Patient falls: profile for prevention

Patient falls are common in the hospital or long-term care setting. In a large Southwestern teaching hospital, patient falls have been monitored on an ongoing basis. A multidisciplinary task force developed a method of identifying patient fall risk factors. A survey was used concurrently as falls were reported during the month of July. Forty-seven falls were reported. Of this sample, neurological patients accounted for 12 (25.5%) of the incidents. The neurological patient fall profile was identified as a high-risk profile, and interventions were taken to prevent falls in this group. A second data collection was conducted six months later with this population. While the number of patients on the neurological services remained constant, the incidence of falls decreased (25%). By using a comprehensive approach of data collection and assessment, education, and follow-up, the institution has decreased neurological patient falls.     

A collaborative occupational therapy and nursing approach to falls prevention in hospital inpatients

A retrospective audit of inpatient falls at the Gold Coast Hospital was conducted in August 1996. This collaborative approach of occupational therapy and nursing staff aimed to reduce the number of patients falling while they were hospital inpatients. From the first audit a number of high risk patient groups, activities and ward environments were identified and a falls prevention program implemented. A second audit conducted 2 years later demonstrated a decrease in falls and related injuries. This paper discusses the findings of the falls audit and presents the 'Fall STOP' falls prevention program that was initiated.     

An evidence-based approach to fall risk assessment, prevention, and management: lessons learned

Nurses at an academic medical institution undertook a fall safety initiative. Using an evidence-based approach, they created a risk stratification tool, developed a comprehensive protocol, investigated fall-prevention products and technologies, and piloted the protocol and products/technologies before the full implementation. This article describes their journey and lessons learned along the way, the most compelling of which is the need for a simple, guided, and time-efficient approach to implementing the best practices into clinical care.     

Cardiometabolic risk assessment: an approach to the prevention of cardiovascular disease and diabetes mellitus

An alarming increase in the development of cardiovascular disease (CVD) during the past 5 decades has led to intensive research on the epidemiology and pathogenesis of CVD, resulting in dramatic improvements in treatment. Today, there is an alarming increase in obesity and diabetes mellitus (DM), with a concomitant increase in diabetes-related complications, including CVD. Researchers have found that the risk of CVD becomes greater with increasing hyperglycemia and insulin resistance that occur in people long before the onset of clinical DM. Lifestyle modification with moderate weight loss has been shown to prevent or delay the onset of DM in patients who are at high risk for developing this disease. Unfortunately, the current guidelines for risk assessment provided by medical societies and national organizations are numerous, confusing, and inconsistent in their basic approach to identify specific risk factors for CVD and DM in patients. Extending routine systematic assessment from cardiovascular risk to cardiometabolic risk--that is, risk for developing CVD and/or DM--and increasing our understanding of the basic mechanisms that regulate energy balance and metabolic risk factors are needed to address this impending epidemic of DM.     

A physiological approach to the assessment of disease activity in rheumatoid arthritis

A method is described for assessing the in vivo oxygen consumption and lactate production rates of human knee joints. It is based on the rate of fall of P_o2 and the rate of rise in lactate concentration in an intra-articular saline pool after interruption of the circulation to the joint with an arterial tourniquet. Studies in 5 control patients with degenerative joint disease and 29 patients with rheumatoid arthritis showed a 2- to 3-fold higher mean oxygen uptake rate and a 10- to 12-fold higher mean lactate appearance rate in the saline in the rheumatoid joints with severe disease compared to the control joints. These metabolic variables correlated with tissue metabolic demand as estimated in synovial biopsies. ¹³³Xe washout from the intra-articular space, which reflects joint circulatory flow, showed a 3-fold greater mean washout rate from the rheumatoid joints (48 studies) than control joints (7 studies) with extensive overlap between the two groups. ¹³³Xe washout rate correlated with knee joint inflammation estimated both clinically and histologically. After synovectomy in four patients, the operated knee showed a greater fall in lactate production than the opposite knee in three of these patients. Neither knee joint oxygen uptake nor ¹³³Xe washout rate changed significantly. Intra-articular corticosteroid injection (eight patients) resulted in decreased lactate production and a decreased ¹³³Xe washout rate in the injected knee and variable results in the untreated knee. Oxygen uptake again was unchanged after therapy.     

Systematic approach to community risk assessment and management

A move from institutional to community health care means that health service staff are increasingly requested to visit patients in their own homes. This undertaking is not without risk, particularly where the patient or the locality is unknown. There are no nationally available guidelines for formally assessing potential risk to a health worker before the home visit. A protocol for risk assessment and a safety schedule before making a home visit was therefore developed and is described in this article. The difficulties in carrying out a comprehensive risk assessment are outlined. Several ways in which the assessment of risk before home visits could be made more effective are suggested.     

住院患者跌倒危险因素评估单的设计与应用

设计住院患者跌倒危险因素评估单,经过临床应用,2010年无1例跌倒事件发生。住院患者跌倒危险因素评估单有利于住院患者跌倒防范的规范管理,提高了护理人员预防跌倒发生的防范意识,及对住院患者安全管理的力度。     

Pressure ulcer risk assessment and prevention

Pressure ulcers were once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, pressure ulcers have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of pressure ulcer risk assessment and prevention drawn from a variety of national policy documents.     

