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Lin FF, Yang WY, Zhou JX, Cao LY, Huang LL. Retrospective Investigation and Research on Fall Events Among Hospitalized Patients in the Rehabilitation Department. Risk Manag Healthc Policy 2024; 17:1069-1078. [PMID: 38699655 PMCID: PMC11063461 DOI: 10.2147/rmhp.s445808] [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: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Objective We investigated the clinical characteristics, fall outcomes, and related factors of falls in patients who were hospitalized in the rehabilitation department, and explored strategies to reduce the incidence of falls and prevent falls in patients. Methods Data from 60 patients who fell in the rehabilitation department between 2016 and 2021 were analyzed for clinical characteristics, associated factors, incidence of falls, injuries, and patient demographics. Under the random stratified sampling method, 60 patients who did not fall during the same period were selected as the control group, and relevant data was collected. Measurement data were compared using an independent sample t-test. Enumeration data were compared using chi-squared (χ2) test was employed to compare these data between the two groups. Non-parametric data were analyzed using the Mann-Whitney U-test. Factors potentially influencing falls were scrutinized through both univariate and binary logistic regression analyses. Results The median annual incidence of falls among patients who were hospitalized in the rehabilitation department was 0.04%, while the overall fall injury rate was 60%. Falls were most prevalent within 30 days of hospitalization (71.67%). The most common fall-related condition was craniocerebral disease (83.33%). The incidents of falls location of fall were mainly reported in nearby areas of rehabilitation ward (70%). Most accidents occurred between 7:00 a.m.-12:00 p.m. and 3:01 p.m.-6:00 p.m. (63.33%), and dyskinesia was the most common cause of falls (71.67%). There were 39 patients (65.00%) with Barthel Index (BI) scores ranging between 40-60. Conclusion Patients in the rehabilitation department had a greater incidence of falls and fall injuries. Within 30 days of admission, patients with moderately dependent craniocerebral disorders and dyskinesia frequently experienced falls during typical daytime shifts in areas characterized by endemic conditions.
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Affiliation(s)
- Fang-Fang Lin
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Wei-Yuan Yang
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Jun-Xiang Zhou
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Luo-Yuan Cao
- Department of Central Laboratory, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Ling-Ling Huang
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
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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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Najafpour Z, Arab M, Rashidian A, Shayanfard K, Yaseri M, Biparva-Haghighi S. A Stepped-Wedge Cluster-Randomized Controlled Trial of Multi-interventional Approach for Fall Prevention. Qual Manag Health Care 2023:00019514-990000000-00066. [PMID: 38031258 DOI: 10.1097/qmh.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. METHODS The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. RESULTS The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52). CONCLUSIONS This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Najafpour); School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Drs Arab and Rashidian); University of Luxembourg, Luxembourg (Dr Shayanfard); Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Yaseri); and Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (Dr Biparva-Haghighi)
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Zisberg A. Defensive Nursing and Patient Mobility: Balancing Safety and Autonomy. Res Gerontol Nurs 2023; 16:162-164. [PMID: 37526631 DOI: 10.3928/19404921-20230629-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Chair of the Center of Research & Study of Aging, University of Haifa, Mount Carmel, Israel
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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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Inoue S, Otaka Y, Horimoto Y, Shirooka H, Sugasawa M, Kondo K. Discrepancies in perception of fall risk between patients with subacute stroke and physical therapists in a rehabilitation hospital: a retrospective cohort study. FRONTIERS IN AGING 2023; 4:1204488. [PMID: 37342863 PMCID: PMC10277567 DOI: 10.3389/fragi.2023.1204488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Objective: Falls are one of the most common complications of a stroke. This study aimed to clarify the discrepancy between the perceived fall risk of hospitalized patients with stroke and the clinical judgment of physical therapists and to examine the changes in discrepancy during hospitalization. Design: Retrospective cohort study. Patients: This study included 426 patients with stroke admitted to a Japanese convalescent rehabilitation hospital between January 2019 and December 2020. Methods: The Falls Efficacy Scale-International was used to assess both patients' and physical therapists' perception of fall risk. The difference in Falls Efficacy Scale-International scores assessed by patients and physical therapists was defined as the discrepancy in fall risk, and its association with the incidence of falls during hospitalization was investigated. Results: Patients had a lower perception of fall risk than physical therapists at admission (p < 0.001), and this trend continued at discharge (p < 0.001). The discrepancy in fall risk perception was reduced at discharge for non-fallers and single fallers (p < 0.001), whereas the difference remained in multiple fallers. Conclusion: Unlike physical therapists, patients underestimated their fall risk, especially patients who experienced multiple falls. These results may be useful for planning measures to prevent falls during hospitalization.
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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, Toyoake, Aichi, Japan
| | - Yukari Horimoto
- Education and Management in Health and Welfare Section, Health Sciences Program, Graduate School of International University of Health and Welfare, Tokyo, Japan
| | - Hidehiko Shirooka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Masafumi Sugasawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
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Reichmann JP, Kreulen CD. Post-operative Inpatient Falls Among Major Lower Limb Amputees. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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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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Pelliard T, Brika M, Rulleau T. Prévention des chutes chez les personnes âgées fragiles hospitalisées en court séjour : utilisation des chaussettes antidérapantes. Une revue systématique de littérature. Rech Soins Infirm 2022; 146:60-73. [PMID: 35724024 DOI: 10.3917/rsi.146.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Falls among hospitalized frail elderly patients are a worrying, major daily phenomenon. CONTEXT Inadequate footwear, frequently observed in this population, is one of the main risk factors behind falls. Several hospitals use non-slip socks as a preventive measure. However, in the context of evidence-based medicine, it is important to verify the existence of strong evidence for their effectiveness. OBJECTIVE The aim of this study is to determine the preventive effectiveness of non-slip socks. METHOD Five databases were investigated (PubMed, PEDro, Cochrane, ScienceDirect, and Google Scholar). Eligibility criteria were established (using the PICO method), for studies including elderly hospitalized patients. RESULTS Seven studies were included. Non-slip socks showed a preventive effect in reducing the recurrence of falls (p=0.009) and the prevalence of falls related to urinary incontinence. DISCUSSION Several studies conclude on the added value of non-slip socks compared to traditional socks or slippers. The limitations inherent in the selected studies are taken into account when drawing conclusions. CONCLUSION Footwear that is considered safe by therapists and secure by the patient is currently the most recommended option. However, more clinical studies are needed to support our findings.
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Affiliation(s)
| | - Marine Brika
- Kinésithérapeute, Ph.Dc, Institut de Formation des Métiers de la Santé (IFMS), Hôpital Nord Franche-Comté, Filière Kinésithérapie-Physiothérapie, Montbéliard, France
| | - Thomas Rulleau
- Kinésithérapeute, ingénieur de recherche, Ph.D, Unité de recherche clinique, CHD-Vendée, La Roche-sur-Yon, France
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10
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Close JCT, Lord SR. Fall prevention in older people: past, present and future. Age Ageing 2022; 51:6618056. [PMID: 35754196 DOI: 10.1093/ageing/afac105] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
Over the past 50 years we have transitioned from accepting falls as an inevitable consequence of ageing to something that can and should be prevented. Numerous studies have elucidated the contributors to falls and how to assess a person's risk of falling. There are many effective approaches to preventing falls in older people including those with cognitive and physical impairments. Exercise is the most tried and tested approach with good evidence that moderate to high intensity balance training is an effective fall prevention strategy. Other successful single modality interventions include enhanced podiatry, home safety interventions, expedited cataract extraction, cardiac pacing for people with carotid sinus hypersensitivity and vitamin D supplementation in people living in care homes. Multiple interventions (everyone receives the same intervention package) and multifactorial interventions (interventions tailored to identified risk factors) are effective particularly in high-risk populations. In more recent years we have seen the emergence of new technologies such as devices and software programs that can offer low-cost interventions which may be more sustainable than our traditional time- and resource-limited approach to prevention. There is still more to be done and a translational focus is needed to ensure that effective interventions are scaled up and delivered to more people while at the same time maximising adherence and maintaining the fidelity of the interventions.
