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Modica A, Bitterman AD. The Impact of Patient Education on Inpatient Fall Risk: A Review. JBJS Rev 2024; 12:01874474-202405000-00005. [PMID: 38748810 DOI: 10.2106/jbjs.rvw.24.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
» Patient falls in the hospital are one of the leading sentinel events identified by the Joint Commission.» Hospital falls affect orthopaedic patients of older age at higher rates, and up to 34% of falls lead to injury such as fractures.» Patients often misperceive their fall risk, and modalities aimed at educating patients to address the incongruence between perceived and actual fall risk significantly reduce fall rate and injurious fall rate.» Adequate communication with patients and their families with the goal of educating them may diminish the physical, psychological, and emotional detriment to orthopaedic patients.
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Affiliation(s)
- Anthony Modica
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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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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Alvarado N, McVey L, Wright J, Healey F, Dowding D, Cheong VL, Gardner P, Hardiker N, Lynch A, Zaman H, Smith H, Randell R. Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review. BMC Geriatr 2023; 23:381. [PMID: 37344760 DOI: 10.1186/s12877-023-04045-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. METHODS A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. RESULTS Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. CONCLUSIONS Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients' individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. TRIAL REGISTRATION PROSPERO: CRD42020184458.
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Affiliation(s)
- Natasha Alvarado
- Wolfson Centre for Applied Health Research, Bradford, UK.
- University of Bradford, Bradford, UK.
| | - Lynn McVey
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
| | - Judy Wright
- University of Leeds, Leeds, West Yorkshire, UK
| | | | | | | | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
| | | | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Heather Smith
- Leeds Office of NHS West Yorkshire Integrated Care, Leeds, UK
| | - Rebecca Randell
- Wolfson Centre for Applied Health Research, Bradford, UK
- University of Bradford, Bradford, UK
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Ehn M, Kristoffersson A. Clinical Sensor-Based Fall Risk Assessment at an Orthopedic Clinic: A Case Study of the Staff's Views on Utility and Effectiveness. SENSORS (BASEL, SWITZERLAND) 2023; 23:1904. [PMID: 36850500 PMCID: PMC9958653 DOI: 10.3390/s23041904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.
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Affiliation(s)
- Maria Ehn
- School of Innovation, Design and Engineering, Mälardalen University, Box 883, 721 23 Västerås, Sweden
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Woltsche R, Mullan L, Wynter K, Rasmussen B. Preventing Patient Falls Overnight Using Video Monitoring: A Clinical Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13735. [PMID: 36360616 PMCID: PMC9657748 DOI: 10.3390/ijerph192113735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Inpatient falls are devastating for patients and their families and an ongoing problem for healthcare providers worldwide. Inpatient falls overnight are particularly difficult to predict and prevent. The aim of this cohort study was to evaluate effectiveness of overnight portable video monitoring as an adjunct falls prevention strategy for high falls risk patients in inpatient clinical units. Over three months, three clinical inpatient wards were provided with baby monitor equipment to facilitate portable video monitoring. Portable video monitoring registers were completed nightly and nursing staff were invited to complete surveys (n = 31) to assess their experiences of using portable video monitoring. A total of 494 episodes of portable video monitoring were recorded over the three-month period, with clinical areas reporting a total of four inpatient falls from monitoring participants (0.8% of total portable video monitoring episodes). Overall, there was a statistically significant reduction in total inpatient falls overnight on the target wards. Surveyed nursing staff reported feeling better equipped to prevent falls and indicated they would like to continue using portable monitoring as a falls prevention strategy. This study provides evidence to support the use of portable video monitoring as an effective falls prevention strategy in the hospital environment.
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Affiliation(s)
- Rebecca Woltsche
- Directorate of Nursing & Midwifery, Western Health, 176 Furlong Road, St. Albans, VIC 3021, Australia
| | - Leanne Mullan
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD 4014, Australia
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation—Western Health Partnership, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation—Western Health Partnership, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, 5230 Odense, Denmark
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Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10060995. [PMID: 35742046 PMCID: PMC9222288 DOI: 10.3390/healthcare10060995] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.
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Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study. PLoS One 2022; 17:e0266797. [PMID: 35476840 PMCID: PMC9045665 DOI: 10.1371/journal.pone.0266797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.
