Use of a postfall assessment tool to prevent falls

Systematic review of types of safety incidents and the processes and systems used for safety incident reporting in care homes

AIMS

To identify the safety incident reporting systems and processes used within care homes to capture staff reports of safety incidents, and the types and characteristics of safety incidents captured by safety incident reporting systems.

DESIGN

Systematic review following PRISMA reporting guidelines.

METHODS

Databases were searched January 2023 for studies published after year 2000, written in English, focus on care homes and incident reporting systems. Data were extracted using a bespoke data extraction tool, and quality was assessed. Data were analysed descriptively and using narrative synthesis, with types and characteristics of incidents analysed using the International Classification for Patient Safety.

DATA SOURCES

Databases were CINAHL, MEDLINE, PsycINFO, EMBASE, HMIC, ASSISA, Nursing and Allied Health Database, MedNar and OpenGrey.

RESULTS

We identified 8150 papers with 106 studies eligible for inclusion, all conducted in high-income countries. Numerous incident reporting processes and systems were identified. Using modalities, typical incident reporting systems captured all types of incidents via electronic computerized reporting, with reports made by nursing staff and captured information about patient demographics, the incident and post-incident actions, whilst some reporting systems included medication- and falls-specific information. Reports were most often used to summarize data and identify trends. Incidents categories most often were patient behaviour, clinical process/procedure, documentation, medication/intravenous fluids and falls. Various contributing and mitigating factors and actions to reduce risk were identified. The most reported action to reduce risk was to improve safety culture. Individual outcomes were often reported, but social/economic impact of incidents and organizational outcomes were rarely reported.

CONCLUSIONS

This review has demonstrated a complex picture of incident reporting in care homes with evidence limited to high-income countries, highlighting a significant knowledge gap. The findings emphasize the central role of nursing staff in reporting safety incidents and the lack of standardized reporting systems and processes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings from this study can inform the development or adaptation of safety incident reporting systems in care home settings, which is of relevance for nurses, care home managers, commissioners and regulators. This can help to improve patient care by identifying common safety issues across various types of care home and inform learning responses, which require further research.

IMPACT

This study addresses a gap in the literature on the systems and processes used to report safety incidents in care homes across many countries, and provides a comprehensive overview of safety issues identified via incident reporting.

REPORTING METHOD

PRISMA.

PATIENT OR PUBLIC CONTRIBUTION

A member of the research team is a patient and public representative, involved from study conception.

Using Mobile Technology to Assess Balance During a Sit-to-Stand Maneuver Among Older Adults With Fall Risk: A Pilot Study

Older adults age ≥65 are susceptible to balance impairment with subsequent reduced mobility and increased fall risk. Orthostatic hypotension or blood pressure drop with standing is a treatable condition associated with loss of balance and falls. To understand this phenomenon, the current project used an Android^® device attached to participants' center of mass to determine body sway during a simple sit-to-stand maneuver, while researchers assessed participants' sitting and standing blood pressure and symptomology of dizziness. Analysis of study data from two older adult participants are presented illustrating the applicability for future development of a measure to assess balance during simple movements. The next step in the authors' research trajectory is to analyze larger samples using other computations of data provided by the inertial measurement unit sensing technology. [Journal of Gerontological Nursing, 45(10), 18-23.].

Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals

Falls and injurious falls are a major safety concern for patient care in acute care hospitals. Inpatient falls and injurious falls can cause extra financial burden to patients, families, and healthcare facilities. This article provides clinical implications and recommendations for adult inpatient fall and injurious fall prevention through a brief review of factors associated with falls and injurious falls and current fall prevention practices in acute care hospitals.

Nursing Home Registered Nurses' and Licensed Practical Nurses' Knowledge of Causes of Falls

Reducing falls in nursing homes requires a knowledgeable nursing workforce. To test knowledge, 8 validated vignettes representing multifactorial fall causes were administered to 47 nurses from 3 nursing homes. Although licensed practical nurses scored higher than registered nurses in individual categories of falls, when we computed the average score of all 8 categories between groups of registered nurses and licensed practical nurses, registered nurses scored higher (F = 4.106; P < .05) in identifying 8 causal reasons for older adults to fall.

Orthostatic Hypotension in Older Nursing Home Residents Who Fall

Orthostatic hypotension (OH) and dizziness have been linked to older adult falls. As a treatable condition, the detection of OH is of clinical importance to falls prevention. Gaps in the literature about symptoms associated with OH among older adult fallers, such as dizziness led to this secondary analysis of blood pressure data and reported symptoms. Of the 194 Registered Nurse (RN) documented falls, most ( n = 91; 46.9%) failed to meet the prevailing diagnostic criteria for OH; 18 (9.2%) met criteria; and 8 (4%) nearly met the OH criteria. OH determinations were incomplete or absent in 41% ( n = 77). Of the 18 residents with OH, none reported dizziness, instead half reported loss of balance. We conclude, older residents did not report symptoms of dizziness prior to OH drops in blood pressure and falls. Further study is warranted to identify other predictive symptoms of OH and to evaluate nursing staff’s understanding of OH.