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Affiliation(s)
- Jacqueline C T Close
- School of Population Health, University of New South Wales, Sydney, Australia.,Prince of Wales Clinical School, UNSW, Sydney, Australia
| | - Stephen R Lord
- School of Population Health, University of New South Wales, Sydney, Australia
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Leland NE, Lekovitch C, Martínez J, Rouch S, Harding P, Wong C. Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults. J Appl Gerontol 2022; 41:2187-2196. [PMID: 35618304 DOI: 10.1177/07334648221104375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.
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Affiliation(s)
- Natalie E Leland
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Cara Lekovitch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenny Martínez
- Department of Occupational Therapy, 6559Jefferson College of Rehabilitation Sciences, Philadelphia, PA, USA
| | - Stephanie Rouch
- Department of Occupational Therapy, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Harding
- Chan Division of Occupational Science and Occupational Therapy, 5116University of Southern California, Los Angeles, CA, USA
| | - Carin Wong
- Department of Sociology, 14669California State University Los Angeles, Los Angeles, CA, USA
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12
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Falling for It: Of Falls, Families, and Delirium. Crit Care Med 2022; 50:889-891. [PMID: 35485590 DOI: 10.1097/ccm.0000000000005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Mollayeva T, Tran A, Chan V, Colantonio A, Sutton M, Escobar MD. Decoding health status transitions of over 200 000 patients with traumatic brain injury from preceding injury to the injury event. Sci Rep 2022; 12:5584. [PMID: 35379824 PMCID: PMC8980052 DOI: 10.1038/s41598-022-08782-0] [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: 04/23/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
For centuries, the study of traumatic brain injury (TBI) has been centred on historical observation and analyses of personal, social, and environmental processes, which have been examined separately. Today, computation implementation and vast patient data repositories can enable a concurrent analysis of personal, social, and environmental processes, providing insight into changes in health status transitions over time. We applied computational and data visualization techniques to categorize decade-long health records of 235,003 patients with TBI in Canada, from preceding injury to the injury event itself. Our results highlighted that health status transition patterns in TBI emerged along with the projection of comorbidity where many disorders, social and environmental adversities preceding injury are reflected in external causes of injury and injury severity. The strongest associations between health status preceding TBI and health status at the injury event were between multiple body system pathology and advanced age-related brain pathology networks. The interwoven aspects of health status on a time continuum can influence post-injury trajectories and should be considered in TBI risk analysis to improve prevention, diagnosis, and care.
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC, Farrell-Savage K, Okunribido O. Shock-absorbing flooring for fall-related injury prevention in older adults and staff in hospitals and care homes: the SAFEST systematic review. Health Technol Assess 2022; 26:1-196. [PMID: 35089119 DOI: 10.3310/zowl2323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Injurious falls in hospitals and care homes are a life-limiting and costly international issue. Shock-absorbing flooring may offer part of the solution; however, evidence is required to inform decision-making. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of shock-absorbing flooring for fall-related injury prevention among older adults in care settings. REVIEW METHODS A systematic review was conducted of experimental, observational, qualitative and economic studies evaluating flooring in care settings targeting older adults and/or staff. Studies identified by a scoping review (inception to May 2016) were screened, and the search of MEDLINE, AgeLine and Scopus (to September 2019) was updated, alongside other sources. Two independent reviewers assessed risk of bias in duplicate (using Cochrane's Risk of Bias 2.0 tool, the Risk Of Bias In Non-randomized Studies - of Interventions tool, or the Joanna Briggs Institute's qualitative tool). RESULTS Of the 22 included studies, 20 assessed the outcomes (three randomised controlled trials; and seven observational, five qualitative and five economic studies) on novel floors (n = 12), sports floors (n = 5), carpet (n = 5) and wooden subfloors (n = 1). Quantitative data related to 11,857 patient/resident falls (nine studies) and 163 staff injuries (one study). Qualitative studies included patients/residents (n = 20), visitors (n = 8) and staff (n = 119). Hospital-based randomised controlled trial data were too imprecise; however, very low-quality evidence indicated that novel/sports flooring reduced injurious falls from three per 1000 patients per day on vinyl with concrete subfloors to two per 1000 patients per day (rate ratio 0.55, 95% confidence interval 0.36 to 0.84; two studies), without increasing falls rates (two studies). One care home-based randomised controlled trial found that a novel underlay produces similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to those of a plywood underlay with vinyl overlays and concrete subfloors. Very low-quality data demonstrated that, compared with rigid floors, novel/sports flooring reduced the number of falls resulting in injury in care homes (26.4% vs. 33.0%; risk ratio 0.80, 95% confidence interval 0.70 to 0.91; three studies) and hospitals (27.1% vs. 42.4%; risk ratio 0.64, 95% confidence interval 0.44 to 0.93; two studies). Fracture and head injury outcomes were imprecise; however, hip fractures reduced from 30 per 1000 falls on concrete to 18 per 1000 falls on wooden subfloors in care homes (odds ratio 0.59, 95% confidence interval 0.45 to 0.78; one study; very low-quality evidence). Four low-quality economic studies concluded that shock-absorbing flooring reduced costs and improved outcomes (three studies), or increased costs and improved outcomes (one study). One, more robust, study estimated that shock-absorbing flooring resulted in fewer quality-adjusted life-years and lower costs, if the number of falls increased on shock-absorbing floors, but that shock-absorbing flooring would be a dominant economic strategy if the number of falls remained the same. Staff found moving wheeled equipment more difficult on shock-absorbing floors, leading to workplace adaptations. Staff injuries were observed; however, very low-quality evidence suggests that these are no less frequent on rigid floors. LIMITATIONS Evidence favouring shock-absorbing flooring is of very low quality; thus, much uncertainty remains. CONCLUSIONS Robust evidence is lacking in hospitals and indicates that one novel floor may not be effective in care homes. Very low-quality evidence indicates that shock-absorbing floors may be beneficial; however, wider workplace implications need to be addressed. Work is required to establish a core outcome set, and future research needs to more comprehensively deal with confounding and the paucity of hospital-based studies, and better plan for workplace adaptations in the study design. STUDY REGISTRATION This study is registered as PROSPERO CRD42019118834. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Lambert M Felix
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Southampton, UK
| | | | | | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Lockwood I, Walker RM, Latimer S, Chaboyer W, Cooke M, Gillespie BM. Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review. Contemp Clin Trials Commun 2022; 26:100894. [PMID: 36684693 PMCID: PMC9846456 DOI: 10.1016/j.conctc.2022.100894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 01/25/2023] Open
Abstract
Background There is increasing recognition of the importance of undertaking process evaluations alongside implementation of health interventions by examining mechanisms of impact and contextual factors. However, a comprehensive synthesis of process evaluations undertaken alongside clinical trials in hospital settings is lacking. We undertook a scoping review to address this gap. Methods This review was guided by the methodological framework for scoping studies. Studies were identified using four databases; Ovid Medline, EBSCO CINAHL, EMBASE and Scopus. Two authors independently screened all titles and available abstracts, with a third author available to adjudicate. Studies were eligible for inclusion if they described a process evaluation undertaken alongside a randomised controlled trial in the hospital setting. Data were abstracted by one author and checked by two others and analysed both descriptively and using inductive content analysis. Results Data were extracted from 30 articles reporting on 15 trials, most of which were cluster randomised trials (c-RTs) (n = 12). The most common data collection methods used in process evaluations were interviews, questionnaires or surveys, and records or logs. Data analysis revealed three themes relative to how authors: use process data to interpret, understand and explain trial outcomes; evaluate responses to the intervention; and consider the implementation context. Conclusions Findings from this review demonstrate the complex nature of intervention implementation in the hospital setting. Overall, there is need for standardised reporting of process evaluations and more explicit descriptions of how authors use frameworks to guide their evaluation.
