Preventing In-Patient Hospital Fall: Matrix and Appraisal of Evidence

Question (PICOT)

Do nursing interventions such as fall prevention kits, assisted trips to the bathroom, hospital orientation, and monitored medication versus patient restraints among in-patients, especially those aged 65 years old and above, reduce the number of falls and fall-related injuries during a hospital stay?

(Evidence Appraisal and Matrixomitted for preview. Available via download)

Appraisal of Evidence

The need to address in-patient falls is reiterated in all the studies. All the studies agree that falls among patients in hospitals and nursing care facilities cause injuries and death. The risk of falling and resulting injuries differ is different hospitals as evident from the study by Krauss et al. (2007). However, the study could not establish whether differences reflect true variations or the differences were as a result of varied reporting practices. Intervention methods in the studies differ from using a fall prevention fall kit, using pre-printed care plans to identify the risk of falling, and employing a multi-strategy approach such as staff education and risk screening. The outcomes across the studies reveal that appropriate intervention reduces the risk and number of falls among in-patients, especially among the elderly.

All the reports support the fact that falls are more common among inpatients, especially those aged 65 years old and above. However, according to Cameron et al. (2010), interventions targeting multiple risk factors are not effective in preventing falls but can be with the help of coordinated teams of staff.

A unique intervention method in the studies was the use of Vitamin D supplements to reduce falls in nursing care facilities. This intervention method, as suggested by a compilation of studies conducted by Cameron, et al. (2010) introduces the aspect of bone health among elderly patients. The intervention methods were studied on the basis that elderly people lacking Vitamin D have a higher risk of bone fractures, poor muscle strength, and poor strength and coordination. A deficiency, therefore, increases their chances of falling, and more serious injury-related injuries.

The use of technology to minimize falls also arises from the study by Dykes et al. (2010). The study, which utilizes Health Information Technology (HIT) and an FPTK introduces the use of integrated communication and workflow patterns to address patients’ determinants of fall risk at an individual level. Using FPTK software and fall risk assessment on each individual patient, a nurse can determine the patient’s fall risk. By attaching a bed poster with that information and the patient’s plan care, the nurses, doctors and other attendants are aware of how to help a patient and protect them from falling.

These studies, though informative, do not provide conclusive results and evidence of the best and most effective intervention methods to prevent falls, and most importantly, falls-related injuries. According to Healey, Monro, Cockram and Adams (2004), in their study on whether reduced target risk factors can prevent falls in older in-patients, introducing the care plan reduced the relative risk of falls, but there was no significant reduction in falls-related injuries. In Cameron, et al. (2010) analysis of different studies on the prevention of falls in nursing homes, the results testing intervention methods such as supervised exercise were inconsistent. Vitamin D supplementation reduced the rate of falls among patients, but there was no evidence that it reduced the risk of falling. Multi-factorial interventions, according to the studies, did not reduce the rate of falls among elderly patients.

Implementing a Change in Clinical Practice

The results from the studies support the use of intervention methods to reduce the rate of falls among in-patients, reduce the risk of fall and minimize fall-related injuries. According to the study by Fonda, Cook, Sandler and Bailey (2006), a multi-strategy invention program that involves work practice, equipment, and environmental changes, data gathering, and staff education, produces a significant reduction in number falls in aged care hospitals. Consequently, the number of fall-related injuries reduces. Education and policy changes in healthcare will be done to accommodate initiatives such as supervised exercise, assistance in the bathroom and care outside a patient’s room.

The team members for this project will be the staff nurses, unlicensed staff, physical therapists, occupational therapists, charge nurses, nurse managers, discharge coordinators, medical staff, and pharmacists. The available resources will be the nurse manager, the chief of nursing staff, risk management officer, and chief of medical staff. The intervention programs will also include patient education and discussions with them to establish what methods would work best for them. An analysis by a doctor will determine which patients require vitamin D and calcium supplements to boost their muscle and bone strength.

Change Strategy

Safety model

The Unit Specific Safety Model is a good model to improve patient safety and minimize in-patient falls. The model is based on the notion that every staff member has the same responsibility for patient safety. This model is based on the ABCD plan; the area around the patient, bathroom or toileting, comfort of the patient and desire for every staff to assist the patients.

(Plan and Evaluation Plan Chart omitted for preview. Available via download)

Resources

This plan will require educators and specialists to train the staff nurses, unlicensed staff, physical therapists, occupational therapists, charge nurses, nurse managers, discharge coordinators, medical staff, and pharmacists on the benefits of intervention programs to stop or minimize in-patient falls. It will also require collaboration with a college that offers medical safety programs to allow team the project team members to acquire certificates after successful training. The project also suggests the purchase of a fall prevention kit and software, using HIT to ensure that individual patient’s risk of falling is determined and personalized intervention methods are put in place.

Conclusion

Research and studies analyzed in this paper agree that in-patient falls are dangerous and can be prevented or minimized with the use of appropriate intervention methods. It is also important to note that “risk of falls increases markedly with age” (Dykes et al., 2010). Intervention methods include supervised bathroom and toileting activities, exercising, supplements to improve bone and muscle health, and use of technology to analyze the risk of falling for a patient, and possibly predict risky incidents. The first step towards implementing such intervention methods include education and training among relevant authorities and team members – in this case, staff nurses, unlicensed staff, physical therapist, occupational therapist, charge nurses, nurse manager, discharge coordinator, medical staff, and pharmacist – to help them understand the relevance and methods of intervention. Fall-related injuries can be devastating to patients, and according to Krauss et al. (2007) 42 percent of falls result in injury, and 8 percent of these are serious, and sometimes, fatal injuries. The most efficient way to minimize them is to prevent falls and this paper recommends how that can be achieved through a plan and evaluation process.

References

Cameron, I.D., Murray, G.R., Gillespie, L.D., Robertson, M.C., Hill, K.D., Cumming, R.G., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. Published by Wiley Online Library.

Dykes, P. C., Zuyov, L., Tsurikova, R., Meltzer, S., Chang, F., Benoit, A.,…...Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. JAMA: The Journal of the American Medical Association, 304(17), 1912-1918.

Fonda, D., Cook, J., Sandler, V., & Bailey, M. (2006). Sustained reduction in serious fall-related injuries in older people in hospital. The Medical Journal of Australia, 184(8): 379-382.

Healey, F., Monro, A., Cockram, A., & Adams, V. (2004). Using targeted risk factor reduction to prevent falls in older in-patients: a randomized controlled trial. Age and Ageing, 33(4), 390-395.

Krauss, M.J., Nguyen, S.L., Dunagan, C., Birge, S., Constatinou, E., Johnson, S., Fraser, V.J. (2007). Circumstances of Patient Falls and Injuries in 9 Hospitals in a Midwestern Healthcare System. Infection Control and Hospital Epidemiology, 28(5).