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Kuznetsova M, Kim AY, Scully DA, Wolski P, Syrowatka A, Bates DW, Dykes PC. Implementation of a Continuous Patient Monitoring System in the Hospital Setting: A Qualitative Study. Jt Comm J Qual Patient Saf 2024; 50:235-246. [PMID: 38101994 DOI: 10.1016/j.jcjq.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Technology can improve care delivery, patient outcomes, and staff satisfaction, but integration into the clinical workflow remains challenging. To contribute to this knowledge area, this study examined the implementation continuum of a contact-free, continuous monitoring system (CFCM) in an inpatient setting. CFCM monitors vital signs and uses the information to alert clinicians of important changes, enabling early detection of patient deterioration. METHODS Data were collected throughout the entire implementation continuum at a community teaching hospital. Throughout the study, 3 group and 24 individual interviews and five process observations were conducted. Postimplementation alarm response data were collected. Analysis was conducted using triangulation of information sources and two-coder consensus. RESULTS Preimplementation perceived barriers were alarm fatigue, questions about accuracy and trust, impact on patient experience, and challenges to the status quo. Stakeholders identified the value of CFCM as preventing deterioration and benefitting patients who are not good candidates for telemetry. Educational materials addressed each barrier and emphasized the shared CFCM values. Mean alarm response times were below the desired target of two minutes. Postimplementation interview analysis themes revealed lessened concerns of alarm fatigue and improved trust in CFCM than anticipated. Postimplementation challenges included insufficient training for secondary users and impact on patient experience. CONCLUSION In addition to understanding the preimplementation anticipated barriers to implementation and establishing shared value before implementation, future recommendations include studying strategies for optimal tailoring of education to each user group, identifying and reinforcing positive process changes after implementation, and including patient experience as the overarching element in frameworks for digital tool implementation.
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Randell R, McVey L, Wright J, Zaman H, Cheong VL, Woodcock DM, Healey F, Dowding D, Gardner P, Hardiker NR, Lynch A, Todd C, Davey C, Alvarado N. Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-194. [PMID: 38511977 DOI: 10.3310/jwqc5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting Three Trusts, one orthopaedic and one older person ward in each. Results Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration This study is registered as PROSPERO CRD42020184458. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hadar Zaman
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | | | | | | | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | | | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Guo X, Wang Y, Wang L, Yang X, Yang W, Lu Z, He M. Effect of a fall prevention strategy for the older patients: A quasi-experimental study. Nurs Open 2022; 10:1116-1124. [PMID: 36178024 PMCID: PMC9834535 DOI: 10.1002/nop2.1379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/02/2022] [Accepted: 09/06/2022] [Indexed: 01/19/2023] Open
Abstract
AIM To explore the effect of a fall prevention strategy on older patients based on the Patient Engagement Framework. DESIGN A longitudinal quasi-experimental quantitative design. METHODS Older patients who met the inclusion criteria were recruited from geriatric, oncology, neurology and cardiology departments of a teaching general hospital in China. Development of a fall prevention intervention strategy for older patients was based on the Patient Engagement Framework. Patients in the intervention group were given this fall prevention strategy (N = 58), and those in the control group were given conventional measures (N = 58). The following indicators were compared between the two groups after intervention: (a) number of falls; (b) Knowledge-Attitude-Practice (KAP) score; (c) Modified Fall Efficacy Scale score. RESULTS After the implementation of an intervention strategy in older patients, the number of falls decreased from 3 to 0; the score of KAP and Modified Fall Efficacy Scale was promoted (p < .05).
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Affiliation(s)
- Xiaobei Guo
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Ying Wang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Lei Wang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Xueke Yang
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Weimei Yang
- Internal Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Zhihui Lu
- Nursing Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Mei He
- Intensive Care Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
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Chen Z, Zhong Q, Chen Y, Chen L, Peng H. The U-shaped association between hospitalization time and fall incidence in inpatients using publicly available data: A cross-sectional study in Japan. Nurs Open 2022; 10:1526-1535. [PMID: 36177862 PMCID: PMC9912438 DOI: 10.1002/nop2.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/17/2021] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To examine the association between the hospitalization time and fall incidence. DESIGN A secondary analysis using the Dryad Digital Repository public database. METHODS Data were extracted from the Fukushima Medical University Hospital cohort study between August 2008 and September 2009. The final analytic sample included 8,598 participants, 156 of who fell. The risk of fall incidents according to hospitalization time was estimated using logistic proportional hazards models, and restricted cubic splines with four knots model were developed. RESULTS The median hospitalization time was 9.00 (4.00, 17.00) days. The incidence of falls was 1.81% (N = 156). A U-shaped association between the hospitalization time and fall incidence, with an inflextion point of 8 days. We found a decreasing fall incidence as the hospitalization time increased from 0 to 8 days (OR 0.72 [0.62 ~ 0.83], p < .001); beyond 8 days, the fall incidence increased as the hospitalization time increased (OR 1.06 [1.04 ~ 1.09]).
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Affiliation(s)
- Zihong Chen
- Department of OncologyWuzhou Red Cross HospitalWuzhouChina
| | - Qiang Zhong
- Department of RadiotherapyWuzhou Red Cross HospitalWuzhouChina
| | - Yonghong Chen
- Department of OncologyWuzhou Red Cross HospitalWuzhouChina
| | - Lihua Chen
- Department of Intensive CareWuzhou Red Cross HospitalWuzhouChina
| | - Huanhuan Peng
- Department of CardiologyWuzhou Red Cross HospitalWuzhouChina
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5
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Zhao J, Wang G, Chen L, Yu S, Li W. Risk factors for falls in hospitalized patients with cancer: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2022; 9:100107. [PMID: 36033969 PMCID: PMC9398916 DOI: 10.1016/j.apjon.2022.100107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
A primary cancer diagnosis has been confirmed as an important risk factor for falls, and the incidence of falls has been shown to be higher in patients who have undergone cancer treatment than in those who have not undergone cancer treatment. Falls during hospitalization increase the medical costs of additional treatment and falls-related mortality. Many falls are preventable and a good understanding of the predictors of falls in this population is needed. However, the risk factors for falls have not yet been identified. The purpose of this review was to identify the risk factors for falls in hospitalized patients with cancer. Eleven English and Chinese electronic databases were searched from their inception to April 2022 and the methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Five studies involving 1237 patients with cancer were included. The meta-analysis identifies eleven risk factors for falls in hospitalized patients with cancer, including age, history of falls, opiates, benzodiazepines, steroids, antipsychotics, sedatives, radiation therapy, chemotherapy, the use of an assistive device and length of hospitalization. Based on the evidence presented in this article, healthcare workers have the capacity to help reduce fall risk through the development of preventive support strategies in this population. Multicenter, prospective studies of patients with cancer should be conducted to further identify and validate their risk factors for falls.