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Affiliation(s)
- Ishtar Lockwood
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Rachel M. Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia,Corresponding author. Building L05, Room 3.44, Griffith University, Logan, Queensland, 4131, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Marie Cooke
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia
| | - Brigid M. Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia,School of Nursing and Midwifery, Griffith University, Brisbane and Gold Coast, Australia,Gold Coast University Hospital, Southport, Queensland, Australia
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Drahota A, Felix LM, Raftery J, Keenan BE, Lachance CC, Mackey DC, Markham C, Laing AC. The SAFEST review: a mixed methods systematic review of shock-absorbing flooring for fall-related injury prevention. BMC Geriatr 2022; 22:32. [PMID: 34991466 PMCID: PMC8739972 DOI: 10.1186/s12877-021-02670-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Shock-absorbing flooring may minimise impact forces incurred from falls to reduce fall-related injuries; however, synthesized evidence is required to inform decision-making in hospitals and care homes. METHODS This is a Health Technology Assessment mixed methods systematic review of flooring interventions targeting older adults and staff in care settings. Our search incorporated the findings from a previous scoping review, MEDLINE, AgeLine, and Scopus (to September 2019) and other sources. Two independent reviewers selected, assessed, and extracted data from studies. We assessed risk of bias using Cochrane and Joanna Briggs Institute tools, undertook meta-analyses, and meta-aggregation. RESULTS 20 of 22 included studies assessed our outcomes (3 Randomised Controlled Trials (RCTs); 7 observational; 5 qualitative; 5 economic), on novel floors (N = 12), sports floors (N = 5), carpet (N = 5), and wooden sub-floors (N = 1). Quantitative data related to 11,857 patient falls (9 studies), and 163 staff injuries (1 study). One care home-based RCT found a novel underlay produced similar injurious falls rates (high-quality evidence) and falls rates (moderate-quality evidence) to a plywood underlay with vinyl overlay and concrete sub-floors. Very low-quality evidence suggested that shock-absorbing flooring may reduce injuries in hospitals (Rate Ratio 0.55, 95% CI 0.36 to 0.84, 2 studies; 27.1% vs. 42.4%; Risk Ratio (RR) = 0.64, 95% CI 0.44 to 0.93, 2 studies) and care homes (26.4% vs. 33.0%; RR 0.80, 95% CI 0.70 to 0.91, 3 studies), without increasing falls. Economic evidence indicated that if injuries are fewer and falls not increased, then shock-absorbing flooring would be a dominant strategy. Fracture outcomes were imprecise; however, hip fractures reduced from 30 in 1000 falls on concrete to 18 in 1000 falls on wooden sub-floors (OR 0.59, 95% CI 0.45 to 0.78; one study; very low-quality evidence). Staff found moving wheeled equipment harder on shock-absorbing floors leading to workplace adaptations. Very low-quality evidence suggests staff injuries were no less frequent on rigid floors. CONCLUSION Evidence favouring shock-absorbing flooring is uncertain and of very low quality. Robust research following a core outcome set is required, with attention to wider staff workplace implications. TRIAL REGISTRATION PROSPERO CRD42019118834 .
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Affiliation(s)
- Amy Drahota
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK.
| | - Lambert M Felix
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - James Raftery
- Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - Bethany E Keenan
- School of Engineering, Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Chantelle C Lachance
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive East, Burnaby, British Columbia, V5A 1S6, Canada
| | - Chris Markham
- School of Health and Care Professions, University of Portsmouth, St. Andrew's Court, St. Michael's Road, Portsmouth, PO1 2PR, UK
| | - Andrew C Laing
- Department of Kinesiology, University of Waterloo, B.C. Matthews Hall, Waterloo, Ontario, N2L 3G1, Canada
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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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19
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Cho I, Jin IS, Park H, Dykes PC. Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series. JMIR Med Inform 2021; 9:e26456. [PMID: 34626168 PMCID: PMC8663467 DOI: 10.2196/26456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/15/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patient falls are a common cause of harm in acute-care hospitals worldwide. They are a difficult, complex, and common problem requiring a great deal of nurses' time, attention, and effort in practice. The recent rapid expansion of health care predictive analytic applications and the growing availability of electronic health record (EHR) data have resulted in the development of machine learning models that predict adverse events. However, the clinical impact of these models in terms of patient outcomes and clinicians' responses is undetermined. OBJECTIVE The purpose of this study was to determine the impact of an electronic analytic tool for predicting fall risk on patient outcomes and nurses' responses. METHODS A controlled interrupted time series (ITS) experiment was conducted in 12 medical-surgical nursing units at a public hospital between May 2017 and April 2019. In six of the units, the patients' fall risk was assessed using the St. Thomas' Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) system (control units), while in the other six, a predictive model for inpatient fall risks was implemented using routinely obtained data from the hospital's EHR system (intervention units). The primary outcome was the rate of patient falls; secondary outcomes included the rate of falls with injury and analysis of process metrics (nursing interventions that are designed to mitigate the risk of fall). RESULTS During the study period, there were 42,476 admissions, of which 707 were for falls and 134 for fall injuries. Allowing for differences in the patients' characteristics and baseline process metrics, the number of patients with falls differed between the control (n=382) and intervention (n=325) units. The mean fall rate increased from 1.95 to 2.11 in control units and decreased from 1.92 to 1.79 in intervention units. A separate ITS analysis revealed that the immediate reduction was 29.73% in the intervention group (z=-2.06, P=.039) and 16.58% in the control group (z=-1.28, P=.20), but there was no ongoing effect. The injury rate did not differ significantly between the two groups (0.42 vs 0.31, z=1.50, P=.134). Among the process metrics, the risk-targeted interventions increased significantly over time in the intervention group. CONCLUSIONS This early-stage clinical evaluation revealed that implementation of an analytic tool for predicting fall risk may to contribute to an awareness of fall risk, leading to positive changes in nurses' interventions over time. TRIAL REGISTRATION Clinical Research Information Service (CRIS), Republic of Korea KCT0005286; https://cris.nih.go.kr/cris/search/detailSearch.do/16984.