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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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Stutzbach J, Jones J, Taber A, Recicar J, Burke RE, Stevens-Lapsley J. Systems Approach Is Needed for In-Hospital Mobility: A Qualitative Metasynthesis of Patient and Clinician Perspectives. Arch Phys Med Rehabil 2020; 102:984-998. [PMID: 32966808 DOI: 10.1016/j.apmr.2020.09.370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe how different key stakeholders (ie, interprofessional clinical care team and patients) perceive their role in promoting in-hospital mobility by systematically synthesizing qualitative literature. DATA SOURCES PubMed, Ovid MEDLINE, Ovid PsychInfo, and Cumulative Index to Nursing and Allied Health were searched using terms relevant to mobility, hospitalization, and qualitative research. A total of 510 unique articles were retrieved and screened for eligibility. STUDY SELECTION Eligible qualitative studies included stakeholder perspectives on in-hospital mobility, including patients, nursing staff, rehabilitation staff, and physicians. Eleven articles remained after inclusion/exclusion criteria were applied. DATA EXTRACTION At least 2 authors independently read, coded, and derived themes from each study. We used a team-based inductive approach to thematic synthesis informed by critical realism and the socioecological model. Reciprocal translation unified convergent and divergent constructs across primary studies. Investigator triangulation enhanced interpretation. DATA SYNTHESIS Three primary themes emerged: (1) patient, family, and clinician expectations shape roles in in-hospital mobility; (2) stakeholders' role in mobility depends on hospital environment, infrastructure, culture, and resources; and (3) teamwork creates successful in-hospital mobility, but lack of coordination and cooperation leads to delay in mobilizing. Studies suggested that while mobility is an essential construct in the professional role of clinicians and in the personal identity of patients, the ability of stakeholders to realize their role in mobility is highly dependent on the hospital physical and cultural environment, administrative support, clarity in professional roles, and teamwork. CONCLUSIONS Interventions designed to address the problem of low hospital mobility should take a systems approach and consider allocation of resources, clarity around professional responsibilities, and elevation of patient and clinician expectations surrounding mobility.
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Affiliation(s)
- Julie Stutzbach
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado.
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Anna Taber
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; College of Nursing, Nevada State College, Henderson, Nevada
| | - John Recicar
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Trauma and Burn Program, Children's Hospital Colorado, Aurora, Colorado
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania; Hospital Medicine Section, Division of General Internal Medicine, Department of Medicine, University of Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado; Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado
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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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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: 53] [Impact Index Per Article: 13.3] [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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Grealish L, Chaboyer W, Darch J, Real B, Phelan M, Soltau D, Lunn M, Brandis S, Todd JA, Cooke M. Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events. J Clin Nurs 2019; 28:1346-1353. [PMID: 30520196 DOI: 10.1111/jocn.14724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 11/02/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. BACKGROUND While there are evidence-based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. DESIGN Critical incident technique. METHODS Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south-east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. RESULTS Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. CONCLUSIONS Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. RELEVANCE TO CLINICAL PRACTICE To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in-service from lectures to specific case presentations, with collaborative analysis on person-focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.
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Affiliation(s)
- Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,Gold Coast Hospital and Health Service, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,Gold Coast Hospital and Health Service, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Jacob Darch
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Belinda Real
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Maggie Phelan
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Dawn Soltau
- Gold Coast Hospital and Health Service, QLD, Australia
| | - Matthew Lunn
- Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Jo-Anne Todd
- School of Nursing & Midwifery, Griffith University, QLD, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, Griffith University, QLD, Australia.,School of Nursing & Midwifery, Griffith University, QLD, Australia
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13
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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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14
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Fehlberg EA, Lucero RJ, Weaver MT, McDaniel AM, Chandler AM, Richey PA, Mion LC, Shorr RI. Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns. Innov Aging 2018; 1. [PMID: 29911187 PMCID: PMC6002153 DOI: 10.1093/geroni/igx036] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints. Research Design and Methods Using electronic medical record data collected from four hospitals between 2005 and 2010, this secondary observational analysis examined the associations between the CMS no-pay policy and nursing interventions and medical orders related to fall prevention. Multivariable generalized linear mixed models with logit link function and accommodation for matching was used to assess the associations between the CMS no-pay policy and nursing interventions and medical orders. Results After the CMS policy change, nurses were more likely to perform one or more fall-related interventions (adjusted odds ratio (aOR): 1.667; 95% confidence interval (CI): 1.097–2.534). Of the four prevention practices, the use of bed alarms (aOR: 2.343; 95% CI: 1.409–3.897) increased significantly after the CMS policy change. Discussion and Implications The CMS no-pay policy increased utilization of fall prevention strategies despite little evidence that these measures prevent falls.