A risk assessment based approach to the management of acute poisoning

Early assessment and management of poisoning constitutes a core emergency medicine competency. Medical and psychiatric emergencies coexist; the acute poisoning is a dynamic medical illness that represents an acute exacerbation of a chronic underlying psychosocial disorder. The emergency physician must use an approach that ensures early decisions address potentially time critical interventions, while allowing management to be tailored to the individual patient's needs in that particular medical setting. This article outlines a rationale approach to the management of the poisoned patient that emphasises the importance of early risk assessment. Ideally, this approach should be used in the setting of a health system designed to optimise the medical and psychosocial care of the poisoned patient.     

A physiological approach to hemidiaphragm paralysis

The occurrence of unilateral phrenic nerve injury with the resultant hemidiaphragm paralysis or paresis can cause significant respiratory distress or respiratory failure in infants and children. An early bedside diagnosis of this problem will allow appropriate therapy and prevent needless diagnostic procedures. With the patient in the lateral decubitus position and the paralyzed side up, accentuated paradoxical inspiratory inward epigastric motion ipsilateral to the paralyzed hemidiaphragm can be seen. With the paralyzed hemidiaphragm down, abdominal motion appears to be normal as if the paralyzed hemidiaphragm were plicated. Thus, ventilation may be improved by changing body position as well as instituting ventilatory support while the potential for phrenic nerve recovery is evaluated.     

社区老年人跌倒的评估及预防研究进展

通过对国内外有关社区老年人跌倒危险的测定方法及评估量表的归纳总结,从体育锻炼、居家环境改造、药物保健、健康教育、应用辅助器械等方面来阐述近几年预防老人跌倒所采取的措施,以最大限度预防及减少社区老年人跌倒的发生。     

Biomechanics and injury risk assessment of falls onto protective floor mats

This study investigated the biomechanics of simulated sideways falls from various bed heights onto two types of protective floor mats. This article presents biomechanical injury criteria for evaluating the probability of sustaining injuries to the head, thorax, and pelvis. A side-impact dummy was raised to drop heights of 45.7 cm, 61.0 cm, and 76.2 cm and released. Two types of protective floor mats were evaluated and compared with impacts experienced on an unpadded, rigid floor. Results of the study demonstrated a high risk (> 50%) for serious head injury for falls onto an unpadded, rigid floor at 61.0-cm and 76.2-cm drop heights. Falls onto floor mats demonstrated significant reductions in injury risk to the head and pelvis for all drop heights. Thoracic injury risk was significantly reduced for all but the highest drop height.     

住院病人跌倒危险因素评估量表的设计与应用

目的减少和避免住院病人跌倒发生。方法设计住院病人跌倒危险因素评估量表及住院病人跌倒危险护理措施表,应用于内科4个护理单元评估病人。结果427例病人实施护理措施表后,无一例跌倒事件发生。结论应用病人跌倒评估量表,使护理措施更具体及个性化,可以预防病人跌倒的发生。     

Managing risk and exerting control: determining follow through with falls prevention

Purpose/Method: This study used in-depth interviews to explore the perspectives of nine older women who had not followed through with environmental modification recommendations to reduce their risk of falls in the home. Results: It was found that the core concept of 'exerting control' provided an understanding of their experience following an occupational therapy home visit. Exerting control was a behavioural, cognitive and affective process whereby the women made decisions about whether or not to follow through with environmental modification recommendations based on their knowledge of environmental risks, perceptions of degree of risk, perceived ability to mediate these risks through behaviour and the degree of freedom she had in decision making. Exerting control meant that the women made daily choices about their home environment which increased or decreased the risk of falls with identified home hazards. Conclusion: The findings suggest that, for some women, health professionals need to understand and work with the phenomenon of exerting control, in order to work with clients to reduce environmental hazards.     

Health visitor risk assessment for preventing falls in elderly people

This study was undertaken to look at the feasibility of a health visitor risk assessment for falls at the time of the routine health check for people aged 75 years and above. A total of 162 people were eligible for inclusion in the study. The standard over-75 assessment check was carried out either in the GP surgery or the person's home. A questionnaire was developed to obtain additional information not collected in the routine health check. The results identified two key risk areas: a history of polypharmacy and living in sheltered housing. There were no differences for a range of physical, emotional and environmental factors between people who had fallen and those who had not. A larger study is required to look at the identification of risk factors for falling at the routine over-75 health check, and appropriate referrals that can be put into place to deal with any problems uncovered. Education of health professionals on the risk factors of falls is also required.     

Restraints use and falls prevention

The Health Care Financing Administration defines physical restraints as "any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. Restraints have the potential to produce serious outcomes, including physical or psychological harm, loss of dignity, violation of a patient's rights, and possibly death. Health care providers need to identify opportunities to decrease the risks associated with the use of restraints through preventive strategies, innovative alternatives, and process improvements to help focus on the patient's overall well-being, health, and safety.