Effect of a multidisciplinary fall risk assessment on falls among neurology inpatients

OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit.PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention.RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not.CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls.Falls are the most common adverse event reported in acute care settings.^1,2 They prolong hospitalization, increase cost of care, and have the potential to cause serious injury.³ Multiple risk factors for falls have been identified: advanced age, muscle weakness, gait or balance problems, visual impairment, altered bowel or bladder elimination patterns, dizziness or vertigo, depression, cognitive deficits, impaired activities of daily living, use of psychotropic medications, and a history of falls.^1,4-7 These risk factors are common among patients with neurologic disease. For this reason, several specific neurologic conditions, such as stroke, dementia, Parkinson disease, and peripheral neuropathy, confer an increased risk for falls,⁸ and neurology inpatient units have among the highest rates of falls.⁹Among hospitalized patients, rates of falls range from 1.97 to 8.40 falls per 1000 patient-days.^9-13 The rate of falls on our neurology inpatient unit was 5.69 falls per 1000 patient-days during 2006 and 2007. The objective of this study was to evaluate whether the addition of a physician fall risk assessment to the existing nurse fall risk assessment process was feasible and whether it would lead to a reduction in our inpatient rate of falls. Our hypothesis was that adding a physician assessment would increase the number of neurology inpatients identified as at risk for falls, leading to more patients receiving fall prevention measures and, ultimately, a reduction in rate of falls.     

Fall risk factors assessment tool: enhancing effectiveness in falls screening

A quasi-experimental study was conducted to explore the effectiveness of fall prevention among hospital patients based on the modified fall risk factors assessment tool. We investigated the frequency of falls among hospital patients at a medical center in Taiwan. The experimental group of falls victims was selected from patients (n = 39) hospitalized in 2002 after falls. The control group of patients falls was selected by means of a retrospective incident report review which identified patients (n = 43) hospitalized one year earlier. The results showed that there was no significant difference in the incidence of falls between the two groups. Nevertheless, there were significant differences in age, indications of falls, use of sedatives, walking ability and evaluated grade of fall risk factors. In addition, the average level of satisfaction under recently modified fall risk factors evaluation guideline was 2.68 points (upper limit = 4 points) based upon investigation derived from nursing staff ' s opinions. Moreover, nursing staff from GYN/OBS and orthopedics departments acknowledged the enhanced effectiveness of these new guidelines. The screening rate for high-risk orthopedic patients was increased from 20.7 % to 41.9 %. Furthermore, the screening rate among the experimental group (74.4 % ) was also higher than that among the control group (60.5 % ) ( p <.01). In line with our effective tool to screen high-risk patients, we also added the concept of continuous quality improvement in nursing care to implement a fall prevention program to reduce unnecessary injury. This strategy may assist nursing personnel in providing immediate and individualized care as well as health education for high-risk patients. It may also cause the incidence of patient falls in hospitals to continue to decline.     

Evaluation of the STRATIFY falls prediction tool on a geriatric unit

Accurate prediction of fall-prone hospitalized older adults may be integral to reducing falls. The STRATIFY, a simple 5-point falls prediction tool, was prospectively validated on a Geriatric Assessment and Rehabilitation Unit as a one-time initial predictor of patients likely to fall. Sensitivity and specificity were lower than in the original British study. Introducing risk assessments validated elsewhere on a patient care unit or on a hospital-wide scale requires caution.     

The impact of fall risk assessment on nurse fears,patient falls,and functional ability in long-term care

Purpose: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. Methods: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Results: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Conclusion: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research.

• Implications for Rehabilitation

• Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important.

• Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient’s ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls.

• Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

     

Older people's perspectives on fall risk and fall prevention programs: a literature review

Despite evidence supporting fall prevention methods, fall-related injury and death rates continue to rise. Understanding older people's views on fall risk and prevention will help nurses and other health professionals in the design of fall prevention strategies that will broaden their scope, reach and adoption. This literature review synthesised 19 qualitative and quantitative studies examining older people's perspectives about fall risk and prevention using a social-ecological framework. Three themes emerged about fall risk; fearing vulnerability, maintaining autonomy and independence and interpreting risk. Four themes emerged about fall prevention programs: influence of participant and program characteristics, need for personal relevance and preference, maintaining autonomy and independence and increased support for and access to programs. Implications for practice include individual, interpersonal, organizational and community level considerations for improving fall prevention efforts.     

