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Abstract
Objective: To evaluate the effectiveness of a patient education programme for preventing falls in the subacute hospital setting. Design: Randomized controlled trial, subgroup analysis. Participants: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a patient education intervention for the prevention of falls when enrolled in a larger randomized controlled trial of a falls prevention programme. Methods: Participants in both the control and intervention groups who were recommended for the education programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Only participants in the intervention group who were recommended for this intervention actually received it. In addition, these participants completed an evaluation survey at the completion of their education programme. Results: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However the difference in the proportion of fallers was not significant (relative risk 1.21, 95% confidence interval 0.68 to 2.14). Conclusion: Patient education is an important part of a multiple intervention falls prevention approach for the subacute hospital setting.
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Affiliation(s)
- Terry P Haines
- The University of Queensland and Princess Alexandra Hospital, Queensland, Australia.
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Kong QH, Wang Y, Song CG, Liu YS, Qin HY, Feng YD, Li YJ. Prospective analysis of the risk factors for falls in lymphoma patients. Eur J Oncol Nurs 2014; 18:540-4. [PMID: 24954769 DOI: 10.1016/j.ejon.2014.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 03/01/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore the risk factors for falls in lymphoma patients receiving chemotherapy. METHODS Lymphoma patients (203) who received chemotherapy were prospectively recruited and analyzed. Eligible participants were followed up by weekly telephone contact for 6 months or until the time of a fall or death. Risk factors for falling in lymphoma patients were identified using univariate regression analysis and multivariate binary logistic regression analysis. RESULTS Of the 203 cases, 13.3% (27 cases) had a fall during follow-up. Univariate regression analysis showed the following risk factors for falls in lymphoma patients: gender (P = 0.023), Eastern Cooperative Oncology Group (ECOG) performance status score (P < 0.0001), cancer stage (P < 0.0001), extranodal involvement (P = 0.041), serum lactate dehydrogenase (LDH) level (P < 0.0001), revised International Prognostic Index (R-IPI) (P < 0.0001), history of falls (P < 0.0001), gait (P < 0.0001), cognitive condition (P = 0.029) and intravenous catheter placement (P < 0.0001). Multivariate binary logistic regression analysis found four independent factors significantly associated with the risk of falling in lymphoma patients: female gender (P = 0.042), later stage (P = 0.021), R-IPI (P = 0.030), and intravenous catheter placement (P = 0.001). CONCLUSIONS Gender, stage, R-IPI, and intravenous catheter placement were independent risk factors for falls in patients with lymphoma. Lymphoma patients with these four risk factors should receive particular attention and fall prevention education to reduce the incidence of falls. The R-IPI may be a new predictor of falling in lymphoma patients and may aid in the management of falls.
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Affiliation(s)
- Qiu-Huan Kong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Chen-Ge Song
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yu-Shan Liu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Hui-Ying Qin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yan-Dan Feng
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Ya-Jun Li
- Department of Lymphoma and Hematology, Hunan Provincial Tumor Hospital, Changsha, Hunan, China; The Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, Hunan, China.
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Chaudhury H, Mahmood A, Valente M. The Effect of Environmental Design on Reducing Nursing Errors and Increasing Efficiency in Acute Care Settings. ENVIRONMENT AND BEHAVIOR 2009; 41:755-786. [DOI: 10.1177/0013916508330392] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Physical environment is an important component in the acute care setting that can affect nursing and medication accuracies, as any inadequacy in physical environment would contribute to staff fatigue, stress, and burnout and result in errors. The article discusses a study conducted involving an extensive review and analysis of the literature on this topic and focus groups with various categories of staff members at three hospitals. The review demonstrates that the following environmental variables can contribute to errors in acute care settings: noise levels, ergonomics/furniture/equipment, lighting, and design/layout. Focus groups address the role of the physical environment on medication ordering, storage, delivery, dispensation, preparation, administration, and possible design responses to reduce errors. Integrating the major issues identified and the key findings from the focus groups, four design-related principles are recommended: balance between patient accessibility and reduction of disruptions, automation, minimize staff fatigue, and promoting a culture of safety.
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Haines TP, Hill K, Walsh W, Osborne R. Design-Related Bias in Hospital Fall Risk Screening Tool Predictive Accuracy Evaluations: Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2007; 62:664-72. [PMID: 17595425 DOI: 10.1093/gerona/62.6.664] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice. METHODS A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies. RESULTS Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy. DISCUSSION Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.
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Affiliation(s)
- Terry P Haines
- Physiotherapy Department, GARU, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
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Schwendimann R, Milisen K, Bühler H, De Geest S. Fall Prevention in a Swiss Acute Care Hospital Setting: Reducing Multiple Falls. J Gerontol Nurs 2006; 32:13-22. [PMID: 16544453 DOI: 10.3928/00989134-20060301-04] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Preventing in-hospital falls is an important goal in avoiding poor patient outcomes. In this quasi-experimental study, the authors evaluated the effectiveness of a nurse-led fall prevention program in a 300-bed Swiss hospital. Four hundred and nine patients (internal medicine) were included: intervention group (n = 198), usual-care group (n = 211). The program consisted of training nurses in the use of the Morse Fall Scale, and the implementation of 15 selected preventive interventions. In the intervention group, the proportion of patients at risk for falls was higher (p = .048), and fewer patients with multiple falls were observed (p = .009). The intervention program showed an effect in preventing multiple falls, but not first falls. The prolonged mean time to a first fall in a subgroup of fallers in the intervention group may indicate an increased awareness of the nurses and the appropriateness of the interventions used.
