In-patient falls: what can we learn from incident reports?
ABSTRACT Background: a previous analysis of 12 months data from the National Reporting and Learning System offered useful insights on contributory factors for patient falls but was limited due to the small data set of free-text analysis (n = 400). A subsequent pilot study of 4,571 reports found an apparent difference in the contributory factors for patients described as having cognitive and physical impairments.
to analyse 3 years national incident data (2005-08) to further explore the contributory factors of in-patient falls.
a total of 20,036 reports (15% sample) were analysed by coding the free-text data field. Contributory risk factors were compared with the whole sample and explored with the Chi-squared and Fisher's exact tests.
data were reported about the degree of harm (100% of reports), (un)witnessed status of fall (78%), location (47%), patient activity (27%), physical impairment/frailty (9.5%) and cognitive impairment/confusion (9.2%). Less than 0.1% of reports provided data about dizziness, illness, vision/hearing, and medicines. Overall, patients were more likely to be harmed when away from the bed space, mobilising/walking and by falling from the bed when not intending to leave the bed.
this analysis explored incident reports at a level of detail not previously achieved. It identifies significant contributory factors for fall locations and activities associated with physical and cognitive characteristics.
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ABSTRACT: delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention. to assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly. a systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ(2) and I(2) tests. a total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63-0.85, P < 0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P = 0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well. multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: email@example.com.Age and Ageing 11/2014; DOI:10.1093/ageing/afu173 · 3.11 Impact Factor