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Affiliation(s)
- Elizabeth A Fehlberg
- Division of Research on Healthcare Value, Equity, and the Lifespan, RTI International, Research Triangle Park, North Carolina
| | - Robert J Lucero
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville.,Clinical and Translational Science Institute, University of Florida, Gainesville.,Center for Latin American Studies, University of Florida, Gainesville
| | - Michael T Weaver
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville
| | - Anna M McDaniel
- Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville
| | | | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Lorraine C Mion
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus
| | - Ronald I Shorr
- Clinical and Translational Science Institute, University of Florida, Gainesville.,Geriatric Research Education and Clinical Centers (GRECC), Malcom Randall VAMC, Gainesville, Florida.,Department of Epidemiology, University of Florida, Gainesville
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15
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Rushton C. Problematising the problem: a critical interpretive review of the literature pertaining to older people with cognitive impairment who fall while hospitalised. Nurs Inq 2016; 23:148-57. [PMID: 26833849 DOI: 10.1111/nin.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
This article presents a reflexive account by way of a critical interpretive review of the literature pertaining to falls of older people with cognitive impairment who have been hospitalised in an acute care setting. A key aim of this review was to use thematic analysis and problematisation to challenge assumptions underpinning the current falls literature and to bring into consideration alternate foci of research and new approaches to falls research. An innovative approach is used to generate descriptive and interpretive summaries of the literature which are presented graphically to reveal the prevailing themes and assumptions within. It is argued that currently, falls research in the context of cognitive impairment is constrained by scientism. Meta-paradigmatic approaches, which have the potential to provide a better understanding of why falls may or may not occur among this particular subgroup of older people, are proposed as an alternative.
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Affiliation(s)
- Carole Rushton
- School of Nursing and Midwifery, Menzies Health Institute, Brisbane, Queensland, Australia
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16
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Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite. Gastroenterol Nurs 2015; 40:216-221. [PMID: 26458266 DOI: 10.1097/sga.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.
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Affiliation(s)
- Jennifer Goldsack
- At Christiana Care Health System in Wilmington, Del., Jennifer Goldsack is a research associate at the Value Institute, Janet Cunningham is vice president of professional excellence and associate CNO, and Susan Mascioli is director of nursing quality and safety
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18
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Anderson C, Dolansky M, Damato EG, Jones KR. Predictors of serious fall injury in hospitalized patients. Clin Nurs Res 2014; 24:269-83. [PMID: 24789939 DOI: 10.1177/1054773814530758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to identify predictors of falls that result in serious injury in hospitalized patients. The study involved secondary data analysis of 1,438 patient falls in a community hospital system between 2008 and 2010. The analysis included demographics, severity of illness, diagnosis-related group (surgical vs. medical), event type (bathroom, bed, chair, transfer, ambulating), risk factors identified by the Hendrich II fall risk assessment prior to the fall (confusion, depression, altered elimination, dizziness, antiepileptic or benzodiazepine medications), and contributing factors identified through an online event reporting system post-fall (incontinence, confusion, history of falls, alteration in mobility, and medication-related). Logistic regression results indicated that the overall model was a good fit and two predictors, age greater than 64 and male gender, were statistically reliable in predicting which patient falls would result in serious injury.
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19
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Kirkpatrick H, Boblin S, Ireland S, Robertson K. The Nurse as Bricoleur in Falls Prevention: Learning from a Case Study of the Implementation of Fall Prevention Best Practices. Worldviews Evid Based Nurs 2014; 11:118-25. [DOI: 10.1111/wvn.12026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Helen Kirkpatrick
- BPSO Co-ordinator, St. Joseph's Healthcare Hamilton, and Assistant Clinical Professor; McMaster University School of Nursing; Hamilton ON Canada
| | - Sheryl Boblin
- Associate Professor, McMaster University School of Nursing; Hamilton ON Canada
| | - Sandra Ireland
- Assistant Clinical Professor, McMaster University School of Nursing; Hamilton ON Canada
| | - Kim Robertson
- Risk Management Specialist, St. Joseph's Health Care Hamilton; Hamilton ON Canada
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20
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Abstract
This article presents the implementation and 1-year evaluation of a staff nurse-driven initiative addressing a Joint Commission patient safety imperative to improve the consistency of handoff communication. An interdepartmental ticket was developed and implemented through a planned process. The interdepartmental ticket serves as a requisite passport for providing key communication of critical information to facilitate a safe transition between medical-surgical and progressive care nursing units and specific ancillary departments.
