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Wang YP, Dai C, Ou-Yang P, Zhao YH, Xu D. Evaluation of a concise fall risk stratification among older adults with cataracts in day surgery settings: A historically controlled study. Jpn J Nurs Sci 2024; 21:e12579. [PMID: 38058225 DOI: 10.1111/jjns.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023]
Abstract
AIM This study aimed to evaluate the use of a concise fall risk stratification in assessing and predicting falls compared with the Morse Falls Scale among older adults with cataracts in day surgery settings. METHODS A historically controlled study conducted from July 2020 to June 2022 was used in a municipal ophthalmic hospital in China. The concise fall risk stratification which directly graded fall risk by multifactorial judgment was used during the intervention period, while the Morse Falls Scale which graded fall risk by scale scores was used during the control period. The fall risk levels, fall assessment time, fall rates, fall-related injuries, predictive validity, and patient satisfaction with day surgery care were extracted. Propensity score matching was performed to balance baselines. RESULTS After matching, 4132 patients were included in the final analysis. Compared with the control group, the intervention group had significantly higher assessment results for fall risk level, a significantly shorter (by 48.15%) fall assessment time, and higher patient satisfaction. There were no differences in fall rates and fall-related injuries. Compared with the Morse Falls Scale, the concise fall risk stratification had higher sensitivity and negative predictive validity, and lower specificity and positive predictive validity, while the area under curve did not differ significantly. CONCLUSION The use of the concise fall risk stratification reduced fall assessment time, improved patient satisfaction, and is unlikely to impact falls with an overall predictive performance comparable to that of the Morse Falls Scale for older cataract adults in day surgery settings.
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Affiliation(s)
- Ya-Ping Wang
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Can Dai
- Department of Nursing, Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Ping Ou-Yang
- Department of Nursing, Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Yan-Hua Zhao
- Department of Nursing, Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Dan Xu
- Department of Nursing, Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
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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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Di Gennaro G, Chamitava L, Pertile P, Ambrosi E, Mosci D, Fila A, Alemayohu MA, Cazzoletti L, Tardivo S, Zanolin ME. A stepped-wedge randomised controlled trial to assess efficacy and cost-effectiveness of a care-bundle to prevent falls in older hospitalised patients. Age Ageing 2024; 53:afad244. [PMID: 38251740 PMCID: PMC10801830 DOI: 10.1093/ageing/afad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Patient accidental falls in a hospital environment are a serious problem for patient safety, and for the additional costs due to associated medical interventions. OBJECTIVE The endpoints of this study were the assessment of the fall incidence in the hospital before and after the implementation of a multidisciplinary care-bundle, along with a cost-effectiveness evaluation. DESIGN A stepped-wedge trial was conducted between April 2015 and December 2016 in Bologna University Hospital. METHODS Incidence rates (IRs) of falls in both the control and intervention periods were calculated. A multilevel mixed-effects generalised linear model with logit link function, adjusted for age, sex, cluster cross-over timing and patients' clinical severity was used to estimate odds ratios (OR) of fall risk of patients of the intervention group respect to the controls.Intervention costs associated with the introduction of the care-bundle intervention were spread between patients per cluster-period-group of exposure. Incremental cost-effectiveness ratio was evaluated using total costs in the intervention and control groups. RESULTS IRs of falls in control and intervention periods were respectively 3.15 and 2.58 for 1,000 bed-days. After adjustment, the subjects receiving the intervention had a statistically significant reduced risk of falling with respect to those who did not (OR = 0.71, 95% confidence interval: 0.60-0.84). According to the cost-effectiveness analysis, the incremental cost per fall prevented was €873.92 considering all costs, and €1644.45 excluding costs related falls. CONCLUSIONS Care-bundle had a protective effect on patients, with a statistically significant reduction of the fall risk. This type of intervention appears cost-effective compared to routine practices.
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Affiliation(s)
- Gianfranco Di Gennaro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Liliya Chamitava
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Pertile
- Department of Economics, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Daniela Mosci
- Hospital Hygiene and Prevention, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alice Fila
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Inoue S, Otaka Y, Mori N, Matsuura D, Tsujikawa M, Kawakami M, Kondo K. Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling. J Am Med Dir Assoc 2024; 25:160-166.e1. [PMID: 38109942 DOI: 10.1016/j.jamda.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined. DESIGN We conducted a retrospective cohort study. SETTING AND PARTICIPANTS We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital. METHODS Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated. RESULTS Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition. CONCLUSIONS AND IMPLICATIONS The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.
