Selecting patients for falls-prevention protocols: an evidence-based approach on a geriatric rehabilitation unit

Developing a Unit-Specific Falls Reduction Program

Though an extensive amount of literature addresses the significance of patient falls and mechanisms to identify those at high risk, much less has been written regarding units in which nearly every patient fits the high-risk category. In addition, little information describes specific interventions designed to protect at-risk patients. In response to a record number of falls in the Transitional Care Unit at an acute care facility, an interdisciplinary team was developed to review patient falls, design a unit-specific falls reduction program, and begin its implementation. In the subsequent 6 quarters, the number of patient falls was reduced by 57%.

Evidence-based practice

Evidence-based practice (EBP) has been received with enthusiasm and interest by many nurses. It has, however, raised skepticism and negative reactions from others. This article seeks to address the place of EBP in care of the elderly by outlining EBP and providing some pertinent examples of how it can be used in caring for older people. Finally, it promotes EBP as a useful tool, provided its definition and implementation are broadened to reflect the science and art of nursing.

Medical comorbidity and rehabilitation efficiency in geriatric inpatients

OBJECTIVES

To measure and describe medical comorbidity in geriatric rehabilitation patients and investigate its relationship to rehabilitation efficiency.

DESIGN

Prospective, multivariate, within-subject design.

SETTING

The Geriatric Rehabilitation inpatient unit of the SCO Health Service in Ottawa, Canada.

PARTICIPANTS

One hundred ten patients, with a mean age of 82 years.

MEASUREMENTS

The rehabilitation efficiency ratio, based on gains in functional status achieved with rehabilitation treatment, and the length of stay were computed for all patients. Values were regressed on the scores of the Cumulative Illness Rating Scale (CIRS), the Mini-Mental State Examination, and the Geriatric Depression Scale to establish predictive power.

RESULTS

The findings suggest that geriatric rehabilitation patients experience considerable medical comorbidity. Sixty percent of patients had impairments across six of the 13 dimensions of the CIRS, whereas 36% of patients had impairments across 11 of the 13 dimensions. In addition, medical comorbidity was negatively related to rehabilitation efficiency. This relationship was significant even after controlling for age, cognitive status, depressive symptoms, and functional independence status at admission.

CONCLUSION

Medical comorbidity was a significant predictor of rehabilitation efficiency in geriatric patients. Comorbidity scores >5 were prognostic of poorer rehabilitation outcomes and can serve as an empirical guide in estimating a patient's suitability for rehabilitation. Medical comorbidity predicted both the overall functional change achieved with retabilitation (Functional Independence Measure gains) and the rate at with which those gains were reached (rehabilitation efficiency ratio).