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.     

老年人跌倒危险因素评估及护理干预研究进展

随着世界老年人口数量快速增长,老年健康问题引起了空前的关注。跌倒及其相关问题是老年健康问题的重要组成部分。跌倒可引发或加重老年人原有疾病,引起心理创伤,降低其灵活性和独立性,进而减少自主活动,严重影响老年人的生活质量。跌倒已成为老年人伤残、失能和死亡的主要原因之一。本文针对老年人跌倒危险因素的评估及护理干预进行综述,旨在为科学、有效地预防老年人跌倒提供参考和依据。     

Fall risk in the elderly.

Falls contribute to significant morbidity and mortality in the elderly. This article identifies a number of intrinsic and extrinsic factors that increase the risk for falling. Application of effective clinical strategies that have been identified through research to reduce the occurrence of falls is a necessary component of caring for the elderly. As this population increases, so must nurses' knowledge of implementing successful fall prevention programs.     

An analysis of falls occurring in patients with stroke on an acute rehabilitation unit.

Falls are a common occurrence in stroke patients admitted to a rehabilitation unit. This study evaluates the effect of current fall risk screening and prevention strategies on the number of falls in stroke patients admitted to an acute rehabilitation facility. All stroke patients admitted to a designated acute rehabilitation unit were considered at risk for falls by virtue of their diagnosis. These patients were studied retrospectively during a 24-month period. Wheelchair lap belts and bedrails were provided to all patients admitted to the unit. Further measures consisting of bed and chair alarms, enclosed beds, and placement in rooms close to the nursing station were implemented with high-fall risk patients. One hundred seventeen (15.5%) of the 754 patients in this study fell. The fall index rate was 8.2 falls, based on patient care days during the study period. No injury was observed in 143 of 159 fall cases (90%). In 13 cases (8%) there were only minor injuries, and 3 falls (2%) resulted in serious injuries. Current preventive strategies decrease the number of falls and the severity of fall-related injuries. Patients who do fall are cognitively impaired on admission and have lower ambulation speed.     

Falls in hospices: a cancer network observational study of fall rates and risk factors

Falls have been identified as a problem in frail patient populations, but their risk factors have not been studied prospectively in the hospice setting. We calculated fall rates in three hospices in the Yorkshire region, identified risk factors for falls based on previous studies in elderly patients, and then carried out a prospective study of inpatients in two of these hospices. We compared these risk factors in patients who subsequently fell with patients that did not fall during the study period. Information was recorded on 102 admissions. Twelve patients fell, generating 23 falls; six patients fell more than once. Significant risk factors for falling were cognitive impairment, low systolic lying and standing blood pressure, visual impairment and age over 80. Males with these risk factors fell more often than female patients with these risk factors. Strategies to prevent falls in hospice inpatients need to be directed appropriately towards patients with cognitive and visual impairment and low systolic blood pressure.     

Assessing falls risk in older adult mental health patients: A Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12‐month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health‐specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health‐care settings. In assessing falls risk and implementing falls‐prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.     

Current guidelines for using physiotherapy to prevent falls

Falls are one of the primary causes of reduced quality of life, disability, and mortality in the elderly. 90-100% of limb fractures in this population result from falls. Preventing falls is a difficult problem, and unfortunately not fully appreciated in Poland. One in three people aged 65 and over experience a fall at least once a year. In the case of community-dwelling individuals, 5% of falls lead to fractures, while among those living in nursing homes and hospitals this figure reaches 20%. Malfunctions of many internal organs and systems can contribute to falls, so that 400 different risk factors have been described; therefore, fall prevention should be multi-dimensional. At the current state of knowledge even a 40% decrease in fracture risk would be possible, provided that the patient is treated by a multidisciplinary team (family practitioner, rheumatologist, orthopedic surgeon, neurologist, physiotherapist, psychologist). Guidelines have already been developed on this subject in Europe and around the world. The present study reviews current opinions on osteoporosis and fall prevention, based on recent literature.     

Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention

IntroductionFalls in the emergency department pose an important challenge for patient safety. Multifactorial fall prevention bundles have been associated with a reduction in patient falls in the inpatient setting. The purpose of this project was to tailor and implement a comprehensive fall prevention bundle in our emergency department.MethodsFall bundle components for this intervention were selected on the basis of a review of fall prevention research and included fall risk assessment, safe ambulation, safe toileting, staff communication, early warning, and patient education. The fall risk assessment was tailored to the emergency department through an appraisal of select inpatient fall risk assessments, literature search for ED-specific fall risk factors, and a site-specific chart review, after which pertinent fall risk factors were integrated into a modified screening. Fall prevention materials that were both practical and applicable to the emergency department and facilitated patient safety along each bundle domain were selected for implementation at our site.ResultsThe tailored fall prevention bundle was championed by the interdisciplinary ED Fall Prevention Team and implemented over the course of 5 months in 1 emergency department. Education on fall prevention equipment was delivered in a peer-to-peer format, and an online module was designed to guide staff through the new fall risk assessment. The fall prevention bundle was adopted into clinical practice after staff education was completed, and the fall risk screening was merged into the electronic medical record.DiscussionED fall prevention requires a comprehensive bundled approach, which includes a fall risk screening and multifactorial interventions that are tailored to the ED setting. Successful implementation relies on the involvement of front-line staff from the design through the delivery of the bundled fall prevention measures. Continued inquiry and innovation in ED fall prevention will help provide a safer health care environment and improve patient outcomes.     

风险管理在预防老年关节置换患者术后跌倒中的应用

目的探讨风险管理在预防老年关节置换患者术后跌倒中的应用效果。方法便利抽样法选取2009年12月至2010年12月在湖州市中心医院骨科行关节置换(髋关节、膝关节)的60岁以上老年患者234例作为对照组,同法选取2011年1月至2012年12月在湖州市中心医院骨科行关节置换(髋关节、膝关节)的60岁以上老年患者256例作为观察组,对照组患者实施骨科常规护理,观察组患者在对照组的基础上实施预防跌倒的风险管理,评价并比较两组患者的跌倒发生率。结果对照组234例患者中,8例发生跌倒,跌倒发生率为3.41%;跌倒风险管理流程实施后,观察组256例患者中无一例患者发生跌倒事件,两组比较,差异有统计学意义(χ2=8.81,P0.05)。结论对老年关节置换术后患者实施预防跌倒的风险管理,有利于减少跌倒事件的发生,保障了患者安全。     

Older patients presenting to a county hospital ED after a fall: missed opportunities for prevention

Little is known about the characteristics of elderly persons who present to an ED after a fall or about the nature of the care received for the fall itself. We identified elders presenting to a large urban United States ED after a fall, determined risk factors that may have contributed to the fall, and assessed the extent to which falls were addressed in the ED setting. One hundred seventeen fallers were identified. Nearly half were aged 80 years or older. After age, polypharmacy was the most common fall risk factor, followed by more than 1 contributing medical condition and cognitive impairment. Fall risk factors differed significantly for older compared with younger subgroups. More than half (57%) who had fallen were admitted. Of the remainder who fell and were discharged, more than half were scheduled for follow-up of their fall-related injury only, with no follow-up scheduled to address prevention of future falls. In summary, elders who present to an ED after having fallen have a variety of risk factors for falls that can be addressed to reduce their risk of future falls and injury; however, many may not receive such follow-up care. There must be increased awareness among ED providers of the need for a medical evaluation of a fall. Randomized trials evaluating the effect of a focused fall risk factor assessment after presentation to the ED may be warranted.     

Falls in the elderly: what can be done?

AIM: This article gives information about falls in the elderly. BACKGROUND: The evaluation of an older patient who has fallen includes a focused history with an emphasis on medications, risk factors and physical examination. The article also discusses the aetiology and prevention of falls. CONCLUSION: Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. To reduce the incidence of patient falls, clinicians and researchers have developed a variety of risk assessment tools to aid in the identification of patients at greater risk of falling.     

Disparity between perceived and physiological risks of falling among older patients in an acute care hospital

BackgroundFalls are the most frequent adverse events among hospitalised older adults. Previous studies highlighted that older adults might not understand the risk factors associated with falls and may have an altered perception of their actual risk.AimTo describe differences between perceived and actual physiological risk of falling among older adults and to explore factors associated with the differences.Methods: A prospective cohort study was done. Older adults (age 65 years and above) were interviewed one-to-one at bedside. Morse Fall Scale (MFS) and other risk factors for falls were used to identify the patients’ physiological fall risks. Patients’ perceived risk of falls were assessed using the Falls Efficacy Scale-International (FES-I).ResultsThree hundred patients were recruited. Patients’ mean age was 75.3 (SD = ± 6.2). Majority were males (51.7%), lived with others (91.7%), and had received primary school education (35.3%). Based on the MFS, most patients had moderate fall risk (59.7%). Using the FES-I, more than half the patients (59%) interviewed had high concerns about falling. About one-third of the patients’ (31.3%) perceived risk matched with their physiological fall risk (Risk-Aware). Half of the patients’ perceived risks was higher than their physiological fall risk (50.7%) (Risk-Anxious), while the remaining patients’ perceived risks was reported to be lower than their physiological fall risk (18%) (Risk-Taker).ConclusionOlder patients are poor at recognizing their fall risks. Both patients’ perceived and actual fall risks should be evaluated in the inpatient setting in order to inform individualized fall prevention education and strategies.     