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Affiliation(s)
- Jing Zhao
- Department of Nursing, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Corresponding author.
| | - Guozhou Wang
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Lei Chen
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Simiao Yu
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Wenli Li
- Department of Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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Ojo EO, Thiamwong L. Effects of Nurse-Led Fall Prevention Programs for Older Adults: A Systematic Review. PACIFIC RIM INTERNATIONAL JOURNAL OF NURSING RESEARCH 2022; 26:417-431. [PMID: 36051891 PMCID: PMC9432804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Falls among older adults are preventable events and fall prevention programs led by nursing staff are promising and viable programs for preventing falls. This systematic review aimed to gain insight into the effects of nurse-led fall prevention programs for older adults. The Preferred Reporting Items for Systemic Reviews and Meta-Analysis was used as a guideline in reporting this literature search conducted through CINAHL, MEDLINE, Eric, Science Direct, and Google Scholar databases. The Johns Hopkins Nursing Evidence-Based Practice was used to determine the level of evidence and quality rating of the articles, while data extraction was done by a matrix review method. The review included six randomized controlled trials, two non-randomized controlled trials, and three quasi-experimental designs. Six studies directed their education component of the intervention on the nursing staff, while three focused on the older participants. Nurses' roles were patient assessment, patient education, administration of exercise programs, and follow-up post interventions. Fall rates and fall incidents were reduced in five studies, while three studies changed patients' behavior. Fall prevention programs with education components specific for older adults and nursing staff resulted in positive outcomes. Nursing staff make a significant contribution to improving patients' outcomes, and a fall prevention program that focuses on reducing injurious fall rates and enhancing participants' behavior could maximize its effects.
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Affiliation(s)
- Eunice Oladepe Ojo
- Correspondence to: Eunice Oladepe Ojo, DNP, RN, CV-BC, PCCN, DNP Graduate (Nurse Executive), College of Nursing, University of Central Florida, Orlando, FL, 32826, USA.
| | - Ladda Thiamwong
- Department of Nursing Systems, College of Nursing University of Central Florida Orlando, FL, 32826, USA
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7
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Dykes PC, Khasnabish S, Burns Z, Adkison LE, Alfieri L, Bogaisky M, Carroll DL, Carter EJ, Hurley AC, Jackson E, Kurian S, Lindros ME, Ryan V, Scanlan M, Sessler K, Shelley A, Spivack LB, Walsh MA, Bates DW, Adelman JS. Development and Validation of a Fall Prevention Efficiency Scale. J Patient Saf 2022; 18:94-101. [PMID: 33480645 PMCID: PMC8292432 DOI: 10.1097/pts.0000000000000811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based fall prevention program that led to a 25% reduction in falls in hospitalized adults. Because it would be helpful to assess nurses' perceptions of burdens imposed on them by using Fall TIPS or other fall prevention program, we conducted a study to learn benefits and burdens. METHODS A 3-phase mixed-method study was conducted at 3 hospitals in Massachusetts and 3 in New York: (1) initial qualitative, elicited and categorized nurses' views of time spent implementing Fall TIPS; (2) second qualitative, used nurses' quotes to develop items, research team inputs for refinement and organization, and clinical nurses' evaluation and suggestions to develop the prototype scale; and (3) quantitative, evaluated psychometric properties. RESULTS Four "time" themes emerged: (1) efficiency, (2) inefficiency, (3) balances out, and (4) valued. A 20-item prototype Fall Prevention Efficiency Scale was developed, administered to 383 clinical nurses, and reduced to 13 items. Individual items demonstrated robust stability with Pearson correlations of 0.349 to 0.550 and paired t tests of 0.155 to 1.636. Four factors explained 74.3% variance and provided empirical support for the scale's conceptual basis. The scale achieved excellent internal consistency values (0.82-0.92) when examined with the test, validation, and paired (both test and retest) samples. CONCLUSIONS This new scale assess nurses' perceptions of how a fall prevention program affects their efficiency, which impacts the likelihood of use. Learning nurses' beliefs about time wasted when implementing new programs allows hospitals to correct problems that squander time.
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Affiliation(s)
| | | | | | | | - Lois Alfieri
- Montefiore Medical Center Hospitals, New York, NY
| | | | | | - Eileen J. Carter
- Columbia University School of Nursing, New York, NY
- New York-Presbyterian Hospital
| | | | | | - Susan Kurian
- Montefiore Medical Center Hospitals, New York, NY
| | | | | | | | | | | | | | | | - David W. Bates
- Partners HealthCare, Boston, MA
- Harvard Medical School, Boston, MA
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8
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Tzeng HM, Jansen LS, Okpalauwaekwe U, Khasnabish S, Andreas B, Dykes PC. Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home. J Nurs Care Qual 2021; 36:327-332. [PMID: 33534349 DOI: 10.1097/ncq.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally. LOCAL PROBLEM About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada. METHODS We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home. INTERVENTION The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside. RESULTS The rates of falls and injuries decreased after implementing the Fall TIPS intervention. CONCLUSION Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, Galveston (Dr Tzeng); University of Saskatchewan, Saskatoon, Saskatchewan, Canada (Dr Jansen and Mr Okpalauwaekwe), Saskatchewan Health Authority, Saskatchewan, Canada (Ms Andreas); and Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Dykes and Ms Khasnabish)
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9
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Dykes PC, Khasnabish S, Adkison LE, Bates DW, Bogaisky M, Burns Z, Carroll DL, Carter E, Hurley AC, Jackson E, Kurian SS, Lindros ME, Ryan V, Scanlan M, Spivack L, Walsh MA, Adelman J. Use of a perceived efficacy tool to evaluate the FallTIPS program. J Am Geriatr Soc 2021; 69:3595-3601. [PMID: 34460098 DOI: 10.1111/jgs.17436] [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: 03/10/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES To assess nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. DESIGN Survey research. SETTING Seven adult acute-care hospitals in 2 hospital centers located in Boston and NYC. PARTICIPANTS A total of 298 medical-surgical nurses on 14 randomly selected units. INTERVENTION Three-step FallTIPS fall prevention program that had been in use as a clinical program for a minimum of 2 years in each hospital. MEASUREMENTS Fall Prevention Efficiency Scale (FPES), range 13-52; four-factorilly derived subscales: valued, efficiency, balances out and inefficiency; and 13 psychometrically validated individual items. RESULTS Nurses perceived the FallTIPS fall prevention program to be efficacious. The FPES mean score of 38.55 (SD = 5.05) and median of 39 were well above the lowest possible score of 13 and scale midpoint of 32.5. Most nurses (N = 270, 90.6%) scored above 33. There were no differences in FPES scores between nurses who had only used FallTIPS and nurses who had previously used a different fall prevention program. CONCLUSION The nurses who used FallTIPS perceived that efficiencies in patient care compensated for the time spent on FallTIPS. Nurses valued the program and findings confirmed the importance of patient and family engagement with staff in the fall prevention process. Regardless of the fall prevention program used, organizations should examine staff perceptions of their fall prevention program because programs that are not perceived as being useful, efficient, and valuable will lead to nonadherence over time and then will not reduce falls and injuries. The recently developed FPES used in this study is a brief tool available for organizations to assess nurses' perceptions of the efficacy of their fall prevention program. Additional FPES research is needed with larger and more diverse samples.