Visual spatial abilities and fall risk: an assessment tool for individuals with dementia

Risk of falling is a major concern of long-term care facilities with residents diagnosed with dementia. Use of a brief cognitive assessment focusing on visual spatial abilities could be one strategy in the prevention of falls in residents with dementia. The objective of this study was to determine if a clock test could predict a risk of falls in residents diagnosed with dementia. Three hundred sixty-four individuals with dementia participated (92 men and 272 women; ages 37 to 100, mean 80.5 years, median 83 years). Each participant was given the Reality Comprehension Clock Test (RCCT) three times, and Mini Mental-Status Examination (MMSE) two times to determine criterion-related validity, test-retest reliability, internal consistency; and to set and evaluate a risk of falls score based on the Visual Spatial Score (VSS) component produced by the RCCT. Significant findings included .72 (p < .01) correlation between the RCCT and the MMSE, .90 (p < .01) correlation between the first administration of the RCCT and the second administration of the RCCT; an alpha of .95 (p, < .001) and an F value of 7.6 (p < .001) producing a risk of falls initial VSS of 5 or lower compared to 9 or greater. Chi-square of 6.3 for 30 days (p,< .01), 11.08 for 60 days (p < .01) and 13.3 for 90 days (p < .01) indicated a significant difference in the number of falls occurring in the high risk group (VSS of 5 or lower) compared to the low/ no risk group (VSS of 9 or higher). A risk factor analysis suggested that residents in the higher risk group were three times more likely to have fallen than residents in the low risk group. Knowing a resident's visual spatial ability offers health care providers an opportunity to implement a resident-specific intervention that addresses their cognitive ability and visual spatial deficit that may reduce the resident's risk of falling.     

Triangulating the extrinsic risk factors for inpatient falls from the fall incident reports and nurse's and patient's perspectives

This study triangulated the extrinsic risk factors for inpatient falls from incident reports and nurse's and patient's perspectives. Similar perspectives were shared on the patient-room-design-associated factors. Patients' concerns focused on their needs not being met in time. Fall prevention should have a priority on addressing patients' needs.     

The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review

Background

The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls.

Thinking falls-taking action: a falls prevention tool for care homes

Falls in older people resident within care home settings are common and serious, often resulting in injury and mortality. Yet there is no standardised approach within UK care homes to assessing the risk of falls for individuals or identifying risk factors relevant for that person. The Guide to Action for Falls Prevention Tool - Care Homes (GtACH) was developed with local care homes in Nottinghamshire. Ten care homes were selected to participate in the study, four withdrawing before data collection commenced. Fourteen care home staff across six care homes tested the tool for usability and found it quick (20 minutes) and easy to use, yet only 53% of the recommended interventions highlighted were completed. The GtACH needs further evaluation to test whether its use prompts actions which reduce the number of falls, and the barriers to these actions being taken.     

Acute care patient falls: evaluation of a revised fall prevention program following comparative analysis of psychiatric and medical patient falls

Eliminating falls and fall-associated injuries are priorities in health care. This study examined the impact of revised fall prevention interventions on psychiatric and medical patient falls. After policy revisions were well established, psychiatric falls diminished and medical falls increased. A contributing factor to the medical population finding was policy intervention noncompliance.     

社区老年人跌倒危险评估工具的信效度检验

目的:通过测试内部一致性、条目分析、重测信度,评价自制跌倒危险量表的可靠性,分析其在社区老年人跌倒预防中应用的可行性。方法:使用老年人跌倒评估量表对100名社区老年人进行跌倒危险评估,根据评估结果检验该工具的信度和效度。结果:老年人跌倒评估量表Cronbach’sα系数为0.706,具有较好的内部一致性,护理实习生和社区医生应用老年人跌倒评估量表测评结果比较,差异无统计学意义(P0.05)。有跌倒与无跌倒的老年人评分比较,差异有统计学意义(P0.01)。结论:老年人跌倒评估量表是一种简单、方便、安全的评估工具,其信度和效度较好,适合社区卫生服务人员评估老年人的跌倒危险性。