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Affiliation(s)
- Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
| | - Naoki Mori
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Daisuke Matsuura
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
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Albites-Sanabria J, Greene BR, McManus K, Palmerini L, Palumbo P, Sousa I, van Schooten KS, Weicken E, Wenzel M. Fall risk stratification of community-living older people. Commentary on the world guidelines for fall prevention and management. Age Ageing 2023; 52:afad162. [PMID: 37897807 PMCID: PMC10612991 DOI: 10.1093/ageing/afad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/12/2023] [Indexed: 10/30/2023] Open
Abstract
The Task Force on Global Guidelines for Falls in Older Adults has put forward a fall risk stratification tool for community-dwelling older adults. This tool takes the form of a flowchart and is based on expert opinion and evidence. It divides the population into three risk categories and recommends specific preventive interventions or treatments for each category. In this commentary, we share our insights on the design, validation, usability and potential impact of this fall risk stratification tool with the aim of guiding future research.
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Affiliation(s)
| | - Jose Albites-Sanabria
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” – DEI, University of Bologna, Bologna, Italy
- Institute of Advanced Studies, University of Bologna, Bologna, Italy
| | | | - Killian McManus
- Linus Health Europe Ltd, Dublin, Ireland
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” – DEI, University of Bologna, Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Center for Industrial Research, University of Bologna, Bologna, Italy
| | - Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” – DEI, University of Bologna, Bologna, Italy
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Eva Weicken
- Fraunhofer Heinrich Hertz Institute, Berlin, Germany
| | - Markus Wenzel
- Fraunhofer Heinrich Hertz Institute, Berlin, Germany
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Dabkowski E, Missen K, Duncan J, Cooper S. Falls risk perception measures in hospital: a COSMIN systematic review. J Patient Rep Outcomes 2023; 7:58. [PMID: 37358752 DOI: 10.1186/s41687-023-00603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
Falls prevention in hospital continues to be a research priority because of the poor health outcomes and financial burdens that can arise. Recently updated World Guidelines for Falls Prevention and Management strongly recommend evaluating patients' concerns about falling as part of a multifactorial assessment. The aim of this systematic review was to evaluate the quality of falls risk perception measures for adults in a hospital setting. This review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments guidelines and provides a comprehensive summary of these instruments, including psychometric properties, feasibility and clinical recommendations for their use. The review followed a prospectively registered protocol, in which a total of ten databases were searched between the years 2002 and 2022. Studies were included if the instruments measured falls risk perception and/or other psychological falls constructs, if they were conducted in a hospital setting and if the target population contained hospital inpatients. A total of 18 studies met the inclusion criteria, encompassing 20 falls risk perception measures. These falls risk perception instruments were grouped into five falls-related constructs: Balance Confidence, Falls Efficacy/Concern, Fear of Falling, Self-Awareness and Behaviour/Intention. Two of the patient reported outcome measures (PROMs) received Class A recommendations (Falls Risk Perception Questionnaire and the Spinal Cord Injury-Falls Concern Scale); however, this rating is only applicable for the populations/context described in the studies. Thirteen PROMs received Class B recommendations, solidifying the need for further validation studies of these PROMs.
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Affiliation(s)
- Elissa Dabkowski
- Institute of Health and Wellbeing, Federation University Australia, Northways Road, Churchill, VIC, 3842, Australia.
| | - Karen Missen
- Institute of Health and Wellbeing, Federation University Australia, Northways Road, Churchill, VIC, 3842, Australia
| | - Jhodie Duncan
- Research Unit, Latrobe Regional Hospital, Traralgon West, VIC, Australia
| | - Simon Cooper
- Health Innovation and Transformation Centre, Federation University Australia, Berwick, VIC, Australia
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Considine J, Berry D, Mullen M, Chisango E, Webb-St Mart M, Michell P, Darzins P, Boyd L. Nurses' experiences of using falls alarms in subacute care: A qualitative study. PLoS One 2023; 18:e0287537. [PMID: 37347774 PMCID: PMC10286966 DOI: 10.1371/journal.pone.0287537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
Bed and chair alarms have been included in many multifaceted falls prevention interventions. None of the randomised trials of falls alarms as sole interventions have showed significant effect on falls or falls with injury. Further, use of bed and chair alarms did not change patients' fear of falling, length of hospital stay, functional status, discharge destination or health related quality of life. The aim of this study was to explore nurses' experiences of using bed and chair alarms. A qualitative descriptive study using semi-structured interviews with a purposive sample of 12 nurses was conducted on a 32-bed Geriatric Evaluation and Management ward in Melbourne, Australia. Participants were interviewed between 27 January and 12 March 2021.Transcribed audio-recordings of interviews were analysed using inductive thematic analysis. NVIVO 12.6 was used to manage the study data. Three major themes and four subthemes were constructed from the data: i) negative impacts of falls alarms (subthemes: noisy technology, imperfect technology), ii) juggling the safety-risk conflict, and iii) negotiating falls alarm use (subthemes: nurse decision making and falls alarm overuse). Nurses' experience of using falls alarms was predominantly negative and there was tension between falls alarms having limited impact on patient safety and risks associated with their use. Nurses described a need to support nurse decision making related to falls alarms use in practice and policy, and a desire to be empowered to manage falls risk in other ways.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research–Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | - Debra Berry
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research–Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | | | | | | | | | - Peteris Darzins
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Leanne Boyd
- Eastern Health, Box Hill, Victoria, Australia
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Capo-Lugo CE, Young DL, Farley H, Aquino C, McLaughlin K, Calantuoni E, Friedman LA, Kumble S, Hoyer EH. Revealing the tension: The relationship between high fall risk categorization and low patient mobility. J Am Geriatr Soc 2023; 71:1536-1546. [PMID: 36637798 PMCID: PMC10175187 DOI: 10.1111/jgs.18221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. METHODS We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non-ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post-Acute Care (AM-PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM-PAC, comorbidity count, and length of stay. RESULTS 8% of patients at low risk for falls were non-ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9-5.5) and 2.6 (95% CI: 2.4-2.9) times more likely to be non-ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM-PAC 18-24), those categorized as high risk for falls were 4.3 (95% CI: 3.5-5.3) times more likely to be non-ambulatory compared to patients categorized as low risk. CONCLUSIONS Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.