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Affiliation(s)
- Insook Cho
- Nursing Department, College of Medicine, Inha University, Incheon, Republic of Korea
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - In Sun Jin
- Department of Nursing, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Hyunchul Park
- Graduate School of Information & Telecommunications, Konkuk University, Seoul, Republic of Korea
| | - Patricia C Dykes
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Incident Reporting Systems: What Will It Take to Make Them Less Frustrating and Achieve Anything Useful? Jt Comm J Qual Patient Saf 2021; 47:755-758. [PMID: 34716115 DOI: 10.1016/j.jcjq.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Cooper K, Pavlova A, Greig L, Swinton P, Kirkpatrick P, Mitchelhill F, Simpson S, Stephen A, Alexander L. Health technologies for the prevention and detection of falls in adult hospital inpatients: a scoping review. JBI Evid Synth 2021; 19:2478-2658. [PMID: 34149020 DOI: 10.11124/jbies-20-00114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review was to examine and map the evidence relating to the reporting and evaluation of technologies for the prevention and detection of falls in adult hospital inpatients. INTRODUCTION Falls are a common cause of accidental injury, leading to significant safety issues in hospitals globally, and resulting in substantial human and economic costs. Previous research has focused on community settings with less emphasis on hospital settings. INCLUSION CRITERIA Participants included adult inpatients, aged 18 years and over; the concept included the use of fall-prevention or fall-detection technologies; the context included any hospital ward setting. METHODS This scoping review was conducted according to JBI methodology for scoping reviews, guided by an a priori protocol. A wide selection of databases including MEDLINE, CINAHL, AMED, Embase, PEDro, Epistimonikos, and Science Direct were searched for records from inception to October 2019. Other sources included gray literature, trial registers, government health department websites, and websites of professional bodies. Only studies in the English language were included. A three-step search strategy was employed, with all records exported for subsequent title and abstract screening prior to full-text screening. Screening was performed by two independent reviewers and data extraction by one reviewer following agreement checks. Data are presented in narrative and tabular form. RESULTS Over 13,000 records were identified with 404 included in the scoping review: 336 reported on fall-prevention technologies, 51 targeted detection, and 17 concerned both. The largest contributions of studies came from the USA (n=185), Australia (n=65), the UK (n=36), and Canada (n=18). There was a variety of study designs including 77 prospective cohort studies, 33 before-after studies, and 35 systematic reviews; however, relatively few randomized controlled trials were conducted (n = 25). The majority of records reported on multifactorial and multicomponent technologies (n = 178), followed by fall detection devices (n = 86). Few studies reported on the following interventions in isolation: fall risk assessment (n = 6), environment design (n = 8), sitters (n = 5), rounding (n = 3), exercise (n = 3), medical/pharmaceutical (n = 2), physiotherapy (n = 1), and nutritional (n = 1). The majority (57%) of studies reported clinical effectiveness outcomes, with smaller numbers (14%) reporting feasibility and/or acceptability outcomes, or cost-effectiveness outcomes (5%). CONCLUSIONS This review has mapped the literature on fall-prevention and fall-detection technology and outcomes for adults in the hospital setting. Despite the volume of available literature, there remains a need for further high-quality research on fall-prevention and fall-detection technologies.
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Affiliation(s)
- Kay Cooper
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK.,School of Health Sciences, Robert Gordon University, Aberdeen, UK.,NHS Grampian, Aberdeen, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Paul Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Pamela Kirkpatrick
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK.,School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | | | | | - Audrey Stephen
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Lyndsay Alexander
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK.,School of Health Sciences, Robert Gordon University, Aberdeen, UK
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Abstract
INTRODUCTION Falls remain one of the most prevalent adverse events in hospitals and are associated with substantial negative health impacts and costs. Approaches to assess patients' fall risk have been implemented in hospitals internationally, ranging from brief screening questions to multifactorial risk assessments and complex prediction models, despite a lack of clear evidence of effect in reducing falls in acute hospital environments. The increasing digitisation of hospital systems provides new opportunities to understand and predict falls using routinely recorded data, with potential to integrate fall prediction models into real-time or near-real-time computerised decision support for clinical teams seeking to mitigate fall risk. However, the use of non-traditional approaches to fall risk prediction, including machine learning using integrated electronic medical records, has not yet been reviewed relative to more traditional fall prediction models. This scoping review will summarise methodologies used to develop existing hospital fall prediction models, including reporting quality assessment. METHODS AND ANALYSIS This scoping review will follow the Arksey and O'Malley framework and its recent advances, and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews recommendations. Four electronic databases (CINAHL via EBSCOhost, PubMed, IEEE Xplore and Embase) will be initially searched for studies up to 12 November 2020, and searches may be updated prior to final reporting. Additional studies will be identified by reference list review and citation analysis of included studies. No restriction will be placed on the date or language of identified studies. Screening of search results and extraction of data will be performed by two independent reviewers. Reporting quality will be assessed by the adherence to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis. ETHICS AND DISSEMINATION Ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publication and scientific conferences.
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Affiliation(s)
- Rex Parsons
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Susanna M Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Translation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Clinical Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia
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Designing a Patient Room as a Fall Protection Strategy: The Perspectives of Healthcare Design Experts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168769. [PMID: 34444514 PMCID: PMC8392568 DOI: 10.3390/ijerph18168769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022]
Abstract
Despite decades of research into patient falls, there is a dearth of evidence about how the design of patient rooms influences falls. Our multi-year study aims to better understand how patient room design can increase stability during ambulation, serving as a fall protection strategy for frail and/or elderly patients. The aim of this portion of the study was to ascertain the architect’s perspective on designing a room to mitigate the risk of falls, as well as to evaluate the face validity of a predictive algorithm to assess risk in room design using the input of a design advisory council (AC). The purpose of this paper is to provide insight into the design process and decision-making for patient rooms; summarize the impressions of industry experts about the configurations and layout of the patient rooms tested in a preliminary augmented reality model; establish the face validity of modeled heat maps depicting risk; and report the results of a pre-meeting and post-meeting survey of expert opinions. Feedback was coded using human factors/ergonomic (HF/E) design principles, and the findings will be used to guide further development of an “optimal” prototype room for human subject testing. The results confirm the challenges that architects face as they balance competing priorities and reveal how a participatory process focusing on preventing falls can shift assumptions about design strategies, especially subtle changes (e.g., toilet orientation).
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Liechti FD, Beck T, Ruetsche A, Roumet MC, Limacher A, Tritschler T, Donzé JD. Development and validation of a score to assess complexity of general internal medicine patients at hospital discharge: a prospective cohort study. BMJ Open 2021; 11:e041205. [PMID: 33958334 PMCID: PMC8103941 DOI: 10.1136/bmjopen-2020-041205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We aimed to develop and validate a score to assess inpatient complexity and compare its performance with two currently used but not validated tools to estimate complexity (ie, Charlson Comorbidity Index (CCI), patient clinical complexity level (PCCL)). METHODS Consecutive patients discharged from the department of medicine of a tertiary care hospital were prospectively included into a derivation cohort from 1 October 2016 to 16 February 2017 (n=1407), and a temporal validation cohort from 17 February 2017 to 31 March 2017 (n=482). The physician in charge assessed complexity. Potential predictors comprised 52 parameters from the electronic health record such as health factors and hospital care usage. We fit a logistic regression model with backward selection to develop a prediction model and derive a score. We assessed and compared performance of model and score in internal and external validation using measures of discrimination and calibration. RESULTS Overall, 447 of 1407 patients (32%) in the derivation cohort, and 116 of 482 patients (24%) in the validation cohort were identified as complex. Eleven variables independently associated with complexity were included in the score. Using a cut-off of ≥24 score points to define high-risk patients, specificity was 81% and sensitivity 57% in the validation cohort. The score's area under the receiver operating characteristic (AUROC) curve was 0.78 in both the derivation and validation cohort. In comparison, the CCI had an AUROC between 0.58 and 0.61, and the PCCL between 0.64 and 0.69, respectively. CONCLUSIONS We derived and internally and externally validated a score that reflects patient complexity in the hospital setting, performed better than other tools and could help monitoring complex patients.
