Implementation of a patient fall prevention program.

Falls among hospitalized patients are common occurrences and can have detrimental effects on patient outcomes. Identifying high-risk patients and taking measures to prevent patient falls have been successful. The purpose of this project was to decrease the fall rate in adult neuroscience patients. This was accomplished through implementation of a patient fall prevention program. Patients were assessed for risk factors associated with patient falls. Risk factors were identified through the use of the patient's history, nursing data base and patient classification system. Patients with identified risk factors were placed on fall precautions which included interventions specifically designed to prevent patient falls. This project resulted in a decrease in the number of patient falls and increased staff awareness of the risk factors associated with falls among adult neuroscience patients.     

Preventing falls in acute care: an innovative approach

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adults during an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, polypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.     

A student-led demonstration project on fall prevention in a long-term care facility

Falls are a frequent and serious problem facing people aged 65 and older. The incidence of falls increases with greater numbers of intrinsic and extrinsic risk factors and can be reduced by risk modification and targeted interventions. Falls account for 70% of accidental deaths in persons aged 75 and older. Mortality due to falls is significantly higher for older adults living in extended care facilities versus those living in the community. Our objective was to evaluate the effectiveness of a fall prevention training program in a long-term care setting. A single-group repeated-measure design was used, guided by the Precede-Proceed framework. A comprehensive review of the literature and a concept analysis guided the development of testing and educational materials for all nursing and ancillary facility staff. Preliminary testing provided baseline data on knowledge related to fall prevention. Pre- and posttests, a fall prevention newsletter, and informational brochures were distributed to nursing staff and ancillary personnel at training sessions. Certified nursing assistant (CNA) champions were identified and given peer leadership training. "Quick Tips" fall prevention badges were also distributed to staff. Graduate students led interdisciplinary environmental rounds weekly, and new falls were reviewed on a daily basis by the interdisciplinary team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall rates at baseline and for 2 months after the intervention were compared. Preliminary survey data revealed fall prevention learning opportunities, with a pretest mean score of 86.78%. Qualitative data were coded and revealed specific learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057) suggested that learning may have taken place; however, differences in scores did not reach statistical significance. The fall rate before training was 16.1%; 30-day posttraining fall rate was 12.3%, and 60-day postintervention fall rate was 9%. Based on the program results, the model was expanded from long-term care to the university hospital system and outpatient clinics in the same community. The collaboration between a school of nursing and 1 long-term care facility led to the adoption of a significant quality improvement program that was subsequently extended to a local hospital and clinic system. Student-led projects designed to teach community service learning can be meaningful and can lead to changes in patient safety and quality of care.     

医疗失效模式与效应分析在预防社区脑卒中跌倒中的应用

[目的]运用医疗失效模式与效应分析(HFMEA)方法对社区防跌倒管理流程进行改进并实施,以有效规避脑卒中患者跌倒高危因素,降低脑卒中患者跌倒发生率。[方法]选取2016年1-12月静安区某社区卫生服务中心管理的脑卒中患者163名。首先,进行脑卒中患者跌倒风险调查,了解跌倒发生情况,并进行多因素分析筛选跌倒高危因素;然后,采用HFMEA 方法,将上述调查对象随机分为二组,实施6个月干预,并对二组脑卒中患者首次入户随访时间、跌倒风险因素及跌倒次数进行评价。[结果]调查对象一年内跌倒发生率为31.29%,行走辅助用具、视力对日常的影响、对外界反应能力、脚无力是跌倒的独立危险因素,见表3。二组在首次入户干预时间、跌倒风险评估总分、跌倒次数方面存在显著差异 (P<0.05),见表4。[结论]运用医疗失效模式与效应分析(HFMEA)方法改进并实施社区防跌倒管理流程和控制方案,可降低跌倒风险,减少跌倒发生。     

Development,implementation, and evaluation of a comprehensive fall risk program

Purpose. The purpose was to develop and implement I'M SAFE, a comprehensive patient fall‐risk assessment tool linked to a tiered‐intervention falls prevention program. Design and Method. A fall‐risk evaluation tool was incorporated into electronic nurse documentation along with risk‐specific nursing interventions. Results. Intrinsic fall rates declined significantly (preimplementation: .67 falls/1,000 patient days; postimplementation: .51 falls/1,000 patient days, p= .015) and has been sustained 2 years following implementation. Practice Implications. The I'M SAFE tool identifies patients at increased risk for falls. When linked to a multidisciplinary fall prevention program, the incidence of preventable falls can be reduced. The program's impact has persisted across two facilities.     

Prospective study of fall risk assessment among institutionalized elderly in Japan

Abstract The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long-term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long-term care facilities and nursing homes was nurses' prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long-term care facilities, history of falls (odds 3.68, 95CI: 1.47–9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48–6.64) showed significance on adjusted-odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.     