A falls risk-assessment tool in an elderly care environment

Falls are a major cause of morbidity and mortality among older people. In an inpatient setting it has been suggested that the introduction of risk-assessment tools may be an important way of managing the issue. The study reported in this article was carried out in two stages. First, fall incidents were identified retrospectively using 'falls incident forms' and nursing notes, and the characteristics and management of patients who had fallen were compared with those who had not fallen. A risk-assessment tool and care plan were developed and evaluated prospectively. By analysing the data in stage one it was found that falls incidence reporting was poor and patients who had fallen had more evidence of previous falls than those who had not fallen. In stage two staff found the risk-assessment tool and care plan easy to complete; however, there was little documentation about whether any appropriate interventions, specific to the individuals' risk score, were carried out. Appropriate interventions identified on the risk-assessment tool were put into place inconsistently. As a result of this work the hospital has set up a multidisciplinary group to look at falls management.     

Falls in the elderly: spectrum and prevention

Objective

To provide family physicians with a practical, evidence-based approach to fall prevention in the elderly.

Sources of information

MEDLINE was searched using terms relevant to falls among the elderly in the community and in institutions. Relevant English-language papers published from 1980 to July 2010 were reviewed. Relevant geriatric society guidelines were reviewed as well.

Main message

Falls are a common and serious health problem with devastating consequences. Several risk factors have been identified in the literature. Falls can be prevented through several evidence-based interventions, which can be either single or multicomponent interventions. Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population can have a profound effect on public health.

Conclusion

Family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk.     

Incidence and risk factors of hospital falls on long-term care wards in Japan

Rationale, aims and objective Falls among hospitalized patients are an important patient safety issue. In particular, the incidence of falls and risk of related injuries among the elderly are particularly high. Because the epidemiology of falls is not well scrutinized in Japanese long‐term care wards, we evaluated the incidence and risk factors of falls in this setting. Methods A prospective cohort study was conducted on long‐term care wards with 160 beds in a general hospital in Japan. All patients admitted to the wards over 25 months were enrolled and followed until discharge. The baseline characteristics and incidences of falls were measured. Results We enrolled 2973 patients with a mean age of 74 years, and median length of stay was 36 days. During the study period, 657 falls occurred in 411 (14%) patients. The incidence of falls was 3.8 per 1000 patient‐days, and by 15 and 30 days after admission to the ward, 7.3% and 11.4% of patients, respectively, had fallen. Independent risk factors related to falls during hospitalization were advanced age [≥70 years, hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.2–2.0], history of falls (HR 1.2, 95% CI 1.0–1.5), frequent urination (HR 1.4, 95% CI 1.0–1.8) and requirement for toileting assistance (HR 1.4, 95% CI 1.1–1.8). Among patients who fell during the study period, 23% sustained an injury. Conclusions Many patients on long‐term care wards in Japan were elderly and experienced falls during their hospital stay, with consequent injuries. Taking into account the risk factors identified, we need to devise effective strategies to prevent falls and related injuries.     

‘I don't want to impose on anybody’: Older people and their families discuss their perceptions of risk,cause and care in the context of falls

Background

Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care.

Objectives

This study explored the experiences of patients and their families after a fall in a healthcare facility.

Methods

Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically.

Results

The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity.

Conclusions

This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing.

Implications for practice

Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.     

Falls in the nursing home: preventable or inevitable?

1. Falls in the elderly are frequent occurrences and are usually a result of the complex interaction of environmental, physiological, and pathological variables. Fall-related injuries happen much less frequently. 2. Physical restraints have not been found effective in preventing falls and may be associated with increased risk of fall-related injury. 3. Because of the complex nature of falls in the elderly, fall prevention programs must emphasize the critical assessment of each resident's risks for falling with targeted interventions.