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Affiliation(s)
- Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Beck
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Ruetsche
- Department of Technology and Innovation, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacques D Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Cognitive Dissonance of Students Between Falls Prevention Evidence and Strategies. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Krakau K, Andersson H, Dahlin ÅF, Egberg L, Sterner E, Unbeck M. Validation of nursing documentation regarding in-hospital falls: a cohort study. BMC Nurs 2021; 20:58. [PMID: 33836734 PMCID: PMC8034134 DOI: 10.1186/s12912-021-00577-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In-hospital fall incidents are common and sensitive to nursing care. It is therefore important to have easy access to valid patient data to evaluate and follow-up nursing care. The aim of the study was to validate the nursing documentation, using a specific term in the registered nurses´ (RNs´) discharge note, regarding inpatient falls according to the outcome of a digitalized data extraction tool and the discharge note itself. METHODS At a teaching hospital, 31,571 episodes of care were eligible for inclusion in this retrospective cohort study. A stratified sampling including five groups was used, two with random sampling and three with total sampling. In total, 1232 episodes of care were reviewed in the electronic patient record using a study-specific protocol. Descriptive statistics were used. RESULTS In total, 590 episodes of care in the study cohort included 714 falls. When adjusted for the stratified sampling the cumulative incidence for the study population was 1.9%. The positive predictive value in total for the data extraction tool regarding the presence of any fall, in comparison with the record review, was 87.4%. Discrepancies found were, for example, that the RNs, at discharge, stated that the patient had fallen but no documented evidence of that could be detected during admission. It could also be the opposite, that the RNs correctly had documented that no fall had occurred, but the data extraction tool made an incorrect selection. When the latter had been withdrawn, the positive predictive value was 91.5%. Information about minor injuries due to the fall was less accurate. In the group where RNs had stated that the patient had fallen without injury, minor injuries had actually occurred in 28.3% of the episodes of care. CONCLUSIONS The use of a specific term regarding fall in the RNs´ discharge note seems to be a valid and reliable data measurement and can be used continuously to evaluate and follow-up nursing care.
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Affiliation(s)
- Karolina Krakau
- Department of Rehabilitation Medicine, Danderyd Hospital, Danderyd, Sweden
| | - Helene Andersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden.,Department of Infection, Danderyd Hospital, Danderyd, Sweden
| | - Åsa Franzén Dahlin
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden. .,Department of Neurology, Danderyd Hospital, Danderyd, Sweden.
| | - Louise Egberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Solna, Sweden.,Department of Surgery and Urology, Danderyd Hospital, Danderyd, Sweden
| | - Eila Sterner
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Department of Trauma, Acute Care Surgery and Orthopedics, Karolinska University Hospital, Solna, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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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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Mitchell P, Cribb A, Entwistle V. Made to Measure: The Ethics of Routine Measurement for Healthcare Improvement. HEALTH CARE ANALYSIS 2021; 29:39-58. [PMID: 33341924 PMCID: PMC7870769 DOI: 10.1007/s10728-020-00421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/24/2022]
Abstract
This paper analyses the ethics of routine measurement for healthcare improvement. Routine measurement is an increasingly central part of healthcare system design and is taken to be necessary for successful healthcare improvement efforts. It is widely recognised that the effectiveness of routine measurement in bringing about improvement is limited-it often produces only modest effects or fails to generate anticipated improvements at all. We seek to show that these concerns do not exhaust the ethics of routine measurement. Even if routine measurement does lead to healthcare improvements, it has associated ethical costs which are not necessarily justified by its benefits. We argue that the practice of routine measurement changes the function of the healthcare system, resulting in an unintended and ethically significant transformation of the sector. It is difficult to determine whether such changes are justified or offset by the benefits of routine measurement because there may be no shared understanding of what is 'good' in healthcare by which to compare the benefits of routine measurement with the goods that are precluded by it. We counsel that the practice of routine measurement should proceed with caution and should be recognised to be an ethically significant choice, rather than an inevitability.
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Affiliation(s)
- Polly Mitchell
- School of Education, Communication & Society, King's College London, London, UK.
| | - Alan Cribb
- School of Education, Communication & Society, King's College London, London, UK
| | - Vikki Entwistle
- Health Services Research Unit and School of Divinity, History and Philosophy, University of Aberdeen, Aberdeen, UK
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Basic D, Huynh ET, Gonzales R, Shanley CG. Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients. J Am Geriatr Soc 2021; 69:779-784. [PMID: 33395498 DOI: 10.1111/jgs.17007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3-5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in-hospital falls. DESIGN Prospective before-after study of older people hospitalized with acute illness. SETTING Two side-by-side aged care wards in a university hospital in Sydney, Australia. PARTICIPANTS A total of 3,673 consecutive inpatients of mean age 83.8 ± 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. INTERVENTION Twice-weekly SIBR. MEASUREMENTS Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall-related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. RESULTS After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52-0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall-related injuries (IRR = 0.79, 95% CI = 0.52-1.20). CONCLUSION This study is the first to investigate the effect of SIBR on in-hospital falls. It provides evidence that a sustainable, twice-weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.
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Affiliation(s)
- David Basic
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elizabeth T Huynh
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Rinaldo Gonzales
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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Reyes L, Drammeh A, Paulino J, Downer J, Mejia-Paulino R, Cabezas V, Dodaj X, Harris K, Cadet MJ. A student-led quality improvement project on fall prevention. Nursing 2021; 51:15-17. [PMID: 33346611 DOI: 10.1097/01.nurse.0000721800.82909.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Reyes
- At Bronx Community College in Bronx, N.Y. Laura Reyes , Amie Drammeh , Jennifer Paulino , Jodian Downer , Rachel Mejia-Paulino , Victoria Cabezas , and Xhuliano Dodaj are all current or former nursing students and Kenya Harris is the chairperson. Myriam Jean Cadet is an adjunct professor at the State University of New York Downstate Medical Center in Brooklyn
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Khorasani Zavareh D, Mousavipour S, Nouri F, Ebadi A, Saremi M, Jabbari M, Ghomian Z, Mohammadi R. Exploring effective factors in reducing the fall of hospitalized patients: A systematic review. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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A Biopsychosocial Approach to Analyzing Inpatient Falls. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhao M, Li S, Xu Y, Su X, Jiang H. Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-Control Study in Multicenter Acute Hospitals. Clin Interv Aging 2020; 15:1767-1778. [PMID: 33061328 PMCID: PMC7522431 DOI: 10.2147/cia.s258171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Injurious falls seriously threaten the safety of elderly patients. Identifying risk factors for predicting the probability of injurious falls is an important issue that still needs to be solved urgently. We aimed to identify predictors and develop a nomogram for distinguishing populations at high risk of injurious falls from older adults in acute settings. PATIENTS AND METHODS A retrospective case-control study was conducted at three hospitals in Shanghai, China. Elderly patients with injurious falls from January 2014 to December 2018 were taken as cases, and control patients who did not have falls were randomly matched based on the admission date and the department. The data were collected through a medical record review and adverse events system. The original data set was randomly divided into a training set and a validation set at a 7:3 ratio. A nomogram was established based on the results of the univariate analysis and multivariate logistic regression analysis, and its discrimination and calibration were verified to confirm the accuracy of the prediction. The cut-off value of risk stratification was determined to help medical staff identify the high-risk groups. RESULTS A total of 115 elderly patients with injurious falls and 230 controls were identified. History of fractures, orthostatic hypotension, functional status, sedative-hypnotics and level of serum albumin were independent risk factors for injurious falls in elderly patients. The C-indexes of the training and validation sets were 0.874 (95% CI: 0.784-0.964) and 0.847 (95% CI: 0.771-0.924), respectively. Calibration curves were drawn and showed acceptable predictive performance. The cut-off values of the training and validation sets were 146.3 points (sensitivity: 73.7%; specificity: 87.5%) and 157.2 points (sensitivity: 69.2%; specificity: 85.5%), respectively. CONCLUSION The established nomogram facilitates the identification of high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.