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Affiliation(s)
- Carmen E. Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham; Birmingham, AL
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
| | - Daniel L. Young
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
- Department of Physical Therapy, University of Nevada, Las Vegas; Las Vegas, NV
| | - Holley Farley
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
| | - Carla Aquino
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
| | - Kevin McLaughlin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Baltimore, MD
| | - Elizabeth Calantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; Baltimore, MD
| | - Erik H. Hoyer
- Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University; Baltimore, MD
- Department of Nursing, Johns Hopkins Hospital; Baltimore, MD
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Cubitt M, Braitberg G, Curtis K, Maier AB. Models of acute care for injured older patients-Australia and New Zealand practice. Injury 2023; 54:223-231. [PMID: 36088125 DOI: 10.1016/j.injury.2022.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/27/2022] [Accepted: 08/26/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand. METHODS This cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components. RESULTS Participants (n=157) were predominantly Australian medical professionals in a major trauma service (MTS) or metropolitan hospital. The most common age defining "geriatric" was aged 65 years and older (43%). HCP described variability in the models and components of acute care for older injured patients in Australia and New Zealand. As a component of care, cognitive, delirium and frailty screening are occurring (60%, 61%, 46%) with HCP from non-major trauma services (non-MTS) reporting frailty and cognitive impairment screening more likely to occur in the emergency department (ED). Access to an acute pain service was more likely in a MTS. Participants described poor likelihood of a geriatrician (highest 16%) or physician (highest 12%) review in ED CONCLUSION: Despite a low response rate, HCP in Australia and New Zealand describe variability in acute care pathways for injured older patients. Given the change in epidemiology of injury towards older patients with low force mechanisms, models of acute injury care should be evaluated to define a cost-effective model and components of care that optimise patient-centred outcomes relevant to injured older patients. HCP described some factors they perceive to determine care, and outcomes of variability, offering guidance for future research and resource allocation in the Australia and New Zealand trauma system.
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Affiliation(s)
- M Cubitt
- Department of Emergency Medicine, The Royal Melbourne Hospital, Grattan Street, Parkville 3050, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
| | - G Braitberg
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - K Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia; Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - A B Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, National University Health System, Singapore
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10
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Dabkowski E, Cooper SJ, Duncan JR, Missen K. Exploring Hospital Inpatients' Awareness of Their Falls Risk: A Qualitative Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:454. [PMID: 36612780 PMCID: PMC9819707 DOI: 10.3390/ijerph20010454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/16/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients' perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient's understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent.
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Affiliation(s)
- Elissa Dabkowski
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, VIC 3842, Australia
| | - Simon J. Cooper
- Health Innovation and Transformation Centre, Federation University Australia, Berwick, VIC 3806, Australia
| | - Jhodie R. Duncan
- Research Unit, Latrobe Regional Hospital, Traralgon, VIC 3844, Australia
| | - Karen Missen
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, VIC 3842, Australia
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Takase M. Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen. Int J Nurs Sci 2022; 10:30-37. [PMID: 36860705 PMCID: PMC9969063 DOI: 10.1016/j.ijnss.2022.12.003] [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: 08/14/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls. Methods A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach. Results A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode. Conclusions Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.