Outcomes of a consult fall prevention screening clinic

OBJECTIVE: To report patient satisfaction and quality outcomes from a standardized, multicenter fall prevention screening clinic. DESIGN: Referrals were made to the fall prevention screening clinic, which was staffed by a physician, pharmacist, therapist, nurse, and the site coordinator. The fall prevention screening clinic staff utilized a team-meeting format with clearly delineated management options to determine the appropriate interventions based on various screening examinations. RESULTS: Primary care providers acknowledged pharmacy recommendations and >80% of the recommendations were followed. There was a reduction in reported falls (initial visit = 297 falls, follow-up visit = 141 falls, P = 0.0002) and in the number of recurrent fallers. There was a small (average difference = 1.8 secs) but significant (P = 0.025) decrease in the 8-foot Up-and-Go time, representing a functional improvement in walking speed. There was no significant change in the Fall Efficacy Scale, however. At least 80% of the patients reported that they were completely satisfied with their care. CONCLUSIONS: Patients who attended the fall prevention screening clinic demonstrated improved confidence during activities of daily living and reduced falls. They reported high satisfaction with the clinic format.     

住院精神病患者跌倒风险管理的效果观察

目的 ：探讨跌倒风险管理对预防住院精神病患者跌倒及减轻跌倒造成伤害的影响。方法 ：将2011年7月至2013年7月的4647例精神病患者作为观察组,运用跌倒风险管理理念和方法,并与作为对照组的2009年6月至2011年6月的4504例精神病患者进行比较。结果 ：两组患者跌倒Ⅰ级、Ⅱ级、Ⅲ级伤害程度、无伤害跌倒事件上报率、跌倒风险管理依从性比较,差异有统计学意义;两组跌倒发生率比较,差异无统计学意义;观察组无护理投诉及护理纠纷,对照组有1例因为跌倒引起纠纷,通过经济赔偿解决。结论 ：对住院精神病患者进行跌倒风险管理,既可提高护理人员的质量意识、风险意识及防范跌倒风险的能力,又能促进患者参与预防跌倒管理,有效降低和减轻跌倒造成的严重伤害,提高护理质量,保障患者安全。     

Effectiveness of an automatic manual wheelchair braking system in the prevention of falls

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t (18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.     

对中高危跌倒患者应用护理专案管理的效果观察

目的 探讨对中高危跌倒患者实施护理专案管理的应用效果.方法 成立护理专案小组,采用方便抽样法选取2020年5月—2021年5月厦门市某三级专科医院心内科80名中高危跌倒患者为研究对象,将2020年5月1—15日40例中高危跌倒患者作为对照组,实施常规预防跌倒知识宣教.将2021年5月1—15日40例中高危跌倒患者作为观...     

社区中危以上跌倒风险老年人护理干预效果的评价

目的探讨护理干预在预防社区中危以上跌倒风险老年人跌倒中的应用方法及效果。方法 2015年1-12月,采用便利抽样法选取上海市南码头街道某居委中危以上跌倒风险的老年人100例为研究对象,实施入户跌倒危险因素分析与个性化护理干预措施,采用老年人跌倒风险评估量表、跌倒预防知-信-行问卷及跌倒居家环境危险因素评估表对干预效果进行调查。结果干预后,社区中危以上跌倒风险老年人的跌倒发生率及跌倒风险评分低于干预前、跌倒预防知-信-行评分高于干预前、跌倒环境危险因素评分低于干预前,差异均有统计学意义(均P0.05)。结论个性化的跌倒危险因素分析与护理干预可以提高社区中危以上跌倒风险老年人的跌倒预防知-信-行,减少环境危险因素,有效预防跌倒的发生。     

The development of the RISK tool for fall prevention

The authors tailored a 26-item risk assessment tool (RAT) for falls based on a literature review and an analysis of causative factors of falls that had occurred over a 3-month period at the Olin E. Teague VA Medical Center, an 1,100-bed acute medical-surgical, psychiatric, and extended care facility in Temple, TX. The RAT was completed by nursing staff on 10 patient units (four medical, four surgical, and two nursing home units) for all admissions during the period. A 25% sample of the completed RATs was randomly selected (n = 208). Pearson's correlation coefficient was used to identify factors that would most likely predict falls from the RATs of the randomly selected group and of the patients who fell (n = 78). Only 4 of the 26 items were statistically related to falls. Based on findings from this study, the RAT was shortened to the four items and called the RISK (Reassessment Is Safe "Kare") tool.     

老年脑血管病跌倒患者平衡与步态的评定分析及护理对策

目的 了解并分析老年脑血管病跌倒患者的平衡能力，提出针对性的护理措施，指导临床预防跌倒，保证护理安全。方法对52例老年脑血管病患者进行跌倒情况调查，采用Tinetti平衡与步态评定量表评定其平衡与步态，寻找跌倒发生与平衡能力各因素之间的关系。结果有87．6％的老年脑血管病患者平衡及步态两者相加总分〈19分，显示有跌倒的危险，即刻站立平衡、转立平衡、胸部轻推反应、闭眼站立平衡不能很好完成者居多。其中在即刻站立平衡、转立平衡上跌倒≥3次者比跌倒1次者下降明显，有显著差异（P〈0．05）。结论老年脑血管病患者在即刻站立及转立时容易发生多次跌倒，该两方面是护理人员预防工作的重点。详细观察老人平衡功能和步态，可为采取护理措施提供良好的依据。     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part II

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I (LCM, Nov-Dec 2001) discussed the background and process of a falls program and factors contributing to the occurrence of falls. This month we examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls are also detailed.     