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Affiliation(s)
- Min Zhao
- School of Nursing, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Shuguang Li
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yun Xu
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaoxia Su
- School of Nursing, Fudan University, Shanghai, People's Republic of China
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hong Jiang
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Brusco NK, Hutchinson AM, Mitchell D, Jellett J, Boyd L, Webb-St Mart M, Raymond M, Clayton D, Farley A, Botti M, Steen K, Duncan M, Cummins N, Haines T. Mobilisation alarm triggers, response times and utilisation before and after the introduction of policy for alarm reduction or elimination: A descriptive and comparative analysis. Int J Nurs Stud 2020; 117:103769. [PMID: 33647843 DOI: 10.1016/j.ijnurstu.2020.103769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/23/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mobilisation alarms are a falls prevention strategy used in hospitals to alert staff when an at risk patient is attempting to mobilise. Mobilisation alarms have an estimated annual cost of $AUD58MIL in Australia. There is growing evidence from randomised controlled trials indicating mobilisation alarms are unlikely to prevent falls. AIM The primary aim of this study was to describe the rate of mobilisation alarm false triggers and staff response time across different health services. The secondary aim was to compare pre to post mobilisation alarm utilisation following the introduction of policy to reduce or eliminate mobilisation alarms. METHODS This descriptive and comparative study was conducted through Monash Partners Falls Alliance across six health services in Melbourne, Australia. This study described true and false alarm triggers and trigger response times across three health services and usual care mobilisation alarm utilisation across six health services; and then compared alarm utilisation across two health services following the introduction of policy to reduce (<2.5%) or eliminate (0.0%) mobilisation alarms in the acute and rehabilitation settings. RESULTS The most frequent observation was a false alarm (n = 74, 52%), followed by a true alarm (n = 67, 47%) and no alarm (n = 3, 2%). Time to respond to the true and false alarms was an average of 37 seconds (SD 92) and this included 61 occasions of 0 seconds as a member of staff was present when the alarm triggered. If the 61 occasions of staff being present when the alarm triggered were removed, the average time to respond was 65 seconds (SD114). Usual care mobilisation alarm utilisation in acute was 7% (n = 171/2,338) and in rehabilitation was 11% (n = 286/2,623). Introducing policy for reduced and eliminated mobilisation alarm conditions was successful with a reduced utilisation rate of 1.8% (n = 11/609) and an eliminated utilisation rate of 0.0% (n = 0/521). CONCLUSION Half of mobilisation alarm triggers are false and when alarms trigger without staff present, staff take about a minute to respond. While usual care has one in fourteen patients in acute and one in nine patients in rehabilitation using a mobilisation alarm, it is possible to introduce policy which will change practice to reduce or eliminate the use of mobilisation alarms, providing evidence of feasibility for future disinvestment effectiveness studies that it is feasible to disinvest in the alarms.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Level 3, Building G, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Alison M Hutchinson
- Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia; School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia.
| | - Deb Mitchell
- Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Jo Jellett
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Leanne Boyd
- Eastern Health, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
| | | | - Melissa Raymond
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; College of Science, Health and Engineering, La Trobe University, Melbourne Australia.
| | - Diana Clayton
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Allison Farley
- Eastern Health, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
| | - Mari Botti
- Epworth Richmond, 89 Bridge Road, Richmond, Victoria, 3121, Australia.
| | - Kate Steen
- Epworth Richmond, 89 Bridge Road, Richmond, Victoria, 3121, Australia.
| | - Mo Duncan
- Eastern Health, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
| | - Nicky Cummins
- Cabrini Health, 154 Wattletree Road, Malvern, Victoria 3144, Australia.
| | - Terry Haines
- Rehabilitation, Ageing and Independent living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Level 3, Building G, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia.
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Jessup RL, Tacey M, Glynn M, Kirk M, McKeown L. Evaluation of the effectiveness of a comprehensive care plan to reduce hospital acquired complications in an Australian hospital: protocol for a mixed-method preimplementation and postimplementation study. BMJ Open 2020; 10:e034121. [PMID: 32690732 PMCID: PMC7375497 DOI: 10.1136/bmjopen-2019-034121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A new healthcare standard (Standard 5: Comprehensive Care) has been introduced by the Australian Commission on Safety and Quality in Healthcare. Standard 5 advocates for organisational leadership to develop and maintain systems and processes to deliver patient-centred comprehensive care plans that include appropriate screening to identify and mitigate risks associated with hospitalisation. The aim of this study is to evaluate the effectiveness and cost effectiveness of a comprehensive care and risk evaluation (Comprehensive Assessment and Risk Evaluation (CARE)) plan to reduce hospital acquired complications (HACs) in an Australian hospital network. METHODS AND ANALYSIS This study will comprise a mixed-method pre and post implementation concurrent triangulation evaluation design. The primary clinical outcome will assess the reduction of routinely reported HACs (pressure care and falls), selected based on the likely reliability of routinely collected data prior to implementation. Secondary clinical outcomes will include length of stay and activity-based costing data for each episode, in-hospital mortality, expected and unplanned readmissions within 28 days, compliance with CARE plan completion and referrals for at risk patients, staff satisfaction, patient satisfaction and barriers and enablers to implementation. We expect that the incidence of other HACs (malnutrition, delirium, violence and aggression, and suicide and self-harm) may increase as routine methods for assessing risk were not in place prior to implementation of the CARE plan. We will therefore collect data on incidence of these HACs as tertiary outcomes. Our primary cost-effectiveness outcome will be calculation of an incremental cost-effectiveness ratio. ETHICS AND DISSEMINATION Ethics approval has been received from Northern Health Low Risk Ethics Committee. The results of this study will be published in peer-reviewed journals and presented at conferences.
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Affiliation(s)
- Rebecca Leigh Jessup
- Allied Health, Northern Health, Epping, Victoria, Australia
- Academic & Research Collaborative in Health (Northern ARCH), School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia, La Trobe University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Research, Northern Health, Epping, Victoria, Australia
- Department of Medicine and Radiology, The University of Melbourne-Parkville Campus, Parkville, Victoria, Australia
| | - Maree Glynn
- Clinical Practice Improvement, Northern Health, Epping, Victoria, Australia
| | - Michael Kirk
- Medical Services, Northern Health, Epping, Victoria, Australia
| | - Liz McKeown
- Clinical Practice Improvement, Northern Health, Epping, Victoria, Australia
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de Freitas Luzia M, Vidor ID, da Silva ACFE, de Fátima Lucena A. Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Appl Nurs Res 2020; 54:151273. [PMID: 32650884 DOI: 10.1016/j.apnr.2020.151273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/10/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the nursing outcomes of hospitalized patients at high risk for falls through NOC and correlate NOC outcomes called Knowledge: Fall Prevention and Fall Prevention Behavior with patients' sociodemographic and clinical variables. BACKGROUND Falls represent one of the major safety incidents in the hospital setting. The role of nursing is fundamental in preventing these events, from risk assessment to outcome evaluation. One of the strategies for evaluating nursing outcomes is the use of Nursing Outcomes Classification (NOC). METHODS A cross-sectional study conducted with a sample of 68 adult patients at high risk for falls admitted to clinical and surgical units. The patients received three evaluations. Data collect was prospective with an instrument containing five results and 28 NOC indicators. Descriptive and analytical analysis considered the NOC 5-point Likert scale. RESULTS Evaluation of the Knowledge: Fall Prevention and Fall Prevention Behavior outcomes showed that patients have a limited level of knowledge and rarely demonstrated preventive behavior. Vital Signs (0802), Medication Response (2301) and Safe Health Care Environment (1934) pointed to the existence of adequate patient monitoring and safe environment. CONCLUSION The evaluation of patient outcomes supported by a standardized classification system such as the NOC highlights the patient's clinical evolution and produces data that support the planning of care and management interventions, providing more effective and safer practices.