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Affiliation(s)
- Patricia C Dykes
- Division General Internal Medicine and Primary Care, Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Srijesa Khasnabish
- Division General Internal Medicine and Primary Care, Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - David W Bates
- Division General Internal Medicine and Primary Care, Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Zoe Burns
- Division General Internal Medicine and Primary Care, Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Eileen Carter
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Ann C Hurley
- Division General Internal Medicine and Primary Care, Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily Jackson
- New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Virginia Ryan
- Department of Nursing, Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA
| | | | | | - Mary-Ann Walsh
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason Adelman
- New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
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10
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Leung WY, Adelman J, Bates DW, Businger A, Dykes JS, Ergai A, Hurley A, Katsulis Z, Khorasani S, Scanlan M, Schenkel L, Rai A, Dykes PC. Validating Fall Prevention Icons to Support Patient-Centered Education. J Patient Saf 2021; 17:e413-e422. [PMID: 28230576 DOI: 10.1097/pts.0000000000000354] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Falls with injury are the most prevalent hospital adverse event. The objective of this project was to refine fall risk and prevention icons for a patient-centric bedside toolkit to promote patient and nurse engagement in accurately assessing fall risks and developing a tailored fall prevention plan. METHODS Eighty-eight patients and 60 nurses from 2 academic medical centers participated in 4 iterations of testing to refine 6 fall risk and 10 fall prevention icons. During individual interviews, participants rated their satisfaction with the degree to which that icon represented the concept on a 4-point Likert scale, enabling computation of a Content Validity Index (CVI), and provided comments and suggestions for improvement. After reviewing CVI scores and feedback, the research team consulted with the illustrator to revise the icons. RESULTS Content Validity Index scores improved after icon modifications. Icons that depicted multiple concepts required further iterations to be acceptable. DISCUSSION Using icons to depict an accurate and easy-to-interpret fall risk assessment and intervention plan for all care team members including patients and family to follow should lead to improved adherence with that plan and decreased falls. CONCLUSIONS All 16 icons were refined and used to form the basis for a bedside fall prevention toolkit.
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Affiliation(s)
- Wai Yin Leung
- From the Brigham and Women's Hospital, Boston, Massachusetts
| | | | - David W Bates
- From the Brigham and Women's Hospital, Boston, Massachusetts
| | | | - John S Dykes
- John S. Dykes Illustration, Sudbury, Massachusetts
| | - Awatef Ergai
- Healthcare Systems Engineering Institute at Northeastern University, Boston
| | - Ann Hurley
- From the Brigham and Women's Hospital, Boston, Massachusetts
| | - Zachary Katsulis
- Healthcare Systems Engineering Institute at Northeastern University, Boston
| | - Sarah Khorasani
- From the Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Amisha Rai
- Montefiore Medical Center, Bronx, New York
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11
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Khasnabish S, Burns Z, Couch M, Mullin M, Newmark R, Dykes PC. Best practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. J Am Med Inform Assoc 2021; 27:308-314. [PMID: 31697326 DOI: 10.1093/jamia/ocz190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/08/2019] [Accepted: 10/06/2019] [Indexed: 11/14/2022] Open
Abstract
This case report applied principles from the data visualization (DV) literature and feedback from nurses to develop an effective report to display adherence with an evidence-based fall prevention program. We tested the usability of the original and revised reports using a Health Information Technology Usability Evaluation Scale (Health-ITUES) customized for this project. Items were rated on a 5-point Likert scale, strongly disagree (1) to strongly agree (5). The literature emphasized that the ideal display maximizes the information communicated, minimizes the cognitive efforts involved with interpretation, and selects the correct type of display (eg, bar versus line graph). Semi-structured nurse interviews emphasized the value of simplified reports and meaningful data. The mean (standard deviation [SD]) Health-ITUES score for the original report was 3.86 (0.19) and increased to 4.29 (0.11) in the revised report (Mann Whitney U Test, z = -12.25, P < 0.001). Lessons learned from this study can inform report development for clinicians in implementation science.
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Affiliation(s)
- Srijesa Khasnabish
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zoe Burns
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Madeline Couch
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mary Mullin
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Randall Newmark
- Research Computing, Partners Healthcare, Boston, Massachusetts, USA
| | - Patricia C Dykes
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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12
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Dykes PC, Hurley AC. Patient-centered fall prevention. Nurs Manag (Harrow) 2021; 52:51-54. [PMID: 33633013 DOI: 10.1097/01.numa.0000733668.39637.ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Patricia C Dykes
- At Brigham and Women's Hospital Center for Patient Safety, Research, and Practice in Boston, Mass., Patricia C. Dykes is the program director of research and Ann C. Hurley is a senior nurse scientist
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Turner K, Staggs V, Potter C, Cramer E, Shorr R, Mion LC. Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study. BMJ Qual Saf 2020; 29:1000-1007. [PMID: 32188712 PMCID: PMC7501087 DOI: 10.1136/bmjqs-2019-010642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised. OBJECTIVE To identify and describe the prevalence of specific hospital fall prevention implementation strategies. METHODS In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables. RESULTS A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff). CONCLUSIONS Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.
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Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vincent Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Catima Potter
- Press Ganey Associates Inc, South Bend, Indiana, USA
| | - Emily Cramer
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ronald Shorr
- GRECC (182), Malcom Randall VAMC, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Lorraine C Mion
- Ohio State University College of Nursing, Columbus, Ohio, USA
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Dykes PC, Burns Z, Adelman J, Benneyan J, Bogaisky M, Carter E, Ergai A, Lindros ME, Lipsitz SR, Scanlan M, Shaykevich S, Bates DW. Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA Netw Open 2020; 3:e2025889. [PMID: 33201236 PMCID: PMC7672520 DOI: 10.1001/jamanetworkopen.2020.25889] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. OBJECTIVE To assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. INTERVENTIONS A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. RESULTS During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P = .01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P = .003). CONCLUSIONS AND RELEVANCE In this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient-care team partnership appears to be beneficial for prevention of falls and fall-related injuries. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02969343.
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Affiliation(s)
- Patricia C. Dykes
- Center for Patient Safety, Research and Practice, Division of General and Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Zoe Burns
- Center for Patient Safety, Research and Practice, Division of General and Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jason Adelman
- School of Nursing, Columbia University, New York, New York
- Columbia University Irving Medical Center/New York–Presbyterian, New York, New York
| | - James Benneyan
- Institute of Healthcare Systems Engineering, Boston, Massachusetts
| | | | - Eileen Carter
- School of Nursing, Columbia University, New York, New York
- Columbia University Irving Medical Center/New York–Presbyterian, New York, New York
| | | | | | - Stuart R. Lipsitz
- Center for Patient Safety, Research and Practice, Division of General and Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Shimon Shaykevich
- Center for Patient Safety, Research and Practice, Division of General and Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - David Westfall Bates
- Center for Patient Safety, Research and Practice, Division of General and Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
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Lindberg DS, Prosperi M, Bjarnadottir RI, Thomas J, Crane M, Chen Z, Shear K, Solberg LM, Snigurska UA, Wu Y, Xia Y, Lucero RJ. Identification of important factors in an inpatient fall risk prediction model to improve the quality of care using EHR and electronic administrative data: A machine-learning approach. Int J Med Inform 2020; 143:104272. [PMID: 32980667 PMCID: PMC8562928 DOI: 10.1016/j.ijmedinf.2020.104272] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Inpatient falls, many resulting in injury or death, are a serious problem in hospital settings. Existing falls risk assessment tools, such as the Morse Fall Scale, give a risk score based on a set of factors, but don't necessarily signal which factors are most important for predicting falls. Artificial intelligence (AI) methods provide an opportunity to improve predictive performance while also identifying the most important risk factors associated with hospital-acquired falls. We can glean insight into these risk factors by applying classification tree, bagging, random forest, and adaptive boosting methods applied to Electronic Health Record (EHR) data. OBJECTIVE The purpose of this study was to use tree-based machine learning methods to determine the most important predictors of inpatient falls, while also validating each via cross-validation. MATERIALS AND METHODS A case-control study was designed using EHR and electronic administrative data collected between January 1, 2013 to October 31, 2013 in 14 medical surgical units. The data contained 38 predictor variables which comprised of patient characteristics, admission information, assessment information, clinical data, and organizational characteristics. Classification tree, bagging, random forest, and adaptive boosting methods were used to identify the most important factors of inpatient fall-risk through variable importance measures. Sensitivity, specificity, and area under the ROC curve were computed via ten-fold cross validation and compared via pairwise t-tests. These methods were also compared to a univariate logistic regression of the Morse Fall Scale total score. RESULTS In terms of AUROC, bagging (0.89), random forest (0.90), and boosting (0.89) all outperformed the Morse Fall Scale (0.86) and the classification tree (0.85), but no differences were measured between bagging, random forest, and adaptive boosting, at a p-value of 0.05. History of Falls, Age, Morse Fall Scale total score, quality of gait, unit type, mental status, and number of high fall risk increasing drugs (FRIDs) were considered the most important features for predicting inpatient fall risk. CONCLUSIONS Machine learning methods have the potential to identify the most relevant and novel factors for the detection of hospitalized patients at risk of falling, which would improve the quality of patient care, and to more fully support healthcare provider and organizational leadership decision-making. Nurses would be able to enhance their judgement to caring for patients at risk for falls. Our study may also serve as a reference for the development of AI-based prediction models of other iatrogenic conditions. To our knowledge, this is the first study to report the importance of patient, clinical, and organizational features based on the use of AI approaches.
