, Granger BB, Reynolds SS. The Impact of Nurse Staffing on Falls Performance within a Healthcare System: A Descriptive Study. J Nurs Manag 2022; 30:750-757. [PMID: 35118745 DOI: 10.1111/jonm.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
AIM The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system. BACKGROUND Evidence to support which staffing variables influence fall performance so that healthcare organizations can better allocate resources is lacking. METHOD A descriptive study design was used to analyze the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables. RESULTS A total of 9 units were included (5 high and 4 low performing). Higher performing units showed less use of sitters and travelers, had fewer nurses working overtime hours, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units. CONCLUSION Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers may consider trying to reduce use of sitters and travelers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.
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