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Affiliation(s)
- Melissa de Freitas Luzia
- School of Nursing, Universidade Federal do Rio Grande do Sul, Rua São Manoel, 963 - Rio Branco, Porto Alegre, RS 90620-110, Brazil.
| | - Isabella Duarte Vidor
- School of Nursing, Universidade Federal do Rio Grande do Sul, Rua São Manoel, 963 - Rio Branco, Porto Alegre, RS 90620-110, Brazil
| | | | - Amália de Fátima Lucena
- School of Nursing, Universidade Federal do Rio Grande do Sul, Rua São Manoel, 963 - Rio Branco, Porto Alegre, RS 90620-110, Brazil
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Haines TP, Hill AM. Better Off Doing Falls Prevention “With” Our Patients Rather Than “To” Them? Jt Comm J Qual Patient Saf 2020; 46:127-128. [DOI: 10.1016/j.jcjq.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Despite decades of fall prevention efforts, patient falls remain a common cause of harm in hospitalized older adults. While fall prevention strategies have been historically championed by nurses, hospitalist physicians, nurse practitioners, and physician assistants play a vital role in the multidisciplinary care team in ensuring the safety of our patients. Multiple fall risk assessment tools exist, but no one tool has demonstrated excellence in predicting patient falls in the hospital. Any fall risk assessment tool should be complemented by a clinician's individualized evaluation of patient-specific, situational, and environmental risk factors. A particular emphasis on medication review is critical, as numerous medication classes can increase the risk of falls, and medications are a potentially modifiable risk factor. Multiple studies of individual and multicomponent nursing-based interventions have failed to demonstrate success in reducing falls or fall injuries. Promising strategies for fall prevention include tailoring interventions to patient risk factors and individualized patient education. In addition to nursing-based interventions, the hospitalist's role in fall prevention is to (1) identify and address potentially modifiable risk factors, (2) reinforce individualized education to patients, and (3) advise behavior choices that promote safe mobility. If a patient does sustain a fall, the hospitalist should partner with the multidisciplinary care team in post fall care to assess for injury, evaluate underlying causes of the fall, and determine plans for secondary prevention.
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Affiliation(s)
- Rachel Keuseman
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Donna Miller
- Division of Hospital Internal Medicine, Division of Geriatrics and Gerontology, Mayo Clinic,Rochester, MN, USA
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Tasheva P, Vollenweider P, Kraege V, Roulet G, Lamy O, Marques-Vidal P, Méan M. Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients. JAMA Netw Open 2020; 3:e1920185. [PMID: 32003817 PMCID: PMC7042865 DOI: 10.1001/jamanetworkopen.2019.20185] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. OBJECTIVES To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. DESIGN, SETTING, AND PARTICIPANTS This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. EXPOSURES Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). MEAN OUTCOMES AND MEASURES Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. RESULTS A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). CONCLUSIONS AND RELEVANCE In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.
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Affiliation(s)
- Plamena Tasheva
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | | | - Pedro Marques-Vidal
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Méan
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Pragmatic development of an evidence-based intensive care unit–specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool. Aust Crit Care 2020; 33:65-70. [DOI: 10.1016/j.aucc.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/09/2019] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
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Toye C, Slatyer S, Kitchen S, Ingram K, Bronson M, Edwards D, van Schalkwyk W, Pienaar C, Wharton P, Bharat C, Hill KD. Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study. Clin Interv Aging 2019; 14:2223-2237. [PMID: 31908433 PMCID: PMC6927259 DOI: 10.2147/cia.s211424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/19/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of inter-professional collaboration. METHODS Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. RESULTS From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. CONCLUSION Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia 6102, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Susan Slatyer
- Discipline of Nursing, College of Science, Health, Engineering & Education, Murdoch University, Perth, Western Australia 6150, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Su Kitchen
- Clinical Lead and Clinical Nurse Consultant in Falls Management, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Katharine Ingram
- Consultant Geriatrician, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Mary Bronson
- Deputy Nurse Co Director, Medical Division, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Deborah Edwards
- Occupational Therapy Coordinator, Acute Services Emergency Department, Sir Charles Gardiner Hospital, Perth, Western Australia6009, Australia
| | - Welma van Schalkwyk
- Registered Nurse, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Catherine Pienaar
- Project Officer, Nursing Research, Perth Children’s Hospital and Murdoch University, Perth, Western Australia6009, Australia
| | - Philippa Wharton
- Project Officer, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales2006, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria3199, Australia
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Jones KJ, Skinner A, Venema D, Crowe J, High R, Kennel V, Allen J, Reiter‐Palmon R. Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals. Health Serv Res 2019; 54:994-1006. [PMID: 31215029 PMCID: PMC6736913 DOI: 10.1111/1475-6773.13186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. DATA SOURCES/STUDY SETTING Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. STUDY DESIGN A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. DATA COLLECTION Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. PRINCIPAL FINDINGS The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. CONCLUSIONS Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
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Affiliation(s)
- Katherine J. Jones
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Anne Skinner
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Dawn Venema
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - John Crowe
- Department of PsychologyUniversity of Nebraska at OmahaOmahaNebraska
| | - Robin High
- College of Public HealthUniversity of Nebraska Medical CenterOmahaNebraska
| | - Victoria Kennel
- College of Allied Health ProfessionsUniversity of Nebraska Medical CenterOmahaNebraska
| | - Joseph Allen
- Department of PsychologyUniversity of Nebraska at OmahaOmahaNebraska
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Shorr RI, Staggs VS, Waters TM, Daniels MJ, Liu M, Dunton N, Mion LC. Impact of the Hospital-Acquired Conditions Initiative on Falls and Physical Restraints: A Longitudinal Study. J Hosp Med 2019; 14:E31-E36. [PMID: 31532748 DOI: 10.12788/jhm.3295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services (CMS) implemented the Hospital-Acquired Conditions (HACs) Initiative in October 2008; the CMS no longer reimbursed hospitals for fall injury. The effects of this payment change on fall and fall injury rates are not well described, nor its effect on physical restraint use. OBJECTIVE The aim of this study was to examine the effects of the 2008 HACs Initiative on the rates of falls, injurious falls, and physical restraint use. DESIGN/SETTING This was a nine-year retrospective cohort study (July 2006-December 2015) involving 2,862 adult medical, medical-surgical, and surgical nursing units from 734 hospitals. MEASUREMENTS Annual rates of change in falls, injurious falls, and physical restraint use during the two years before the payment rule went into effect were compared with one-, four-, and seven-year rates of annual change after implementation, adjusting for unit- and facility-level covariates. Stratified analyses were conducted according to bed size and teaching status. RESULTS Compared with prior to the payment change, there was stable acceleration in the one-, four-, and seven-year annual rates of decline in falls as follows: -2.1% (-3.3%, -0.9%), -2.2% (-3.2%, -1.1%), and -2.2% (-3.4%, -1.0%) respectively. For injurious falls, there was an increasing acceleration in the annual declines, achieving statistical significance only at seven years post CMS change as follows: -3.2% (-5.5%, -1.0%). Physical restraint use prevalence decreased from 1.6% to 0.6%. Changes in the rates of falls, injurious falls, and restraint use varied according to hospital bed size and teaching status. CONCLUSIONS AND RELEVANCE Since the HACs Initiative, there was at best a modest decline in the rates of falls and injurious falls observed primarily in larger, major teaching hospitals. An increase in restraint use was not observed. Falls remain a difficult patient safety problem for hospitals, and further research is required to develop cost-effective, generalizable strategies for their prevention.
