Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?

Nursing Informatics & Research, Clinical Informatics Research & Development, Partners HealthCare, 93 Worcester St, Wellesley, MA 02481, USA.
The Journal of nursing administration (Impact Factor: 1.27). 07/2009; 39(6):299-304. DOI: 10.1097/NNA.0b013e3181a7788a
Source: PubMed


Obtain the views of nurses and assistants as to why patients in acute care hospitals fall.
Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.
Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis.
Positive and negative components of 6 concepts-patient report, information access, signage, environment, teamwork, and involving patient/family-formed 2 core categories: knowledge/ communication and capability/actions that are facilitators or barriers, respectively, to preventing falls.
Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.

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    • "The Joint Commission emphasized that the process of establishing a comprehensive fall-reduction program must involve much more than connecting causes to cures. It was stated that any fall prevention interventions should be acknowledged and accepted by the nurses who work at the bedside to ensure successful implementation and improved outcomes [1]. Individual risk factors for falls are either intrinsic or extrinsic to the care recipient system. "
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    ABSTRACT: Background: Patient falls in hospitals are common and affect approximately 2% to 17% of patients during their hospital stay. Patient falls are a nursingsensitive quality indicator in the delivery of inpatient services. Objective: To assess the effect of educational training program on nurses’ knowledge and performance regarding prevention of fall at one of the health insurance organization hospitals in Alexandria. Setting: The study was conducted at 284 bed general hospital affiliated with the Health Insurance Organization in Alexandria. Design: A quasi-experimental design was followed. Participants: The study sample included all nurses of different ranks working at four departments namely, orthopedic, medical, surgical, ICU unit. Results: There was a significant difference regarding all factors under study before and after the educational programme except for two individual factors, old age (p = 0.84), overall poor health status (p = 0.38), and two health factors, uses aids (p = 0.50), treatment by heparin (p = 1.00), and two environmental factors, poor lighting (p = 0.34), loose cords or wires (p = 0.30) and bells (p = 0.30), and one miscellaneous factor, patient education (p = 0.85) and tidy environment(p = 0.85). All departments showed posttest performance improvement, the total performance median for departments regarding environmental factor (p = 0.04) and health education (p = 0.001). Conclusion: Education programmes should be regularly, updated in view of changing knowledge and work practices.
    Open Journal of Nursing 12/2012; 2:358-364. DOI:10.4236/ojn.2012.24053
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    • "One of the patients' major safety concerns during their hospital stay was lack of availability of nurses to help when needed. In a qualitative study to understand why hospitalized patients fall in acute care hospitals, nurses and assistants expressed that having nursing staff work together to rapidly answer call lights is essential to preventing patient falls [10]. A common assumption is that a quick response by a nurse to a call light paired with fewer unmet patient needs translates to less opportunity for a patient to fall [11-14]. "
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    ABSTRACT: Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs), percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063). Hierarchical multiple regression analyses were used. Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider strategizing fall and injurious fall prevention efforts by aiming for a decrease in staff response time to call lights. Monitoring call light response time on a regular basis is recommended and could be incorporated into evidence-based practice guidelines for fall prevention.
    BMC Health Services Research 03/2012; 12(1):84. DOI:10.1186/1472-6963-12-84 · 1.71 Impact Factor
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    • "Educational methods to promote patient self management such as written , verbal, and video materials are provided to the patient and their family. However, the communication of important information is not always relayed to all necessary parties and this communication break down may lead to serious adverse events [6] [7]. Rudimentary methods have been adopted to make critical, information about the patient available at the bedside . "
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    ABSTRACT: Patients and health care providers often lack real time access to information at the bedside required to provide safe patient-centered care. Both groups identified pertinent information needed at the patient's bedside. The purpose of our research was to identify the essential data elements that will be used to define requirements for a useful bedside communication tool in the acute care hospital setting. Descriptive research methods were used to identify bedside information requirements through group and individual interviews. Data from patients and health care providers were analyzed to identify common themes, compiled into a survey, and validated by both groups. Thirty-seven information requirements were identified and classified under five themes: (1) plan of care, (2) patient education, (3) communication of safety alerts, (4) diet, and (5) medications. A survey completed by 30 patients and 30 health care providers confirmed 36 specific bedside information requirements (mean ≥ 5 on an 11-point scale). Patients and health providers each identified 24 specific information requirements that were similar in importance. When compared with nurses, significant differences were noted in the degree to which patients identified knowing the "daily routine schedule," e.g. when their doctor typically sees patients as a key requirement for the electronic bedside communication tool, t=3.52, p=.001. Patients and health care providers identified information requirements at the bedside to promote self-care management of healthcare needs and an understanding of the hospital environment. Accurate, easily accessed information at the bedside is needed for providing safe patient-centered care.
    International Journal of Medical Informatics 01/2012; 81(7):442-51. DOI:10.1016/j.ijmedinf.2011.12.005 · 2.00 Impact Factor
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