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Rahimi S, Khankeh HR, Ebadi A, Mohammadian B, Eghbali M, habibzadeh F. Developing a fall prevention program in an inpatient spinal cord injury rehabilitation unit: A participatory action research study. PLoS One 2024; 19:e0304320. [PMID: 38985738 PMCID: PMC11236094 DOI: 10.1371/journal.pone.0304320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/10/2024] [Indexed: 07/12/2024] Open
Abstract
IMPORTANCE Spinal cord injury is a lifelong disability necessitating early management of falls during inpatient admissions. However, there is a paucity of research on fall prevention and management in Spinal cord injury rehabilitation. OBJECTIVE(S) This study aimed at developing a fall prevention program in an inpatient rehabilitation Spinal cord injury unit. METHOD A participatory action research approach utilizing a before-and-after, mixed-method design was employed for this study. The study was performed at Rofaydeh Rehabilitation Hospital in Tehran, Iran, from 2021 to 2022. the study implemented Cohen's four-stage model, encompassing the design of a change program, action, observation and evaluation, and feedback stages. A purposeful sampling method was utilized to select 19 nurses and members of the rehabilitation team from the hospital, ensuring maximum diversity. Data collection involved semi-structured interviews, focus groups, and a checklist for fall prevention measures. Qualitative content analysis, alongside descriptive (frequency, mean, and standard deviation) and inferential statistics (paired t-tests and Chi-square tests), were employed for data analysis. The study adhered to COREQ guidelines. RESULTS Falls were most common among patients aged fifty years or older (P = 0.026). Throughout the study period, men were more likely to experience falls than women (P = 0.01). Preventive interventions have led to significant improvements in indicators of patient monitoring and care, patient education, and environmental safety, as demonstrated by a paired-sample t-test (P<0.001). Moreover, factors contributing to patients' falls included "shortcomings in fall prevention policies" and "lack of knowledge and participation among patients and caregivers." Changes implemented in the Spinal Cord Injury unit involved enhancing interprofessional interactions, conducting educational workshops for patients and their companions, and identifying high-risk patients. These findings indicate a significant decrease in the incidence of falls following the intervention (P = 0.02). CONCLUSIONS The study found that a multifaceted intervention can increase knowledge about fall risks and substantially reduce both falls and associated minor injuries.
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Affiliation(s)
- Shoeleh Rahimi
- PhD in Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, IR Iran
- Nurse of Javadalaimeh Hospital in Kharameh, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Teheran, Iran
| | - Batol Mohammadian
- Department of Operating Room, School of Allied Medical Sciences, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Eghbali
- Department of Nursing, school of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fatemeh habibzadeh
- MSC of Critical Care Nursing Tehran University of Medical Science, Tehran, Iran
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Sullivan R, Harding K, Skinner I, Hemsley B. Falls in Patients With Communication Disability Secondary to Stroke. Clin Nurs Res 2023; 32:478-489. [PMID: 36541748 DOI: 10.1177/10547738221144214] [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: 12/24/2022]
Abstract
Patients with stroke are at high risk of falls during inpatient rehabilitation admission. Communication disability is common following stroke; however, this population is often excluded from falls research. This study aimed to examine the falls of patients with communication disability following stroke, including the circumstances, contributing factors, and outcomes of the fall. This medical record review used the Generic Reference Model of patient safety as the analytical lens and data were analyzed descriptively. The study included 109 patients who experienced 308 falls. The most common type of fall was an "unwitnessed roll from bed." Patient factors contributed to half of all falls, injuries occurred in 15% of falls, and impacts to the hospital system included additional costs and staffing. Understanding the reasons why patients are attempting to get out of bed may identify ways to reduce the risk and incidence of falls in this population.
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Affiliation(s)
- Rebecca Sullivan
- University of Technology Sydney, Ultimo, NSW, Australia.,Eastern Health, Box Hill, VIC, Australia
| | - Katherine Harding
- Eastern Health, Box Hill, VIC, Australia.,La Trobe University, Bundoora, VIC, Australia
| | - Ian Skinner
- Charles Sturt University, Port Macquarie, NSW, Australia
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He S, Rolls K, Stott K, Shekhar R, Vueti V, Flowers K, Moseley M, Shepherd B, Mayahi-Neysi M, Chasle B, Warner B, Ni Chroinin D, Frost SA. Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis. Australas J Ageing 2022; 41:396-406. [PMID: 35257469 DOI: 10.1111/ajag.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients. METHODS A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels. RESULTS Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively. CONCLUSIONS The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.