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Affiliation(s)
- René Schwendimann
- Institute of Nursing Science, University of Basel, and Division of Clinical Nursing Science, University Hospital of Basel, Switzerland
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6
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McFarlane-Kolb H. Falls risk assessment, multitargeted interventions and the impact on hospital falls. Int J Nurs Pract 2004; 10:199-206. [PMID: 15461689 DOI: 10.1111/j.1440-172x.2004.00482.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There is an urgent need for inquiry to validate existing scales in the accurate assessment of falls risk. Moreover, where fall prevention projects have targeted specific risk factors of falling, such as cognitive impairment, few have measured the impact of their intervention on fall outcomes. A comparative design compared and described differences in falls data within and between two study cohorts before and after a multitargeted intervention was introduced. A cut-off score of > or = 50 using the Morse Scale was a good baseline indicator for accurate identification of fall risk and outcomes verify that the modified Morse Falls Scale, in combination with other risk factors, more accurately profiled fall risk among this population. Fall incidence among the intervention cohort did not increase significantly despite a rise in the number of hospital admissions and a significantly higher reported fall risk potential.
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Butler M, Kerse N, Coggan C. The experiences of staff concerning the introduction and impact of a fall prevention intervention in aged care facilities: a qualitative study. Australas J Ageing 2003. [DOI: 10.1111/j.1741-6612.2003.tb00503.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Westwood B, Westwood G. Falls in older persons in Australia: screening instruments for general practitioners. Australas J Ageing 2003. [DOI: 10.1111/j.1741-6612.2003.tb00487.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
There are numerous fall risk assessment tools developed for use by nurses in hospitals; however, few of them have established validity and reliability. This article will examine the current state of knowledge in regard to fall risk assessment tools through review and critique of the literature on the topic. Recommendations for future research on fall risk assessment tools will be made and a conceptual framework detailing the relationship between the variables involved in assessing the accuracy of fall risk assessment tools will be presented.
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Affiliation(s)
- Helen Myers
- Clinical Nurse (Research), Centre for Nursing Research, Sir Charles Gairdner Hospital, Western Australia.
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10
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Lohman H, Givens D. Balance and Falls with Elders. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 1999. [DOI: 10.1080/j148v16n01_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rawsky E. Review of the literature on falls among the elderly. IMAGE--THE JOURNAL OF NURSING SCHOLARSHIP 1998; 30:47-52. [PMID: 9549941 DOI: 10.1111/j.1547-5069.1998.tb01235.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To review and summarize the literature from nursing, medical, and ancillary fields on falls among the elderly. Major injuries from falls are associated with mortality, especially among the elderly. Researchers indicate that, in many cases, falls can be prevented. A summary of the available literature provides information which can be used to plan interventions. ORGANIZING FRAMEWORK Over 100 publications, 1979-1996 related to falls by elderly were reviewed. Descriptive terms used for searching MEDLINE were falls, elderly, and accidents. Literature from several disciplines was reviewed. FINDINGS Fall risk can be predetermined and nursing actions can be taken to reduce the occurrence and severity of falls. CONCLUSIONS To reduce the deleterious effects of falls in the elderly, knowledge-based practice is essential.
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Affiliation(s)
- E Rawsky
- Internal Medicine Associates, Howell, Michigan, USA
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Abstract
Falls are among the most common, yet potentially preventable, adverse events experienced by patients in hospitals. Such serious outcomes as physical and emotional injury, increased dependence, admission to a long-term care facility, and poor quality of life can result from falling. Traditionally, elderly patients have been at highest risk for falling, with many falls resulting in serious injury. These injuries cost billions of dollars and expose hospitals and their staff to liability. As the elderly population continues to increase, it is imperative that falls and associated injuries be prevented whenever possible identification of nontraditional patients at high risk for falls is emerging in the professional literature. Nurses are the first line of care in prevention of falls. Educating nurses about risk factors, prevention strategies and application of fall index and fall injury statistics can improve the safety of fall-prone patients. Refining, modifying and individualizing fall risk factors and prevention interventions for traditional and nontraditional high-risk groups is a necessary focus for future research.
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Turkoski B, Pierce LL, Schreck S, Salter J, Radziewicz R, Guhde J, Brady R. Clinical nursing judgment related to reducing the incidence of falls by elderly patients. Rehabil Nurs 1997; 22:124-30. [PMID: 9171720 DOI: 10.1002/j.2048-7940.1997.tb02081.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The incidence of falls among elderly patients has been and continues to be a major challenge for nurses. Falls add physical injury and mental stress to patients' existing health problems, are a deterrent to rehabilitation, and increase healthcare costs. This study describes the variables that nurses identify as influencing their clinical decision making and the nursing behaviors associated with preventing patient falls. The study was grounded in the theory that discretionary nursing behaviors are related to nursing expertise, and the study was guided by the assumption that such behaviors are proactive and anticipatory. An analysis of interviews of registered nurses (n = 14) working on a geriatric rehabilitation unit in a medical center in Ohio focused on the zones of association and the contextual meanings of language used by the nurses when discussing patient falls. Four themes emerged: the reasons for patient falls, identifying patients who are likely to fall, preventing falls, and nurses' feelings when patients fall.
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Affiliation(s)
- B Turkoski
- Kent State University School of Nursing, OH 44240, USA
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15
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Protecting Confused Patients from Falls. Am J Nurs 1996. [DOI: 10.1097/00000446-199607000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Meddaugh DI, Friedenberg DL, Knisley R. Special socks for special people: falls in special care units. Geriatr Nurs 1996; 17:24-6. [PMID: 8707140 DOI: 10.1016/s0197-4572(96)80009-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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