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12
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 273] [Impact Index Per Article: 136.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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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: 4] [Impact Index Per Article: 2.0] [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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14
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Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, Kiegaldie D, Slade S, Jazayeri D, Heng H, Shorr R, Carey L, Barker A, Cameron I. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing 2022; 51:6581612. [PMID: 35524748 PMCID: PMC9078046 DOI: 10.1093/ageing/afac077] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. DESIGN Systematic review and meta-analysis. PARTICIPANTS Hospitalised adults. INTERVENTION Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. OUTCOME MEASURES Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). RESULTS There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. CONCLUSION Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
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Affiliation(s)
- Meg E Morris
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia,The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia,Address correspondence to: Meg E. Morris, La Trobe University, Bundoora, Victoria 3186, Australia.
| | - Kate Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cathy Jones
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Monash University, Melbourne, Victoria, Australia
| | - Susan Slade
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Dana Jazayeri
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Hazel Heng
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Leeanne Carey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia,Silver Chain, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia
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15
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Haines TP, Botti M, Brusco N, O’Brien L, Redley B, Bowles KA, Hutchinson A, Mitchell D, Jellett J, Steen K, Boyd L, Webb-St Mart M, Raymond M, Hunter P, Russo P, Bonnici R, Pu D, Sevenhuysen S, Davies V, Shorr R. Disinvestment in the presence of uncertainty: Description of a novel, multi-group, disinvestment trial design and protocol for an application to reduce or cease use of mobilisation alarms for preventing falls in hospitals. PLoS One 2021; 16:e0261793. [PMID: 34969050 PMCID: PMC8717976 DOI: 10.1371/journal.pone.0261793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a “Reduced” (<3%) or “Eliminated” (0%) mobilisation alarm condition. Dynamic randomisation will be used to determine which ward in each pair will be allocated to either the reduced or eliminated condition to promote equivalence between wards for the embedded parallel, cluster randomised component of the design. A project governance committee will set non-inferiority margins. The primary outcome will be rates of falls. Secondary clinical, process, safety, and economic outcomes will be collected and a concurrent economic evaluation undertaken.
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Affiliation(s)
- Terry P. Haines
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia
- * E-mail:
| | - Mari Botti
- School of Nursing & Midwifery, Deakin University, Geelong, Australia
| | - Natasha Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Monash University, Melbourne, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Melbourne, Australia
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Alison Hutchinson
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Melbourne, Australia
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Debra Mitchell
- Allied Health Workforce, Innovation, Strategy, Education and Research (WISER) Unit, Monash Health, Clayton, Australia
| | - Joanna Jellett
- Falls Prevention Service, The Mornington Centre, Peninsula Health, Victoria, Australia
| | | | - Leanne Boyd
- Chief Nursing and Midwifery Officer, Executive Director Learning and Teaching, Eastern Health, Richmond, Australia
| | | | - Melissa Raymond
- Physiotherapy Department, Alfred Health, Melbourne, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Peter Hunter
- Geriatric Medicine, Alfred Health, Melbourne, Australia
| | - Phillip Russo
- School of Nursing & Midwifery, Monash University, Melbourne, Australia
- Department of Nursing Research, Cabrini Institute, Malvern, Australia
| | - Rachel Bonnici
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia
| | - Dai Pu
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, Australia
| | | | - Vicki Davies
- Subacute Ambulatory Care Manager Peninsula Health, Frankston, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida
- Department of Epidemiology, University of Florida, Gainesville, Florida
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16
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Moran C, Bingham G, Tuck M, Crabtree A. Redundancy within hospital-related harm prediction tools. Intern Med J 2021; 51:1535-1538. [PMID: 34541774 DOI: 10.1111/imj.15481] [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: 11/18/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted.
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Affiliation(s)
- Chris Moran
- Department of Aged Care and Rehabilitation, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Academic Unit, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Peninsula Health, Melbourne, Victoria, Australia
| | - Gordon Bingham
- Nursing Services, Alfred Health, Melbourne, Victoria, Australia
| | - Michelle Tuck
- Nursing Services, Alfred Health, Melbourne, Victoria, Australia
| | - Amelia Crabtree
- Department of Aged Care and Rehabilitation, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
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17
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Morris ME, Haines T, Hill AM, Cameron ID, Jones C, Jazayeri D, Mitra B, Kiegaldie D, Shorr RI, McPhail SM. Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial. J Am Geriatr Soc 2021; 69:2598-2604. [PMID: 33834490 PMCID: PMC8518986 DOI: 10.1111/jgs.17125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022]
Abstract
Background/Objectives We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies. Design Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial. Setting Hospital wards. Participants Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days). Intervention Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list. Measurements The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated. Results The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively. Conclusion Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.
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Affiliation(s)
- Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St. Leonards, New South Wales, Australia
| | | | - Dana Jazayeri
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Melbourne, Australia
| | - Biswadev Mitra
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Debra Kiegaldie
- Holmesglen Institute, Melbourne, Victoria, Australia.,Eastern Clinical School, Monash University, Melbourne, Australia
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA and Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
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