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21
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Berland A, Holm AL, Gundersen D, Bentsen SB. Patient safety culture in home care: experiences of home-care nurses. J Nurs Manag 2012; 20:794-801. [DOI: 10.1111/j.1365-2834.2012.01461.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2012] [Indexed: 01/02/2023]
Affiliation(s)
- Astrid Berland
- Department of Health Education; Stord/Haugesund University College; Haugesund; Norway
| | - Anne Lise Holm
- Centre for Women's, Family and Child Health, Faculty of Health Sciences; Vestfold University College; Tønsberg; Norway
| | - Doris Gundersen
- Department of Research; Haugesund Hospital; Helse Fonna; Norway
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22
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Gonski PN, Moon I. Outcomes of a behavioral unit in an acute aged care service. Arch Gerontol Geriatr 2012; 55:60-5. [DOI: 10.1016/j.archger.2011.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/12/2011] [Accepted: 06/13/2011] [Indexed: 12/01/2022]
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Ireland S, Kirkpatrick H, Boblin S, Robertson K. The Real World Journey of Implementing Fall Prevention Best Practices in Three Acute Care Hospitals: A Case Study. Worldviews Evid Based Nurs 2012; 10:95-103. [DOI: 10.1111/j.1741-6787.2012.00258.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra Ireland
- Assistant Clinical Professor, McMaster University School of Nursing; Hamilton; ON; Canada
| | - Helen Kirkpatrick
- Assistant Clinical Professor, McMaster University School of Nursing and BPSO Coordinator; St. Joseph's Healthcare Hamilton; Hamilton; ON; Canada
| | - Sheryl Boblin
- Associate Professor, McMaster University School of Nursing; Hamilton; ON; Canada
| | - Kim Robertson
- Management Specialist, St. Joseph's Health Care Hamilton; Hamilton; ON; Canada
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Abstract
This article summarizes research and draws overall conclusions from the body of literature on fall prevention interventions to provide nurse administrators with a basis for developing evidence-based fall prevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels of evidence using an integrative review process. Multifactoral fall prevention intervention programs that included fall-risk assessments, door/bed/patient fall-risk alerts, environmental and equipment modifications, staff and patient safety education, medication management targeted to specific types, and additional assistance with transfer and toileting demonstrate reduction in both falls and fall injuries in hospitalized patients. Hospitals need to reduce falls by using multifactoral fall prevention programs using evidence-based interventions to reduce falls and injuries.
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25
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Struksnes S, Bachrach-Lindström M, Hall-Lord ML, Slaasletten R, Johansson I. The nursing staff's opinion of falls among older persons with dementia. a cross-sectional study. BMC Nurs 2011; 10:13. [PMID: 21689441 PMCID: PMC3142214 DOI: 10.1186/1472-6955-10-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 06/20/2011] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to describe the nursing staff's opinion of caring for older persons with dementia with the focus on causes of falls, fall-preventing interventions, routines of documentation and report and the nursing staff's experiences and reactions when fall incidents occur. A further aim was to compare these areas between registered nurses (RNs) and enrolled nurses (ENs) and staff with ≤5 and >5 years of employment in the care units in question.
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Affiliation(s)
- Solveig Struksnes
- Associate professor, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway
| | - Margareta Bachrach-Lindström
- Associate Professor, Faculty of Health Sciences, Department of Medicine and Care, Division of Nursing Science, Linköping University, 58183 Linköping, Sweden
| | - Marie Louise Hall-Lord
- Professor in Nursing, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway.,Faculty of Social and Life Sciences, Karlstad University, 65188 Karlstad, Sweden
| | - Randi Slaasletten
- Associate professor, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway
| | - Inger Johansson
- Professor in Nursing, Center of Care Research, Department of Health, Care and Nursing, Gjövik University College, 2815 Gjövik, Norway.,Faculty of Social and Life Sciences, Karlstad University, 65188 Karlstad, Sweden
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26
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Effken JA, Carley KM, Gephart S, Verran JA, Bianchi D, Reminga J, Brewer BB. Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes. Int J Med Inform 2011; 80:507-17. [PMID: 21536492 DOI: 10.1016/j.ijmedinf.2011.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 03/23/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units. METHODS Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA's analysis capability to generate communication metrics for each unit. ORA's visualization capability was used to better understand the metrics. RESULTS We identified communication patterns that correlated with two safety (falls and medication errors) and three quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift. CONCLUSION The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes.
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Use of temporary nurses and nurse and patient safety outcomes in acute care hospital units. Health Care Manage Rev 2010; 35:333-44. [DOI: 10.1097/hmr.0b013e3181dac01c] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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