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Affiliation(s)
- David S Lindberg
- Department of Statistics, College of Liberal Arts and Sciences, University of Florida, United States.
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, United States
| | - Ragnhildur I Bjarnadottir
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States
| | | | | | - Zhaoyi Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Kristen Shear
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States
| | - Laurence M Solberg
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States; NF/SG VAHS, Geriatrics Research, Education, and Clinical Center (GRECC) Gainesville, Florida, United States
| | - Urszula Alina Snigurska
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Yunpeng Xia
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States
| | - Robert J Lucero
- Department of Family, Community, and Health Systems Science, College of Nursing, University of Florida, United States
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Fehlberg EA, Cook CL, Bjarnadottir RI, McDaniel AM, Shorr RI, Lucero RJ. Fall Prevention Decision Making of Acute Care Registered Nurses. J Nurs Adm 2020; 50:442-448. [PMID: 32826513 PMCID: PMC7592292 DOI: 10.1097/nna.0000000000000914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.
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Affiliation(s)
- Elizabeth A Fehlberg
- Author Affiliations: Health Services Researcher (Dr Fehlberg), Division of Research on Healthcare Value, Equity, and the Lifespan, RTI International, Research Triangle Park, North Carolina; Associate Professor (Dr Cook), College of Nursing, University of Central Florida, Orlando; Assistant Professor (Dr Bjarnadottir), Dean and Linda Harman Aiken Professor (Dr McDaniel), and University Term Professor and Associate Professor (Dr Lucero), College of Nursing, University of Florida, Gainesville; and Director (Dr Shorr), Geriatric Research Education and Clinical Centers (GRECC), Malcom Randall VAMC, Gainesville, Florida
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van Rensburg RJ, van der Merwe A, Crowley T. Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape. Health SA 2020; 25:1392. [PMID: 32670623 PMCID: PMC7343942 DOI: 10.4102/hsag.v25i0.1392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix. Aim The study aimed to determine the factors that influence patient falls. Setting A private hospital group in the Cape Metropole of the Western Cape. Methods A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS). Results Intrinsic factors contributing to patient falls includedthe patient’s age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment. Conclusion The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals.
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Affiliation(s)
- Renee Janse van Rensburg
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Anita van der Merwe
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Misra V, Sedig K, Dixon DR, Sibbald SL. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e165-e170. [PMID: 32532734 PMCID: PMC7292506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vaidehi Misra
- Analyste de données pour le London InterCommunity Health Centre en Ontario.
| | - Kimia Sedig
- Assistante de recherche à l'Hôpital général de North York en Ontario
| | - David R Dixon
- Membre du corps professoral de clinique à la Faculté de médecine et de chirurgie dentaire Schulich de l'Université Western à London
| | - Shannon L Sibbald
- Professeure adjointe à l'École des études de la santé de l'Université Western
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Tiase VL, Tang K, Vawdrey DK, Raso R, Adelman JS, Yu SP, Applebaum JR, Lalwani AK. Impact of Hearing Loss on Patient Falls in the Inpatient Setting. Am J Prev Med 2020; 58:839-844. [PMID: 32444002 DOI: 10.1016/j.amepre.2020.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The objectives of this study were to investigate an association between the risk of patient falls and self-reported hearing loss and to examine whether self-reported hearing loss with versus without hearing aids predicts patient falls in an inpatient setting. METHODS This retrospective cohort analysis was conducted in 2018 in a large, urban, academic medical center. Participants included unique inpatients (N=52,805) of adults aged >18 years between February 1, 2017, and February 1, 2018. Outcome measures were falls in the inpatient setting and hearing loss with versus without hearing aids as predictors for patient falls. RESULTS Self-reported hearing loss was associated with falls in the inpatient setting (OR=1.74, 95% CI=1.46, 2.07, p<1.43 × 10-9). Among patients with hearing impairment, a lack of hearing aids increased the risk for falls in the inpatient setting (OR=2.70, 95% CI=1.64, 4.69, p<1.41 × 10-5). After accounting for the risk of fall using the Morse Fall Scale (which does not include hearing impairment) and controlling for age and sex, patients with hearing loss and no hearing aids were significantly more likely to fall (OR=2.44, 95% CI=1.002, 5.654, p<0.042), but patients with hearing loss who did have hearing aids were not significantly more likely to fall (p<0.889). Hearing loss together with the Morse Fall Scale better predicted falls than the Morse Fall Scale alone (p<0.017). CONCLUSIONS In the inpatient setting, there was a positive association between hearing loss and falls. However, among patients with hearing loss, only those without hearing aids were significantly more likely to fall, accounting for the Morse Fall Scale score and demographics characteristics. These findings support adding hearing loss as a modifiable risk factor in risk assessment tools for falls and exploring the use of amplification devices as an intervention.
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Affiliation(s)
- Victoria L Tiase
- The Value Institute, New York-Presbyterian Hospital, New York, New York
| | - Kui Tang
- The Value Institute, New York-Presbyterian Hospital, New York, New York
| | - David K Vawdrey
- The Value Institute, New York-Presbyterian Hospital, New York, New York
| | - Rosanne Raso
- Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York
| | - Jason S Adelman
- Department of Medicine, Division of General Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shao Ping Yu
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York
| | - Jo R Applebaum
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York
| | - Anil K Lalwani
- Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
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Misra V, Sedig K, Dixon DR, Sibbald SL. Prioritizing coordination of primary health care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:399-403. [PMID: 32532718 PMCID: PMC7292521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vaidehi Misra
- Data analyst for the London InterCommunity Health Centre in Ontario.
