Certain subgroups of patients have been identified at higher risk because of the inherent characteristics of their disease process or treatment modalities. Agostini, Baker, and Bogardus conducted a review of the literature related to fall prevention for hospitalized and institutionalized older adults. Clinics such as these provide focused intervention planning for patients identified at risk for falling, but the success of such clinics is contingent upon accurate identification of high-risk patients. In the community, all patients older than 65 years should be screened, and in the home care, acute care, and long-term care settings, patients of all ages should be screened. A recent systematic review by Scott and colleagues examined fall risk assessment instruments in the community. Falls and Related Injuries in the Acute and Long-Term Care Settings Fall and related injury prevention is a major focus for both acute and long-term health care organizations. Bakarich, McMillan, and Prosser examined the impact of a toileting regimen for elderly confused patients with mobility problems in the acute care units of a large metropolitan teaching hospital.
Increase in falls reported by 12. Goal 3 Improve the safety of using medications. Mayo and colleagues conducted a randomized controlled trial to examine if armbands would help identify high-risk patients in a rehabilitation unit and prevent falls in the high-risk group. The overarching goal of these studies is to evaluate the ability of comprehensive risk assessment followed by targeted interventions to prevent future falls and fall-related injuries. According to Graf, factors associated with pediatric falls include 1 seizure medication odds ratio 4. Slips: 58 percent reduction in slips; hazard ratio 0. They examined 200 studies related to identification of predictors, risk assessment instrument development and testing, and fall- and injury-prevention interventions.
Falls in the acute and long-term care settings have several possible consequences. The researchers found that the residents with the history of falls were at highest risk for falls, which is consistent with other research in this domain, but might be useful to tailor interventions and would warrant prospective evaluation. The risk for medications or physiologic factors to precipitate injuries related to bleeding have been explored on a limited basis in the inpatient population. Although fall-prediction research has been performed for two decades, it is clear that fall prevention is a complex problem that cannot be solved by risk assessment alone, hence the dissatisfaction with available risk assessment instruments. Although less than 1 percent of inpatient falls result in death, this translates to approximately 11,000 fatal falls in the hospital environment per year nationwide. This research suggests that activities differ between older African American women and their Caucasian counterparts and should be considered when making fall- and injury-prevention plans. Reports on the outcomes of fall- and injury-prevention research using experimental or quasi-experimental research design is summarized in tables at the end of the chapter.
Do you know what the National Patient Safety Goals are and how they might affect patient care? However, multimodal interventions are not in place across primary care areas, which hinders their potential efficacy, and the aging community would likely benefit from large-scale implementation of these proven preventive interventions. See for individual study results. Other research examining multimodal interventions have had mixed outcomes. Semin-Goossens, van der Helm, and Bossuyt evaluated the effect of a guideline with semistructured interventions and found that fall rates in high-risk neurology and medical patients were not reduced. Hit enter to expand a main menu option Health, Benefits, etc. An associated intervention, a movement detector, has recently been developed.
. Patients in rehabilitation units are also at higher risk, likely because they have suffered neurological injuries such as stroke or head injury, which precipitate muscle weakness, impaired cognition, and impulsivity. On the other hand, vitamin D supplementation may be integral in preventing falls themselves: Recently, Latham and colleagues , demonstrated that vitamin D intake is an individual predictor for fall reduction, primarily by improving muscle strength. However, further research is required to validate such screening and to examine which interventions are effective based on risk status. Some studies have found increased age to be a risk factor, , but others have found that increased age is not a factor in acute care. Automated risk assessment in the community setting To date, a limited number of computer-based, community-based fall assessment instruments have been described. Evans and colleagues, via the Joanna Briggs Institute, performed a systematic review of the evidence up to 1997 for fall and injury prevention in the acute care setting.
Falls and balance clinics present a promising community-based solution to the problem of falls. Although early work found that hip protectors were effective in reducing hip fractures in the frail or osteoporitic elderly, more recent work indicates that compliance with using hip protectors is difficult to maintain, making recommendation for hip protector use conditional. Cardiovascular causes of falls derive predominantly from neurally mediated disorders e. Hip protectors have been evaluated in the long-term care environment since the early 1990s. Although the results of multimodal studies are conflicting, it is important to note that none of the studies of multimodal interventions—whether effective or ineffective results—controlled for staffing ratios or skill mix. Our goal is the nationwide reduction and prevention of inadvertent harm to patients as a result of their care.
In effect, this research used history of fall as a method to triage high-risk patients, who then received a comprehensive risk assessment with targeted interventions. A more recent development in the long-term care setting, the Nursing Home Quality Initiative, promotes the collection of a list of enhanced quality indicators, including those that track declines in functional and cognitive status. Agostini 2001 Fall and injury prevention in the acute care setting Review Design: Review Outcomes: Fall rates Setting: Acute care Population: Patients in acute care setting Multiple interventions; two studies and one systematic review reviewed Falls: Interventions with potential to decrease falls include identification bracelets, bed alarms, special flooring, and hip protectors. A number of researchers are exploring the relationship between nurse-to-patient staffing ratios and an increase in the incidence of falls. However, they did not adequately compare the psychometric properties of the instruments in question; rather they evaluated research related to the implementation of such instruments, which was relatively weak up to that time.
The patient is instructed to call for assistance when needed. However, most of these studies have been carried out in the community and long-term care environments, with few randomized controlled trials evaluating fall- and injury-prevention measures in the acute care setting. These researchers found that half of the patients were on thrombotic therapy and that the incidence of fall-related intracranial hemorrhage was low, even in persons taking warfarin. Therefore, prevention and control strategies must be tailored to the specific needs of each hospital based on its risk assessment. More recently, Oliver and colleagues have performed a meta-analysis of fall- and injury-prevention strategies and found a decrease in fall rates with multimodal intervention and a decrease in hip fractures with hip protectors in the long-term care setting. Despite widespread use, only one study from 1993 has examined bed alarms.