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Affiliation(s)
- Steven He
- South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Kaye Rolls
- South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Katrina Stott
- Bankstown Lidcombe Hospital, New South Wales, Australia
| | - Rozina Shekhar
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Vaulina Vueti
- Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Kelli Flowers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | | | | | - Briony Chasle
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Bradley Warner
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Danielle Ni Chroinin
- Liverpool Hospital, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Steven A Frost
- South Western Sydney Nursing and Midwifery Research Alliance, Western Sydney University and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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Jewell VD, Capistran K, Flecky K, Qi Y, Fellman S. Prediction of Falls in Acute Care Using The Morse Fall Risk Scale. Occup Ther Health Care 2020; 34:307-319. [PMID: 32907452 DOI: 10.1080/07380577.2020.1815928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
The high number of patient falls occurring within acute care hospitals throughout the United States has led to increased patient impairment and contributed to rising healthcare costs. The Morse Fall Risk Scale is a commonly used assessment tool for prediction of a patient's potential for experiencing a fall while in a healthcare facility. This retrospective study reviewed the use of the Morse Fall Risk Scale in a 300+ bed acute care hospital setting to determine adequacy for patient fall predictions over a four-month period. Use of multivariate regressions and Chi-Square test statistics revealed the Morse Fall Risk Scale was a predictor of patients' fall risk in this setting with other significant predictors of fall risk potential including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions). Patients experiencing a fall had a statistically significant longer hospital stay. Occupational therapy practitioners play an important role on the interdisciplinary team by providing a comprehensive fall assessment, developing fall prevention programs, and providing discharge recommendations.
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Affiliation(s)
- Vanessa D Jewell
- Department of Occupational Therapy, Creighton University, Omaha, NE, USA
| | | | - Kathleen Flecky
- Department of Occupational Therapy, Creighton University, Omaha, NE, USA
| | - Yongyue Qi
- Department of Occupational Therapy, Creighton University, Omaha, NE, USA
| | - Sarah Fellman
- Department of Occupational Therapy, Creighton University, Omaha, NE, USA
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Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research. Rehabil Nurs 2020; 46:137-145. [PMID: 32195764 DOI: 10.1097/rnj.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada. DESIGN A modified version of the Stanford Biodesign Methodology was used. METHODS Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS. FINDINGS Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient's fall risk status was rarely discussed as a team. CONCLUSIONS The findings informed recommendations to improve the overall FPS at this IRF. CLINICAL RELEVANCE Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.
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Mathew L, Steigman D, Driscoll D, Moran-Peters JA, Fischer IM, Cordle P, Hyde VMB, Eckardt S. Making Fall Risk Assessment Clinically Relevant in an Adult Psychiatric Setting. J Psychosoc Nurs Ment Health Serv 2020; 58:21-26. [DOI: 10.3928/02793695-20191106-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/23/2019] [Indexed: 11/20/2022]
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Factors influencing fall prevention for patients with spinal cord injury from the perspectives of administrators in Canadian rehabilitation hospitals. BMC Health Serv Res 2019; 19:391. [PMID: 31208427 PMCID: PMC6580568 DOI: 10.1186/s12913-019-4233-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Fall prevention is a priority in Canadian tertiary rehabilitation hospitals. We aimed to understand the perspectives of hospital administrators on the challenges experienced when implementing fall prevention policies/procedures for patients with spinal cord injury (SCI) in tertiary rehabilitation hospitals. Methods Semi-structured interviews were conducted with 10 administrators employed in six Canadian tertiary rehabilitation hospitals. Guided by an interpretive description framework, interviews were analyzed using a constant comparison approach. Results Challenges with fall prevention experienced by administrators fell into the three categories: 1) fall prevention policy and procedural challenges (e.g. fall prevention policy not SCI-specific, expectation of zero falls, determining contributing factors, learning from falls, and overall effectiveness of the fall prevention policy), 2) clinician-related challenges (e.g. variable staff adherence with the organizations’ fall prevention procedures, inconsistent delivery of fall prevention education, and integrating individualized fall risks to guide clinical practice), and 3) patient-related challenges (e.g. balancing risk vs independence and rehabilitation progress, responsibility for fall prevention, and non-preventable falls). Conclusions Fall prevention policies/procedures required by the hospitals were insufficient for clinical practice in SCI rehabilitation. Electronic supplementary material The online version of this article (10.1186/s12913-019-4233-8) contains supplementary material, which is available to authorized users.
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