| | - Kimia Sedig
- Research assistant at the North York General Hospital in Ontario
| | - David R Dixon
- Member of the clinical faculty in the Schulich School of Medicine and Dentistry at Western University in London
| | - Shannon L Sibbald
- Assistant Professor in the School of Health Studies at Western University
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Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Hospital falls prevention with patient education: a scoping review. BMC Geriatr 2020; 20:140. [PMID: 32293298 PMCID: PMC7161005 DOI: 10.1186/s12877-020-01515-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hospital falls remain a frequent and debilitating problem worldwide. Most hospital falls prevention strategies have targeted clinician education, environmental modifications, assistive devices, hospital systems and medication reviews. The role that patients can play in preventing falls whilst in hospital has received less attention. This critical review scopes patient falls education interventions for hospitals. The quality of the educational designs under-pinning patient falls education programmes was also evaluated. The outcomes of patient-centred falls prevention programs were considered for a range of hospital settings and diagnoses. Methods The Arksey and O’Malley (2005) framework for scoping reviews was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Eight databases, including grey literature, were searched from January 2008 until February 2020. Two reviewers independently screened the articles and data were extracted and summarised thematically. The quality of falls prevention education programs for patients was also appraised using a modified quality metric tool. Results Forty-three articles were included in the final analysis. The interventions included: (i) direct face-to-face patient education about falls risks and mitigation; (ii) educational tools; (iii) patient-focussed consumer materials such as pamphlets, brochures and handouts; and (iv) hospital systems, policies and procedures to assist patients to prevent falls. The included studies assessed falls or education related outcomes before and after patient falls prevention education. Few studies reported incorporating education design principles or educational theories. When reported, most educational programs were of low to moderate quality from an educational design perspective. Conclusions There is emerging evidence that hospital falls prevention interventions that incorporate patient education can reduce falls and associated injuries such as bruising, lacerations or fractures. The design, mode of delivery and quality of educational design influence outcomes. Well-designed education programs can improve knowledge and self-perception of risk, empowering patients to reduce their risk of falling whilst in hospital.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Louise Shaw
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia
| | - Debra Kiegaldie
- Healthscope and Faculty of Health Science, Youth & Community Studies, Holmesglen Institute, Melbourne, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Meg E Morris
- Victorian Rehabilitation Centre, ARCH Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Australia.
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Christiansen TL, Lipsitz S, Scanlan M, Yu SP, Lindros ME, Leung WY, Adelman J, Bates DW, Dykes PC. Patient Activation Related to Fall Prevention: A Multisite Study. Jt Comm J Qual Patient Saf 2020; 46:129-135. [DOI: 10.1016/j.jcjq.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
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Kim IJ. Hospital flooring safety and health: knowledge gaps and suggestions. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 27:1116-1135. [PMID: 31679473 DOI: 10.1080/10803548.2019.1688473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.
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Affiliation(s)
- In-Ju Kim
- College of Engineering, University of Sharjah, United Arab Emirates
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McDonald K, Vonnes C, Hartranft S. Direct care nurses and support staff thoughts and feelings about the reasons patients fall at a cancer center. J Healthc Risk Manag 2020; 40:17-23. [PMID: 31912563 DOI: 10.1002/jhrm.21399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Extensive research addresses the prevalence and high fall risk for cancer patients related to age, diagnosis, treatment side effects, pharmacological side effects, and cognitive and/or motor deficits. The purpose of the study was to explore the thoughts and feelings that inpatient and outpatient oncology direct care nurses (registered nurses) and support staffs have about reasons patients fall; as well as their thoughts on what might be done to prevent falls. This descriptive qualitative study used focus groups as the method for discovery. Six themes were identified: Effect on Me, Guilt, Noncompliance, Poor Choices, Inconsistency, and No Authority. This study is significant and relevant because there is little previous research addressing staff thoughts and feelings about why patients fall and what additional interventions they think can be implemented to prevent falls. Findings from this study may be helpful in developing and/or refining current fall policies. Existing research suggests unlicensed patient care providers often have minimal participation in postfall reviews. This study suggests they can provide insight into why patients fall. Additionally, both registered nurses and unlicensed providers describe barriers that often impede their ability to work as a team to prevent patient falls. Findings from this study identified the need for the patient care team to strengthen collaborative work to create safer patient environments.
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Affiliation(s)
- Kathie McDonald
- Risk Management, Moffitt Cancer Center, Tampa, Florida, United States
| | - Cassandra Vonnes
- Nursing Professional Developement, Moffitt Cancer Center, Tampa, Florida, United States
| | - Susan Hartranft
- Nursing Research, Moffitt Cancer Center, Tampa, Florida, United States
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Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Educating hospital patients to prevent falls: protocol for a scoping review. BMJ Open 2019; 9:e030952. [PMID: 31530614 PMCID: PMC6756445 DOI: 10.1136/bmjopen-2019-030952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Falls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended. METHODS AND ANALYSIS The analysis will apply the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed search strategy of Medical Subject Headings and text words will be conducted of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, PsychINFO, Education Resources Information Center and grey literature databases from January 2008 to current. The reference lists of included articles will be hand searched for additional studies. Two reviewers will screen the titles and abstracts independently and analyse the full text of potential articles based on the inclusion and exclusion criteria. The data will be extracted using a structured data form. Thematic analysis and numerical synthesis of the data will be conducted, and key themes will be identified. ETHICS AND DISSEMINATION Results of this scoping review will illuminate the designs and outcomes of patient education research for hospital falls prevention in the current literature. It is anticipated that the findings will highlight best-practice educational design to inform the development of future patient-focused education for falls prevention. Study findings will be presented at relevant conferences and public forums, and published in peer-reviewed journals. Ethics approval is not required.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Louise Shaw
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Debra Kiegaldie
- Healthscope and Faculty of Health Science, Youth and Community Studies, Holmesglen Institute of TAFE Morrabbin Campus, Moorabbin, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
- North Eastern Rehabilitation Centre, Healthscope Ltd, Ivanhoe, Victoria, Australia
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Duckworth M, Adelman J, Belategui K, Feliciano Z, Jackson E, Khasnabish S, Lehman IFS, Lindros ME, Mortimer H, Ryan K, Scanlan M, Berger Spivack L, Yu SP, Bates DW, Dykes PC. Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study. J Med Internet Res 2019; 21:e10008. [PMID: 30664454 PMCID: PMC6360379 DOI: 10.2196/10008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/13/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022] Open
Abstract
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; (2) develop tailored fall prevention plans with the evidence-based interventions; and (3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all 3 steps of the fall prevention process. Over the past decade, our team developed 3 Fall TIPS modalities—the original electronic health record (EHR) version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patients’ fall prevention plan based on the clinical documentation in the EHR. However, the relative effectiveness of each Fall TIPS modality for engaging patients and family in the 3-step fall prevention process remains unknown. Objective This study aims to examine if the Fall TIPS modality impacts patient engagement in the 3-step fall prevention process and thus Fall TIPS efficacy. Methods To assess patient engagement in the 3-step fall prevention process, we conducted random audits with the question, “Does the patient/family member know their fall prevention plan?” In addition, audits were conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from 3 hospitals reported data from April to June 2017 on 6 neurology and 7 medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection. Results Overall, 1209 audits were submitted for the patient engagement measure and 1401 for the presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. While some units maintained high levels of patient engagement and adherence with the poster protocol, others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection. Conclusions Each Fall TIPS modality effectively facilitates patient engagement in the 3-step fall prevention process, suggesting all 3 can be used to integrate evidence-based fall prevention practices into the clinical workflow. The 3 Fall TIPS modalities may prove an effective strategy for the spread, allowing diverse institutions to choose the modality that fits with the organizational culture and health information technology infrastructure.
