Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals (original) (raw)
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Barriers of Fall Risk Assessment and Prevention Implementation in Hospital Setting
2018
Falls are the most worrying incidence of patient safety concern that have an impact on injury and death. 1.9 to 3 percent of patients fall in the hospital, with injuries in 6 to 44 percent. Hospitals are making efforts to reduce those fall rates, but its implementation are hindered by a variety of barriers. This study aims to identify the barriers of fall risk assessment and prevention in the hospital. The research method is systematic review using PRISMA, with 15 included studies. Identified barriers includes insufficient knowledge, lack of motivation, absence of champion, lack of resources, inadequate communication, unsustainable program, and support and access shortage. To successfully implement fall prevention programs in hospitals requires a multifaceted, planned approach that includes: regular education and training for staff and patients; provision of equipment; audit, reminders and feedback; leadership and champions; simple programs; and a framework and time for adaptation i...
Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness, 2013
ObjectivesTo systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals.To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals.DesignSystematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011.Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011.SettingU.S. acute care hospitals.U.S. acute care hospitals.ParticipantsStudies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies).Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies).InterventionFall prevention interventions.Fall prevention interventions.MeasurementsIncidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details.Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details.ResultsFifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR.Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR.ConclusionPromising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.
Fall prevention in acute care hospitals: a randomized trial
JAMA : the journal of the American Medical Association, 2010
Context-Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls.
Inpatient Fall Prevention Programs as a Patient Safety Strategy
Annals of Internal Medicine, 2013
OBJECTIVES: To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U.S. acute care hospitals. DESIGN: Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. SETTING: U.S. acute care hospitals. PARTICIPANTS: Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies).
BMJ Open, 2021
Introduction Falls are the most common type of safety incident reported by acute hospitals and can cause both physical (eg, hip fractures) and non-physical harm (eg, reduced confidence) to patients. It is recommended that, in order to prevent falls in hospital, patients should receive a multifactorial falls risk assessment and be provided with a multifactorial intervention, tailored to address the patient’s identified individual risk factors. It is estimated that such an approach could reduce the incidence of inpatient falls by 25%–30% and reduce the annual cost of falls by up to 25%. However, there is substantial unexplained variation between hospitals in the number and type of assessments undertaken and interventions implemented. Methods and analysis A realist review will be undertaken to construct and test programme theories regarding (1) what supports and constrains the implementation of multifactorial falls risk assessment and tailored multifactorial falls prevention interventi...
BMC health services research, 2006
Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time. This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. A total of 34,972 hospitalized patients (mean age: 67.3, SD +/- 19.3 years; female 53.6%, mean length o...
Getting to Zero: Creating an Infrastructure to Support Fall Prevention in a Medical–Surgical Unit
2019
Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a welldeveloped falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital's departments. Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the hospital consider falls and fallrelated injuries to be a top priority and therefore support the implementation for a cost-effective plan to improve clinical, quality, and fiscal outcomes. Intervention: A unit based Clinical Nurse Leader (CNL) led the team to achieve the unit goal of a 20% reduction in falls by the end of the performance year 2019 utilizing improvement activities to foster the development of both a nursing and patient-centered approach. The primary intervention included the formation of a long-term Fall Prevention Safety Committee (FPSC) to develop, oversee and test a new and multifaceted intervention (or change package) consisting of several best practices. The re-introduction of a well-organized, committed fall prevention team was implemented to enhance the organizational infrastructure and oversight of unit-based fall prevention initiatives. Measures: To evaluate the effectiveness of the FPSC and the change package, three "metrics that matter" were assessed including a quarterly patient and team satisfaction survey, monthly fall rates and an annual analysis of the MST fall rate. These metrics will continue to be INFRASTRUCTURE: SUPPORTING FALL PREVENTION 3 monitored and compared with benchmarks and baseline data in order to assess progress toward a yearly reduction of 20% in fall rates. Results: Implementation testing has been ongoing since June 03, 2019. Based on the preliminary data, the FPSC help reduced the rates of falls during the initial stage of the implementation testing through a collaborative team effort to identify problem areas and implement solutions. Only one fall event has occurred since the test of change began over 8 weeks. The change package significantly impacted the knowledge and behaviors of the staff, patients and their families, thus resulting in heightened awareness and engagement about fall prevention. The result is limited at this time; however, the change is clinically relevant and continues to trend downward. Conclusion: Improving the identification of at-risk patients and decreasing falls is a complex process in the acute care setting. Lack of sustainable organization infrastructure contributes to inconsistent monitoring and interventions to ensure patient safety and decrease fall rates. Unitbased interprofessional teams that are highly motivated and well organized can significantly decrease fall rates through proactive approaches to anticipate risk and implement change strategies.
BMC health services research, 2017
When tested in a randomized controlled trial (RCT) of 31,411 patients, the nurse-led 6-PACK falls prevention program did not reduce falls. Poor implementation fidelity (i.e., program not implemented as intended) may explain this result. Despite repeated calls for the examination of implementation fidelity as an essential component of evaluating interventions designed to improve the delivery of care, it has been neglected in prior falls prevention studies. This study examined implementation fidelity of the 6-PACK program during a large multi-site RCT. Based on the 6-PACK implementation framework and intervention description, implementation fidelity was examined by quantifying adherence to program components and organizational support. Adherence indicators were: 1) falls-risk tool completion; and for patients classified as high-risk, provision of 2) a 'Falls alert' sign; and 3) at least one additional 6-PACK intervention. Organizational support indicators were: 1) provision of...