集束化护理在老年住院健康体检者跌倒防范中的应用效果

目的探讨集束化护理在老年住院健康体检者跌倒防范中的应用效果。方法 2014年1月至2015年1月,便利抽样法选取在解放军总医院国宾三科住院老年健康体检者717例为研究对象。按随机数字表法将其分为观察组(n=354)和对照组(n=363)。观察组体检者采用集束化护理,对照组采用常规护理,比较两组患者防跌倒知识掌握情况和跌倒发生率。结果入院时,两组体检者防跌倒知识的合格率分别为4.96%和4.80%,差异无统计学意义(P0.05)。出院时,观察组体检者防跌倒知识的合格率明显高于对照组,且跌倒发生率低于对照组,差异均有统计学意义(均P0.05)。结论集束化护理是提高老年住院健康体检者防跌倒知识水平和减少跌倒行之有效的措施。     

品质管理在职业陪护预防跌倒中的应用及效果观察

目的探讨在医疗护理活动中运用品管圈(Quality Control Circles,QCC)工具对提高医院护理质量管理的效果。方法回顾性分析2015年7~12月本科收治的205例患者,通过运用跌倒评分量表和筛查量表对其进行跌倒高危筛查,其中属于跌倒高危人员80例,将其随机分为观察组和对照组,对照组采用常规护理,观察组在常规护理的基础上运用QCC管理办法进行护理质量管理。结果两组护理质量均控制在安全范围内无跌倒事件发生,但观察组通过为期6个月QCC活动后,在陪护的照护技能、跌倒预防相关知识和措施、高危标示的识别及与患者的有效沟通、低年资护士对跌倒的筛查、动态评估及管理等方面明显高于对照组。结论通过在职业陪护预防跌倒中开展QCC,能有效调动工作人员积极性,增强其自信心,有效提升科室质量,提高患者和家属的满意度,最终实现"优质护理"目标。     

集束化管理策略联合分级预防措施预防贫血患者跌倒的效果观察

目的 探讨集束化管理策略联合分级预防措施预防血液内科贫血患者跌倒的效果。方法 选取2016年1~12月住院的贫血患者作为观察组,选取2015年1~12月住院的贫血患者作为对照组。对照组按照常规进行风险评估及预防跌倒的健康教育,落实预防跌倒的护理措施。观察组在对照组的基础上实施集束化管理策略联合分级预防。比较2组患者跌倒率、高风险跌倒上报率。结果 患者跌倒率由0.265次/(1 000患者·d)降至0.029次/(1 000患者·d),跌倒高风险上报率由0.716次/(1 000患者·d)升至2.488次/(1 000患者·d)。结论 集束化管理策略联合分级预防能实现血液内科贫血患者预防跌倒的高效管理,能有效筛选出贫血患者中的跌倒高风险人群,降低其跌倒率,保障患者的安全。     

Effectiveness of an Automatic Manual Wheelchair Braking System in the Prevention of Falls

The purpose of this study was to evaluate the effectiveness of an automatic manual wheelchair braking system in the reduction of falls for patients at high risk of falls while transferring to and from a manual wheelchair. The study design was a normative survey carried out through the use of a written questionnaire sent to 60 skilled nursing facilities to collect data from the medical charts, which identified patients at high risk for falls who used an automatic wheelchair braking system. The facilities participating in the study identified a frequency of falls of high-risk patients while transferring to and from the wheelchair ranging from 2 to 10 per year, with a median fall rate per facility of 4 falls. One year after the installation of the automatic wheelchair braking system, participating facilities demonstrated a reduction of zero to three falls during transfers by high-risk patients, with a median fall rate of zero falls. This represents a statistically significant reduction of 78% in the fall rate of high-risk patients while transferring to and from the wheelchair, t(18) = 6.39, p < .0001. Incident reports of falls to and from manual wheelchairs were reviewed retrospectively for a 1-year period. This study suggests that high-risk fallers transferring to or from manual wheelchairs sustained significantly fewer falls when the Steddy Mate automatic braking system for manual wheelchairs was installed. The application of the automatic braking system allows clients, families/caregivers, and facility personnel an increased safety factor for the reduction of falls from the wheelchair.     

养老院护士及护理员对老年人跌倒相关因素认知情况调查研究

目的:了解养老院中护士与护理员对老人跌倒各种因素认识程度,从管理的角度增加相关人员知识的培训,完善相关管理制度,减少老年人跌倒的发生。方法:采用自设调查问卷,对养老院中护士和护理员分别进行问卷调查。结果:其在跌倒的相关因素方面有一定的认识,在疾病因素、护理因素、环境因素、危害因素方面,护士和护理员认知程度有统计学差异(P0.01)。结论:护士、护理员对老人年跌倒相关因素均有一定认识;护理员较护士对老年人跌倒相关知识少,对老年人跌倒的疾病因素、护理因素、环境因素、危害因素等方面认识不足。     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part I

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I discusses the background and process of a falls program and factors contributing to the occurrence of falls. Part II will examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls will be detailed in Part II.