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Affiliation(s)
- Megan Duckworth
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jason Adelman
- NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States
| | - Katherine Belategui
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Zinnia Feliciano
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Emily Jackson
- NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States
| | - Srijesa Khasnabish
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - I-Fong Sun Lehman
- NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States
| | | | - Heather Mortimer
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Kasey Ryan
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | | | | | - Shao Ping Yu
- NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States
| | - David Westfall Bates
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Patricia C Dykes
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Bowden V, Bradas C, McNett M. Impact of level of nurse experience on falls in medical surgical units. J Nurs Manag 2019; 27:833-839. [DOI: 10.1111/jonm.12742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/19/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
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28
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Dykes PC, Bogaisky M, Carter EJ, Duckworth M, Hurley AC, Jackson EM, Khasnabish S, Lindros ME, Lipsitz SR, Scanlan M, Yu SP, Bates DW, Adelman JS. Development and Validation of a Fall Prevention Knowledge Test. J Am Geriatr Soc 2018; 67:133-138. [DOI: 10.1111/jgs.15563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Patricia C. Dykes
- Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | | | - Eileen J. Carter
- School of Nursing; Columbia University; New York New York
- New York-Presbyterian Hospital; New York New York
| | | | | | | | | | | | - Stuart R. Lipsitz
- Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | | | - Shao P. Yu
- New York-Presbyterian Hospital; New York New York
| | - David W. Bates
- Brigham and Women's Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
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Ott LD. The impact of implementing a fall prevention educational session for community-dwelling physical therapy patients. Nurs Open 2018; 5:567-574. [PMID: 30338102 PMCID: PMC6177546 DOI: 10.1002/nop2.165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/14/2018] [Indexed: 11/17/2022] Open
Abstract
AIM The aim of this study was to evaluate the impact of a fall prevention educational session on fall risk knowledge, use of fall prevention interventions and the number of falls in community-dwelling older persons attending physical therapy. DESIGN This pilot study used a mixed method design consisting of a quantitative pretest-posttest quasi-experimental design followed by a qualitative interview. METHOD An educational intervention was given with pre- and posttest questionnaires to determine the outcome measures of: (a) fall risk knowledge; (b) number of participants implementing fall prevention techniques; and (c) the number of falls sustained for 60 days post the educational sessions. The Health Belief Model served as the theoretical underpinnings for development and presentation of two educational sessions. RESULTS Eight of 20 participants completed the fall prevention educational sessions and subsequent evaluation. An increase in fall risk knowledge (p = 0.031) and implementation of fall prevention techniques was noted. One fall was sustained 60 days after therapy discharge.
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Affiliation(s)
- Lynda Dee Ott
- Valdosta State UniversityCollege of Nursing & Health SciencesValdostaGeorgiaUSA
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Baris VK, Seren Intepeler S. Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health. J Clin Nurs 2018; 28:615-628. [DOI: 10.1111/jocn.14656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/30/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty Nursing Management Department Dokuz Eylul University Izmir Turkey
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Brewer BB, Carley KM, Benham-Hutchins MM, Effken JA, Reminga J, Kowalchuck M. Relationship of Staff Information Sharing and Advice Networks to Patient Safety Outcomes. J Nurs Adm 2018; 48:437-444. [PMID: 30095687 PMCID: PMC6105471 DOI: 10.1097/nna.0000000000000646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare information sharing and advice networks' relationships with patient safety outcomes. BACKGROUND Communication contributes to medical errors, but rarely is it clear what elements of communication are key. METHODS We investigated relationships of information-sharing and advice networks to patient safety outcomes in 24 patient care units from 3 hospitals over 7 months. Web-based questionnaires completed via Android tablets provided data to create 2 networks using ORA, a social network analysis application. Each hospital provided nurse-sensitive patient safety outcomes. RESULTS In both networks, medication errors correlated positively with node count and average distance and negatively with clustering coefficient. Density and weighted density negatively correlated with medication errors and falls in both networks. Eigenvector and total degree centrality correlated negatively with both safety outcomes, whereas betweenness centrality positively related to falls in the information-sharing network. CONCLUSION Technology-enabled social network analysis data collection is feasible and can provide managers actionable system-level information.
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Affiliation(s)
- Barbara B Brewer
- Author Affiliations: Associate Professor (Dr Brewer) and Professor Emeritus (Dr Effken), College of Nursing, The University of Arizona, Tucson; Professor (Dr Carley) and Senior Research Programmer (Mr Reminga and Mr Kowalchuck), Carnegie Mellon School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania; and Assistant Professor (Dr Benham-Hutchins), School of Nursing, The University of Texas at Austin
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Evaluation and refinement of a handheld health information technology tool to support the timely update of bedside visual cues to prevent falls in hospitals. INT J EVID-BASED HEA 2018; 16:90-100. [DOI: 10.1097/xeb.0000000000000129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gettens S, Fulbrook P, Jessup M, Low Choy N. The patients' perspective of sustaining a fall in hospital: A qualitative study. J Clin Nurs 2017; 27:743-752. [PMID: 28926152 DOI: 10.1111/jocn.14075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To understand the patient's perspective of falling in hospital. BACKGROUND A fall in hospital can affect a patient physically and psychologically, increasing their hospital length of stay and potentially putting them at risk of further complications. Despite a wealth of literature on falls that focuses on risk assessment, preventive interventions and cost, very little research has focused on the experience of the patient that has fallen, particularly within the acute hospital setting. DESIGN A qualitative phenomenological design was used to investigate the experience of falling in hospital. METHODS Twelve hospital inpatients that had recently fallen were interviewed while in hospital using unstructured interviews. The methodology was guided by Van Manen's approach to data collection and analysis. FINDINGS Three key themes emerged from the analysis: Feeling safe, Realising the risk and Recovering independence and identity. These themes describe a continuum whereby falling was not initially a concern to participants, who trusted staff to keep them safe, and tended to not seek assistance. As participants began to appreciate the reality of their falls risk, they felt disempowered by their loss of independence but were more receptive to receiving assistance. Finally, as participants recovered, their desire to regain independence increased. They wanted others to perceive them as physically competent, rather than as a frail older person, meaning they were more willing to take risks with mobility. CONCLUSION The participants' perspective of falling describes a continuum of responses with participants positioned at different psychosocial standpoints: from initial denial of their risk of falling to realisation of the importance of their fall and acceptance of its repercussions. RELEVANCE TO CLINICAL PRACTICE By understanding the patient's perspective of falling, nurses and other health professionals conducting risk assessment can tailor their discussions and interventions to the patient's perceptions and needs.
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Affiliation(s)
- Stephanie Gettens
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Melanie Jessup
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Nancy Low Choy
- Department of Physiotherapy, The Prince Charles Hospital, Brisbane, QLD, Australia.,School of Physiotherapy, Australian Catholic University, Banyo, QLD, Australia
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Cuttler SJ, Barr-Walker J, Cuttler L. Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ Open Qual 2017; 6:e000119. [PMID: 29450285 PMCID: PMC5699144 DOI: 10.1136/bmjoq-2017-000119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods. Objective To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates. Design Performance improvement study with historic control. Setting Four medical-surgical units in one US public acute care hospital. Study participants Adult medical-surgical inpatients units. Interventions A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling. Main outcome measures The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow-up period of January 2015–December 2015 (intervention). Results Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented. Conclusion The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
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Affiliation(s)
- Sasha J Cuttler
- Collaborative Alliance for Nursing Outcomes Coordinator, San Francisco General Hospital, San Francisco, California, USA.,Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, California, USA
| | - Lauren Cuttler
- Department of Nursing, City College of San Francisco, San Francisco, California, USA
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Duckworth M, Leung E, Fuller T, Espares J, Couture B, Chang F, Businger AC, Collins S, Dalal A, Fladger A, Schnipper JL, Schnock KO, Bates DW, Dykes PC. Nurse, Patient, and Care Partner Perceptions of a Personalized Safety Plan Screensaver. J Gerontol Nurs 2017; 43:15-22. [PMID: 28358972 DOI: 10.3928/00989134-20170313-05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A patient safety plan dashboard was developed that captures disparate data from the electronic health record that is then displayed as a personalized bedside screensaver. The dashboard aligns all care team members, including patients and families, in the safety plan. The screensaver content includes icons that pertain to common geriatric syndromes. In two phases, interviews were conducted with nurses, nursing assistants, patients, and informal caregivers in a large, tertiary care center. End user perceptions of the content and interface of the personalized safety plan screensavers were identified and strategies to overcome the barriers to use for future iterations were defined. Many themes were identified, ranging from appreciation of the clinical decision support provided by the screensavers to the value of the safety-centric content. Differences emerged stemming from each group of end users' role on the care team. All feedback will inform requirements for improvements to the personalized safety plan screensaver. [Journal of Gerontological Nursing, 43(4), 15-22.].
