Risks and suggestions to prevent falls in geriatric rehabilitation: a participatory approach

Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study

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.

The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review

OBJECTIVES

The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms.

METHODS

An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews.

RESULTS

After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail.

CONCLUSIONS

Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.

The SCOPE of Hospital Falls: A Systematic Mixed Studies Review

PURPOSE

This systematic mixed studies review on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design.

BACKGROUND

Falls were identified by the Centers for Medicare & Medicaid Services as a nonreimbursed hospital-acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 U.S. HAC reduction program. In 2015, the Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety & Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level are indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people, and environment.

METHODS

The systematic literature review used Medical Subject Heading terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers.

RESULTS

Following full-text review, 27 papers were included and critically appraised using an evaluation matrix that included a mixed methods appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients), and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability.

CONCLUSIONS

Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework while considering the permanence of solutions.

Gender perspective on fear of falling using the classification of functioning as the model

Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75–93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question “Are you afraid of falling?”. Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to “Are you afraid of falling?” might be highly influenced by gendered patterns.

Implications for Rehabilitation

The question “Are you afraid of falling?” has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age.

Gendered patterns might influence the answer to the question “Are you afraid of falling?” Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.

Reconstructing the fall: individual, behavioural and contextual factors associated with falls in individuals with intellectual disability

BACKGROUND

Falls are a significant and recurrent problem for individuals with intellectual disability (ID). There has been little exploration of the fall event from the perspective of the individual who falls or their carers. Research has focused predominantly on personal risk factors, leaving the behavioural and contextual analysis of falls much less understood. This study aimed to identify these additional factors as well as briefly explore the fall experience for individuals and their carers.

METHOD

A qualitative design was used incorporating fall reconstructions and ethnographic-style interviews conducted in the home setting. Nine people with ID and their carers/family member participated: five pairs were living at home and four were in out-of-family-home settings. Interviews were recorded, transcribed verbatim and major themes identified via thematic analysis.

RESULTS

We identified 17 themes that contributed to falls and fell under the three headings of individual, behavioural or contextual factors. Themes include decreased physical capacity, unsafe behaviours, limited hazard awareness and the impact of others in the home on an individual's fall behaviours. Additionally, families and individuals identified a number of consequences and adaptations which they implemented to alleviate possible fall impact.

CONCLUSIONS

Qualitative interviews, observational methods and carer assistance are valuable in offering insight into understanding the individual, behavioural and contextual factors associated with falls in people with ID. The fall reconstruction technique may be a useful supplement when evaluating intrinsic risk in programmes designed to reduce falls.

Using video-elicitation to assess risks and potential falls reduction strategies in long term care

PURPOSE

To assess the ability to use and the usefulness of video-elicitation to study risks and potential ways to reduce transfer-related falls in long term care.

METHOD

A qualitative research study was conducted in a long term care facility and included a purposeful sample of 16 subjects (6 residents, 6 health care providers, and 4 family members). Field observations, interviews, video-recordings of assisted transfers, and video-elicitation sessions were conducted with the participants. The interviews and video-elicitation sessions were digitally recorded, transcribed and coded independently by at least 2 analysts. The codes were organized under themes.

RESULTS

Six themes related to risks and reduction of transfer-related falls were identified - environment, behaviors, health conditions, specific activities, knowledge and awareness, and balancing values.

CONCLUSIONS

We were able to implement the novel participatory video-elicitation method developed and it was useful to identify risks and risk reduction strategies. Therefore, video-elicitation may be used in future studies to inform the design and testing of interventions to reduce transfer-related falls among LTC residents. Implications for Rehabilitation Falls are common among long term care residents. Visual-elicitation is a useful tool to be used in rehabilitation to assess risks and possible measures to reduce falls. The video-elicitation sessions optimized the ability and engaged residents, health care providers, and family members on providing information and discussing risks and potential measures to reduce transfer-related falls.

The clinical safety of disabled patients: proposal for a methodology for analysis of health care risks and specific measures for improvement

The clinical risks associated with health care have been a known factor since ancient times, and their prevention has constituted one of the foundations of health care. However, concern for the risks involved in health care treatments has risen very significantly in recent years, becoming a modern current of concern for clinical health care risks which is referred to by the name of "patient safety" in the scientific literature. Unfortunately, there are no studies on patient safety in dental practice or case studies of adverse events in this practice. In addition to the lack of studies on adverse events in regular dental practice, there are even fewer references to treatment for disabled patients. In this article, we provide a "proposal for analysis" of the clinical risks associated with treating disabled patients, which will make it possible to evaluate the health care risks associated with the treatment of patients who have a specific disability, at one determined moment and in one specific environment.

Reducing falls among geriatric rehabilitation patients: a controlled clinical trial

Objective:

To evaluate the effectiveness of an intervention programme to reduce falls among geriatric rehabilitation patients.

Design:

Pre/post-test design with independent pre-test and matched post-test samples.

Setting:

Inpatient geriatric wards in a rehabilitation hospital.

Participants:

Seventy-six matched pairs ( n = 152) of geriatric rehabilitation patients from one control and one intervention ward participated in the study, and 36 nursing staff surveys were completed.

Intervention:

The intervention programme was developed based on interviews and systematic reviews. Educational materials were distributed to patients and families, and preventive measures were implemented.

Main outcome measures:

The rates of falls before and after the intervention both within and between the wards were compared, and surveys were completed.

Results:

The matched patients presented no significant differences on age, gender or medical conditions. The falls rates, proportion of fallers and length of stay was higher among those in the control ward ( P< 0.043). The percentage of fallers and the rate of falls/1000 patient days were lower on the intervention ward after implementation: odds ratio (95% confidence interval) = −2.9 (−6.6, −1.2) and −1.8 (−6.0, 0.5). Thirty of 36 respondents considered the tool to be helpful and beneficial for use on other wards.

Conclusion:

The intervention programme was effective in reducing falls among geriatric rehabilitation patients.