Effectiveness of patient-centered interventions on falls in the acute care setting: a quantitative systematic review protocol

Person-Centered Care Practice, Patient Safety Competence, and Patient Safety Nursing Activities of Nurses Working in Geriatric Hospitals

Geriatric nursing activities are closely related to patient safety; therefore, nurses' efforts to improve patient safety in geriatric hospitals are important. In the present study, we investigated the relationships between person-centered care practice, patient safety competence, and patient safety during nursing activities in geriatric hospitals. We used the following tools to investigate the factors affecting patient safety during nursing activities: (a) the Korean version of the Person-Centered Care Assessment Tool (P-CAT), (b) the Patient Safety Competence Assessment Tool for Nurses, and (c) the Patient Safety Nursing Activities Assessment Tool for geriatric nurses. The questionnaire survey was completed by 186 geriatric nurses in 12 geriatric hospitals from 1 August to 31 August 2018. We analyzed the survey data using a t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple regression. We identified patient safety skills (β = 0.417, p < 0.001) and age (β = 0.209, p = 0.035) as key factors that influence patient safety during nursing activities. Therefore, to improve the quality of patient safety during nursing activities conducted by geriatric nurses, it is necessary to develop strategies to improve patient safety skills and expand the pool of competent nurses with clinical experience.

Patients performing lower limb exercises in an orthopedic ward: a best practice implementation project

AIMS

The evidence-based project sought to educate patients on doing lower limb exercises within 24 h of their admissions to the ward. Patients spend most of their time in bed during their hospital stays, which imposes negative outcomes due to inactivity, such as risks of reduced muscle mass and deconditioning, which may further implicate patients' conditions.

METHODS

The project occurred in three phases over a period of 18 months. The project was undertaken in an orthopedic ward of an acute tertiary hospital. A preimplementation and postimplementation audit strategy using the Joanna Briggs Institute's Practical Application of Clinical Evidence System was conducted on a sample of 20 adult patients. The Getting Research into Practice framework was utilized to analyze the barriers and gaps encountered in the clinical ground.

RESULTS

The baseline audit result revealed that only 35% of the patients received education on the exercise program and that there was poor compliance on nursing documentation of the intervention in daily note-free texts. Following the implementation, there was an improvement in nurses' documentation compliance. In follow-up audits one and two, the nurses achieved compliance rates of 60 and 90% in nursing documentation, respectively.

CONCLUSION

Overall, there were improvements in provision of lower limb exercise education to patients. This project has demonstrated that patients were willing to exercise during hospitalization. Nurses play a significant role in providing early education to patients to do simple exercises. The implementation of the evidence-based project may increase the awareness of the importance of exercises to minimize hospital-acquired deconditioning and functional declines among ward nurses and patients.

Use of a Dual mobility cup to prevent hip early arthroplasty dislocation in patients at high falls risk

INTRODUCTION

Hip fracture is a common serious injury that occurs mainly in elderly. Dual-mobility hip arthroplasty or bipolar emiarthroplasty for its treatment remains a controversial decision. Co-morbidities and risk of fall represent additional aspects to be considered. The aim of our study was to determine the rate of mechanical complications for these two types of implants related to fall risk status of patients.

PATIENTS AND METHODS

Our study is a retrospective clinical trial of patients operated with a biarticular hemiarthroplasty or a dual-mobility total hip arthroplasty. Primary outcome was dislocation rate and need for any revision procedure. Patients were treated in a single center from January 2013 to March 2017. In all cases Morse Fall Scale (MSF) was calculated at patient admission to evaluate the risk of postoperative fall. Inclusion criteria to the study were: subcapital or femoral neck fracture of non-pathologic nature, patients with neuromuscular disorders or cognitive dysfunction, age > 75 years with MFS ≥ 45. The patients were reviewed postoperatively at 8 weeks, 6 months, 12 months, and then annually. Patients had clinical (Harris hip score) and radiological assessment.

RESULTS

The mean duration of the follow-up was 283 months. There were five dislocations in Group A (5,6%) and no dislocations in Group B (0%). All dislocations occurred within the first 6 months after surgery. The mean Harris Hip score was 81,7 in Group A patients and 79, 8 in Group B patients.

DISCUSSION

Treatment of hip fractures on non-cooperative patients still represents a dilemma. Falls and runaway motions represent high risk factors of dislocation. Use of dual-mobility cup has been found to be associated with a not statistically proved decrease of dislocation compared to traditional cups.

CONCLUSION

Dual-mobility cups might be considered a valuable option to prevent postoperative dislocation but further study is needed before extending the indications for dual-mobility following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure. So far, despite a lower dislocation risk, the authors actually cannot recommend widely use of a dual-motility cup instead of emiarthroplasty in high falls risk patients.

Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review

BACKGROUND

Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions.

OBJECTIVES

To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

All adult patients admitted to medical or surgical acute care units for any condition or illness.

TYPES OF INTERVENTION(S)

Patient-centered intervention strategies to reduce falls compared to usual care.

TYPES OF STUDIES

Randomized control trials.

TYPES OF OUTCOMES

Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries.

SEARCH STRATEGY

A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository.

METHODOLOGICAL QUALITY

Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute.

DATA EXTRACTION

Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute.

DATA SYNTHESIS

Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form.

RESULTS

Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5).

CONCLUSIONS

Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.

Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall-Risk-Assessment Tool

INTRODUCTION

Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population.

METHOD

A two-phase prospective design was used for this study. Phase one determined the interrater reliability of the MEDFRAT. Phase two assessed the validity of the MEDFRAT in an emergency department (ED) within a 600-bed academic/teaching institution; Level II Trauma Center with >100,000 annual patient visits.

RESULTS

The Memorial ED Fall Risk Assessment Tool was validated in this ED setting. The tool demonstrated positive interrater reliability (k=0.701) and when implemented with a falls prevention strategy and staff education demonstrated a 48% decrease in ED fall rate (0.57 falls/1000 patient visits) post implementation during the study period.

DISCUSSION

The MEDFRAT, an evidenced based ED-specific fall risk tool was implemented on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool demonstrated to be a valid tool for this hospital system.

Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study

Objective:

to assess the factors associated with the risk of fall in patients undergoing surgical procedures.

Method:

quantitative and cross-sectional study carried out with 257 adult patients in a hospital in the state of Minas Gerais, Brazil. Data were collected using the sociodemographic and clinical questionnaire, the Morse Fall Scale, and the Quality of Recovery Score. Data were submitted to descriptive statistical analysis and multinomial logistic regression. The level of significance was set at 0.05.

Results:

35.4% of patients had high risk of falls, 38.9% had moderate risk and 25.7% had low risk. The mean value in the surgical recovery scale was 175.37 points and no patient presented poor surgical recovery. Regarding the results of the bivariate analysis, it was found that age (p<0.001), SAH (p<0.001) and diabetes (p=0.017) were positively associated with high risk of fall, whereas cancer (p=0.004) was positively associated with moderate risk of fall. Surgical recovery (p=0,008) was inversely associated with high risk of fall.

Conclusion:

the results of this study allowed the identification of five factors associated with the risk of fall in adults in the postoperative hospital stay. These findings may support the planning of nursing actions aimed at preventing the risk of fall in the postoperative period.