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Longitudinal Evaluation of Johns Hopkins Fall Risk Assessment Tool and Nurses' Experience. J Nurs Care Qual 2017; 32:242-251. [DOI: 10.1097/ncq.0000000000000235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dykes PC, Duckworth M, Cunningham S, Dubois S, Driscoll M, Feliciano Z, Ferrazzi M, Fevrin FE, Lyons S, Lindros ME, Monahan A, Paley MM, Jean-Pierre S, Scanlan M. Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. Jt Comm J Qual Patient Saf 2017; 43:403-413. [PMID: 28738986 DOI: 10.1016/j.jcjq.2017.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. Strategies were needed to integrate this evidence into clinical practice. METHODS The Institute for Healthcare Improvement's Framework for Spread is the conceptual model for pilot implementation of Fall TIPS at Brigham and Women's Hospital (BWH; Boston) and Montefiore Medical Center (MMC; Bronx, New York). The key to translating the evidence into practice was engaging stakeholders by leveraging existing shared governance structures, identifying unit champions, holding training sessions for all staff, and implementing auditing to assess and provide feedback on protocol adherence and patient outcomes. RESULTS BWH unit compliance with using Fall TIPS averaged 82%, the mean fall rate decreased from 3.28 to 2.80 falls per 1,000 patient-days from January through June 2015 versus 2016, and the mean fall with injury rate for these periods decreased from 1.00 to 0.54 per 1,000 patient-days. At MMC, compliance averaged 91%, but the mean fall rate increased marginally from 3.04 to 3.10, while the mean fall with injury rate decreased from 0.47 to 0.31 per 1,000 patient-days. Patient knowledge survey results show improvement in knowledge of the risks for falls and the ways to prevent falls. CONCLUSION Engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. Barriers to adoption of the protocol have been addressed and detailed to provide guidance for spread to other institutions.
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Hill AM, Waldron N, Francis-Coad J, Haines T, Etherton-Beer C, Flicker L, Ingram K, McPhail SM. 'It promoted a positive culture around falls prevention': staff response to a patient education programme-a qualitative evaluation. BMJ Open 2016; 6:e013414. [PMID: 28003295 PMCID: PMC5223633 DOI: 10.1136/bmjopen-2016-013414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The purpose of this study was to understand how staff responded to individualised patient falls prevention education delivered as part of a cluster randomised trial, including how they perceived the education contributed to falls prevention on their wards. DESIGN A qualitative explanatory study. METHODS 5 focus groups were conducted at participatory hospital sites. The purposive sample of clinical staff (including nurses, physiotherapists and quality improvement staff) worked on aged care rehabilitation wards when a cluster randomised trial evaluating a patient education programme was conducted. During the intervention period, an educator, who was a trained health professional and not a member of staff, provided individualised falls prevention education to patients with good levels of cognition (Mini-Mental State Examination >23/30). Clinical staff were provided with training to support the programme and their feedback was sought after the trial concluded, to understand how they perceived the programme impacted on falls prevention. Data were thematically analysed using NVivo qualitative data analysis software. RESULTS 5 focus groups were conducted at different hospitals (n=30 participants). Staff perceived that the education created a positive culture around falls prevention and further, facilitated teamwork, whereby patients and staff worked together to address falls prevention. The educator was perceived to be a valuable member of the team. Staff reported that they developed increased knowledge and awareness about creating a safe ward environment. Patients being proactive and empowered to engage in falls prevention strategies, such as ringing the bell for assistance, was viewed as supporting staff falls prevention efforts and motivating staff to change practice. CONCLUSIONS Staff responded positively to patient falls prevention education being delivered on their wards. Providing individualised patient education to older patients with good levels of cognition can empower staff and patients to work as a team to address falls prevention on hospital rehabilitation wards.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
- Health Strategy and Networks, Strategic System, Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Terry Haines
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine and Pharmacology, Perth, Western Australia, Australia
- Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine and Pharmacology, Perth, Western Australia, Australia
- Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Hill AM, Francis-Coad J, Haines TP, Waldron N, Etherton-Beer C, Flicker L, Ingram K, McPhail SM. 'My independent streak may get in the way': how older adults respond to falls prevention education in hospital. BMJ Open 2016; 6:e012363. [PMID: 27466244 PMCID: PMC4964303 DOI: 10.1136/bmjopen-2016-012363] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of the study was to determine how providing individualised falls prevention education facilitated behaviour change from the perspective of older hospital patients on rehabilitation wards and what barriers they identified to engaging in preventive strategies. DESIGN A prospective qualitative survey. METHODS Older patients (n=757) who were eligible (mini-mental state examination score>23/30) received falls prevention education while admitted to eight rehabilitation hospital wards in Western Australia. Subsequently, 610 participants were surveyed using a semistructured questionnaire to gain their response to the in-hospital education and their identified barriers to engaging in falls prevention strategies. Deductive content analysis was used to map responses against conceptual frameworks of health behaviour change and risk taking. RESULTS Participants who responded (n=473) stated that the education raised their awareness, knowledge and confidence to actively engage in falls prevention strategies, such as asking for assistance prior to mobilising. Participants' thoughts and feelings about their recovery were the main barriers they identified to engaging in safe strategies, including feeling overconfident or desiring to be independent and thinking that staff would be delayed in providing assistance. The most common task identified as potentially leading to risk-taking behaviour was needing to use the toilet. CONCLUSIONS Individualised education assists older hospital rehabilitation patients with good levels of cognition to engage in suitable falls prevention strategies while on the ward. Staff should engage with patients to understand their perceptions about their recovery and support patients to take an active role in planning their rehabilitation.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jacqueline Francis-Coad
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia
- Health Strategy and Networks, Strategic System, Policy & Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Taylor E, Hignett S. The SCOPE of Hospital Falls: A Systematic Mixed Studies Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 9:86-109. [PMID: 27240563 DOI: 10.1177/1937586716645918] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic mixed studies review on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. BACKGROUND Falls were identified by the Centers for Medicare & Medicaid Services as a nonreimbursed hospital-acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 U.S. HAC reduction program. In 2015, the Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety & Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level are indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people, and environment. METHODS The systematic literature review used Medical Subject Heading terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. RESULTS Following full-text review, 27 papers were included and critically appraised using an evaluation matrix that included a mixed methods appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients), and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. CONCLUSIONS Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework while considering the permanence of solutions.