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Affiliation(s)
- Ronald I Shorr
- Geriatric Research Education & Clinical Center (GRECC), Malcom Randall VAMC, Gainesville, Florida
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Teresa M Waters
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, Florida
| | | | - Nancy Dunton
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas
| | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, Ohio
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Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Educating hospital patients to prevent falls: protocol for a scoping review. BMJ Open 2019; 9:e030952. [PMID: 31530614 PMCID: PMC6756445 DOI: 10.1136/bmjopen-2019-030952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Falls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended. METHODS AND ANALYSIS The analysis will apply the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed search strategy of Medical Subject Headings and text words will be conducted of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, PsychINFO, Education Resources Information Center and grey literature databases from January 2008 to current. The reference lists of included articles will be hand searched for additional studies. Two reviewers will screen the titles and abstracts independently and analyse the full text of potential articles based on the inclusion and exclusion criteria. The data will be extracted using a structured data form. Thematic analysis and numerical synthesis of the data will be conducted, and key themes will be identified. ETHICS AND DISSEMINATION Results of this scoping review will illuminate the designs and outcomes of patient education research for hospital falls prevention in the current literature. It is anticipated that the findings will highlight best-practice educational design to inform the development of future patient-focused education for falls prevention. Study findings will be presented at relevant conferences and public forums, and published in peer-reviewed journals. Ethics approval is not required.
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Affiliation(s)
- Hazel Heng
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Dana Jazayeri
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Louise Shaw
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
| | - Debra Kiegaldie
- Healthscope and Faculty of Health Science, Youth and Community Studies, Holmesglen Institute of TAFE Morrabbin Campus, Moorabbin, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia
- North Eastern Rehabilitation Centre, Healthscope Ltd, Ivanhoe, Victoria, Australia
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Abstract
Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.
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Booth V, Hood-Moore V, Hancox JE, Logan P, Robinson KR. Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults. BMJ Open 2019; 9:e024185. [PMID: 30798309 PMCID: PMC6398678 DOI: 10.1136/bmjopen-2018-024185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Rehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults. DESIGN Systematic scoping review. SETTING Studies were not limited for inclusion based on setting. PARTICIPANTS Studies were included that featured older adults (>65 years of age). INTERVENTIONS Studies were included that reported the development of a rehabilitation intervention. PRIMARY AND SECONDARY OUTCOME MEASURES Data were extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework. RESULTS Thirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson's disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support based, cognitive, physical activities, nursing led, falls prevention and occupational therapy led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) framework for developing and evaluating complex interventions being the most frequently cited (77%, n=17). CONCLUSION At present, the MRC framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required.
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Affiliation(s)
- Vicky Booth
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Victoria Hood-Moore
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Jennie E Hancox
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Phillipa Logan
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Katie R Robinson
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
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Røyset B, Talseth-Palmer BA, Lydersen S, Farup PG. Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments. Clin Interv Aging 2019; 14:145-154. [PMID: 30697039 PMCID: PMC6339647 DOI: 10.2147/cia.s191832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety. Materials and methods Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees’ perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire). Results Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: −2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety. Conclusion The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.
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Affiliation(s)
- Bodil Røyset
- Department for Medicine and Rehabilitation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Bente A Talseth-Palmer
- Department for Research, Innovation, Education and Competence Development, Møre og Romsdal Hospital Trust, Molde, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway, .,Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,
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Backman R, Foy R, Diggle PJ, Kneen R, Easton A, Defres S, McGill F, Michael BD, Solomon T. A pragmatic cluster randomised controlled trial of a tailored intervention to improve the initial management of suspected encephalitis. PLoS One 2018; 13:e0202257. [PMID: 30521521 PMCID: PMC6283633 DOI: 10.1371/journal.pone.0202257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/04/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether a tailored multifaceted implementation strategy improves the initial management of patients with suspected encephalitis. DESIGN Pragmatic two arm cluster randomised controlled trial. SETTING Hospitals within the United Kingdom. PARTICIPANTS Twenty-four hospitals nested within 12 postgraduate deaneries. Patients were identified retrospectively by searching discharge, microbiology, radiology and pharmacy records and included if they met clinical criteria or had a recorded suspicion of encephalitis. INTERVENTION An implementation strategy designed to overcome barriers to change, comprising local action planning, education and training, feedback on performance, a lumbar puncture pack and a range of optional components. OUTCOMES The primary outcome was the proportion of patients with suspected encephalitis undergoing diagnostic lumbar puncture within 12 hours of admission and starting aciclovir treatment within six hours. Secondary outcomes included the proportions of adults and children who had a lumbar puncture, who had appropriate cerebrospinal fluid investigations, and who had appropriate radiological imaging within 24 hours of admission. Data were collected from patient records for 12 months before and 12 months during the intervention period, and analysed blind to allocation. RESULTS 13 hospitals were randomised to intervention and 11 to control (no intervention), with 266 and 223 patients with suspected encephalitis identified respectively. There was no significant difference in primary outcome between intervention and control hospitals (13.5% and 14.8% respectively, p = 0.619; treatment effect -0.188, 95% confidence interval -0.927 to 0.552), but both had improved compared to pre-intervention (8.5%). CONCLUSION The improvement in both intervention and control arms may reflect overall progress in management of encephalitis through wider awareness and education. TRIAL REGISTRATION Controlled Trials: ISRCTN06886935.
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Affiliation(s)
- Ruth Backman
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Peter J. Diggle
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Department Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Rachel Kneen
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Ava Easton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- The Encephalitis Society, Malton, North Yorkshire, United Kingdom
| | - Sylviane Defres
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Fiona McGill
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Benedict Daniel Michael
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Tom Solomon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Gustavsson J, Jernbro C, Nilson F. There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring. Int J Qual Stud Health Well-being 2018; 13:1479586. [PMID: 29869973 PMCID: PMC5990953 DOI: 10.1080/17482631.2018.1479586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. METHOD We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). RESULTS The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. CONCLUSIONS The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
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Affiliation(s)
- Johanna Gustavsson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Ali UM, Judge A, Foster C, Brooke A, James K, Marriott T, Lamb SE. Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis. Age Ageing 2018; 47:818-824. [PMID: 30010697 PMCID: PMC6201822 DOI: 10.1093/ageing/afy097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background falls can negatively affect patients, resulting in loss of independence and functional decline and have substantial healthcare costs. Hospitals are a high-risk falls environment and regularly introduce, but seldom evaluate, policies to reduce inpatient falls. This study evaluated whether introducing portable nursing stations in ward bays to maximise nurse-patient contact time reduced inpatient falls. Methods inpatient falls data from local hospital incident reporting software (Datix) were collected monthly (April 2014-December 2017) from 17 wards in Stoke Mandeville and Wycombe General Hospitals, the UK. Portable nursing stations were introduced in bays on these wards from April 2016. We used a natural experimental study design and interrupted time series analysis to evaluate changes in fall rates, measured by the monthly rate of falls per 1000 occupied bed days (OBDs). Results the wards reported 2875 falls (April 2014-December 2017). The fallers' mean age was 78 (SD = 13) and 58% (1624/2817) were men. Most falls, 99.41% (2858/2875), resulted in none, low or moderate harm, 0.45% (13/2875) in severe harm and 0.14% (4/2875) in death. The monthly falls rate increased by 0.119 per 1000 OBDs (95% CI: 0.045, 0.194; P = 0.002) before April 2016, then decreased by 0.222 per 1000 OBDs (95% CI: -0.350, -0.093; P = 0.001) until December 2017. At 12 months post-intervention, the absolute difference between the estimated post-intervention trend and pre-intervention projected estimate was 2.84 falls per 1000 OBDs, a relative reduction of 26.71%. Conclusion portable nursing stations were associated with lower monthly falls rates and could reduce inpatient falls across the NHS.
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Affiliation(s)
- U M Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - C Foster
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - A Brooke
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - K James
- Oxford Academic Health Sciences Network, Oxford, UK
| | - T Marriott
- Oxford Academic Health Sciences Network, Oxford, UK
| | - S E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
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