Effectiveness of a fall awareness and education program in acute care

Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review

Background

Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting.

Method

A five stage scoping review process was followed based on Arksey and O’Malley’s framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework.

Results

Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions.

Conclusions

Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.

Effectiveness of team training on fall prevention

A longitudinal, repeated-measures design with intervention and comparison groups was used to evaluate the effect of a training curriculum based on TeamSTEPPS with video vignettes focusing on fall prevention. Questionnaires, behavioral observations, and fall data were collected over 9 months from both groups located at separate hospitals. The intervention group questionnaire scores improved on all measures except teamwork perception, while observations revealed an improvement in communication compared with the control group. Furthermore, a 60% fall reduction rate was reported in the intervention group. Team training may be a promising intervention to reduce falls.

The effectiveness of a participatory program on fall prevention in oncology patients

Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety.

Fear of falling: association between the Modified Falls Efficacy Scale, in-hospital falls and hospital length of stay

RATIONALE, AIMS AND OBJECTIVES

Falls in hospital are costly and may impact psychologically on fallers causing them to avoid mobilization, thereby affecting recovery rate and hospital length of stay. The study aim was to investigate the relationships between fear of falling, falls risk, in-hospital falls and hospital length of stay.

METHOD

A convenience sample (n=141) of patients from a large tertiary hospital was recruited. Data were collected over 6 months using the Modified Falls Efficacy Scale (MFES) on ward admission, prior to discharge, and in the event of a fall.

RESULTS

A third of the sample (n=44) was admitted to hospital following a fall. The majority (65%) was categorized as medium falls risk. Twenty-five participants sustained a total of 30 falls during their hospital admission of which 13 sustained a total of 15 falls on the study wards. The mean admission MFES score was 5.5, which increased to 6.1 on hospital discharge. Fallers scored significantly lower admission MFES scores than non-fallers (P=0.003). Receiver-operating curve analysis indicated that admission MFES score was a 'fair' predictor of sustaining a fall (area under curve=0.71, P=0.013). With a cut-off score of 5, admission MFES sensitivity was 77% and specificity was 55%. Study ward fallers had significantly longer hospital length of stay (49 days) than non-fallers (27 days; P=0.037). Furthermore, regardless of whether the participant was a faller or not, significantly longer hospital stay was associated with an admission MFES score of less than 5.

CONCLUSIONS

An admission MFES score of less than 5 is an effective predictor of patient falls and is associated with a significantly longer hospital length of stay.