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Hill AM, McPhail SM, Francis-Coad J, Waldron N, Etherton-Beer C, Flicker L, Ingram K, Haines TP. Educators' perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation. BMJ Open 2015; 5:e009780. [PMID: 26656027 PMCID: PMC4679942 DOI: 10.1136/bmjopen-2015-009780] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/18/2015] [Accepted: 11/13/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators' perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. DESIGN A qualitative exploratory study. METHODS Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. RESULTS Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. CONCLUSIONS Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Nicholas Waldron
- Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia Department of Health Strategy and Networks, Strategic System, Policy & Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine & Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Katharine Ingram
- Department of Rehabilitation, Aged Care Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Terry P Haines
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
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Resnick B, Galik E, Wells PT CL, Boltz M, Holtzman L. Optimizing physical activity among older adults post trauma: Overcoming system and patient challenges. Int J Orthop Trauma Nurs 2015; 19:194-206. [PMID: 26547682 PMCID: PMC4637820 DOI: 10.1016/j.ijotn.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/24/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. PURPOSE The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. RESULTS Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. CONCLUSION Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.
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Affiliation(s)
- Barbara Resnick
- Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Elizabeth Galik
- Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Chris L. Wells PT
- Clinical Associate Professor, Physical Therapy and Rehabilitation Science 655 W. Baltimore Street, Baltimore MD 21201, Tel: 410 706 6663
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467, Tel: 617-552-6379
| | - Lauren Holtzman
- Project Manager, University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
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Bowles KH, Dykes P, Demiris G. The use of health information technology to improve care and outcomes for older adults. Res Gerontol Nurs 2015; 8:5-10. [PMID: 25625621 DOI: 10.3928/19404921-20121222-01] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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da Silva MB, Almeida MDA, Panato BP, Siqueira APDO, da Silva MP, Reisderfer L. Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility. Rev Lat Am Enfermagem 2015; 23:51-8. [PMID: 25806631 PMCID: PMC4376031 DOI: 10.1590/0104-1169.3526.2524] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
AIM to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility METHOD longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed. RESULTS The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035). CONCLUSION the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.
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Affiliation(s)
- Marcos Barragan da Silva
- Doctoral student, Escola de Enfermagem, Universidade Federal do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Miriam de Abreu Almeida
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal do
Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruna Paulsen Panato
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Mariana Palma da Silva
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia Reisderfer
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Johnson M, Kelly L, Siric K, Tran DT, Overs B. Improving falls risk screening and prevention using an e-learning approach. J Nurs Manag 2014; 23:910-9. [PMID: 24848141 DOI: 10.1111/jonm.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the impact of an e-learning education programme for nurses on falls risk screening, falls prevention and post-falls management. BACKGROUND Falls injury within older inpatients is a major patient safety concern. METHOD Using a pre-post design, observation of the patient and environment and patient health care record audits, were conducted following the introduction of a falls e-learning education programme. RESULTS Audits of patient health care records (using the Falls Chart Audit Tool), together with observation of practice for 119 (pre) and 99 (post) patients, were undertaken. Initial risk screening was conducted using the Modified Ontario Stratify Scale for most patients (95%). Interventions such as a falls risk flag in the records/on beds, supervision when the patient is mobilising or in the bathroom, area clear of hazards, use of chair/bed alarms, and referral to allied health staff were significantly improved. CONCLUSIONS Initial risk screening of patients and improvements in preventive interventions were demonstrated. IMPLICATIONS FOR NURSING MANAGEMENT This falls e-learning programme represents a cost-effective method of increasing falls mitigation strategies within large organisations. The Falls Chart Audit Tool provides a valuable monitoring tool for managers. Falls risk screening when the patient's condition changes, requires vigilance by managers or reminders within clinical information systems.
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Affiliation(s)
- Maree Johnson
- School of Nursing and Midwifery, University of Western Sydney, Liverpool, NSW, Australia.,Centre for Applied Nursing Research, South Western Sydney Local Health District, University of Western Sydney (Affiliated with the Ingham Institute, Liverpool NSW), Liverpool, NSW, Australia
| | - Linda Kelly
- Centre for Education and Workforce Development, Rozelle, NSW, Australia
| | - Katica Siric
- Concord Repatriation General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Duong Thuy Tran
- Centre for Health Research, School of Medicine, University of Western Sydney, Penrith, NSW, Australia
| | - Bronwyn Overs
- Mental Health Centre (Level 1), Faculty of Medicine, School of Psychiatry, Liverpool Hospital, Infant Child Adolescent Mental Health Service (ICAMHS) Research, University of New South Wales, Liverpool, NSW, Australia
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Abbott PA, Foster J, Marin HDF, Dykes PC. Complexity and the science of implementation in health IT--knowledge gaps and future visions. Int J Med Inform 2013; 83:e12-22. [PMID: 24444700 DOI: 10.1016/j.ijmedinf.2013.10.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The intent of this paper is in the examination of health IT implementation processes - the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. METHODS A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the framework for implementation research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability. RESULTS Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, "one size fits all" in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as "scaffolding" to begin to assess best practices, their distinct dimensions, and their applicability for use. CONCLUSIONS Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no "one size fits all", there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.
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Affiliation(s)
- Patricia A Abbott
- Division of Nursing Business & Health Systems, University of Michigan School of Nursing, Ann Arbor, MI, USA; Office of Global Outreach, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Joanne Foster
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | | | - Patricia C Dykes
- Center for Patient Safety, Research & Practice, Brigham and Women's Hospital, MA, USA; Center for Nursing Excellence, Brigham and Women's Hospital, MA, USA; Harvard Medical School, Boston, MA, USA
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Capone LJ, Albert NM, Bena JF, Tang AS. Predictors of a fall event in hospitalized patients with cancer. Oncol Nurs Forum 2013; 39:E407-15. [PMID: 22940520 DOI: 10.1188/12.onf.e407-e415] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine predictors of fall events in hospitalized patients with cancer and develop a scoring system to predict fall events. DESIGN Retrospective medical record review. SETTING A 1,200-bed tertiary care hospital in northeastern Ohio. SAMPLE 145 patients with cancer who did not have a fall event were randomly selected from all oncology admissions from February 2006-January 2007 and compared to 143 hospitalized patients with cancer who had a fall event during the same period. METHODS Multivariable logistic regression models predicting falls were fit. Risk score analysis was completed using bootstrap samples to evaluate discrimination between patients who did or did not fall and agreement between predicted and actual fall status. A nomogram of risk scores was created. MAIN RESEARCH VARIABLES Fall episodes during hospitalization and patient characteristics that predict falls. FINDINGS While patients were hospitalized for cancer care, their predictors of a fall episode were low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use (all p < 0.02); risk model c-statistic was 0.89. CONCLUSIONS For hospitalized patients with cancer, predictors reflecting greater fall episode risk can be assessed easily by nursing staff and acted on when the risk is sufficiently high. IMPLICATIONS FOR NURSING Understanding specific risk factors of falls in an adult oncology population may lead to interventions that reduce fall risk.
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Affiliation(s)
- Luann J Capone
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Ohio, USA.
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Dykes PC, Carroll DL, Hurley AC, Benoit A, Chang F, Pozzar R, Caligtan CA. Building and testing a patient-centric electronic bedside communication center. J Gerontol Nurs 2012; 39:15-9. [PMID: 23244060 DOI: 10.3928/00989134-20121204-03] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this article, the authors describe the development and pilot testing of an electronic bedside communication center (eBCC) prototype to improve access to health information for hospitalized adults and their family caregivers. Focus groups were used to identify improvements for the initial eBCC prototype developed by the research team. Face-to-face bedside interviews and questions were presented while patients used the eBCC for usability testing to drive further development. Qualitative methods within an iterative, participatory approach supported the development of an eBCC prototype that was considered both easy to use and helpful for accessing tailored patient information during an inpatient hospitalization to receive acute care.
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