Recognize risk factors to prevent patient falls.

Nurse leaders can reduce the rate of falls and injuries resulting from falls by instituting a fall prevention program. This article describes how one hospital developed a successful program.     

Patient education to prevent falls in subacute care

OBJECTIVE: To evaluate the effectiveness of a patient education programme for preventing falls in the subacute hospital setting. DESIGN: Randomized controlled trial, subgroup analysis. PARTICIPANTS: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a patient education intervention for the prevention of falls when enrolled in a larger randomized controlled trial of a falls prevention programme. METHODS: Participants in both the control and intervention groups who were recommended for the education programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Only participants in the intervention group who were recommended for this intervention actually received it. In addition, these participants completed an evaluation survey at the completion of their education programme. RESULTS: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However the difference in the proportion of fallers was not significant (relative risk 1.21, 95% confidence interval 0.68 to 2.14). CONCLUSION: Patient education is an important part of a multiple intervention falls prevention approach for the subacute hospital setting.     

Home modification to prevent falls by older ED patients

This trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. Three hundred ninety-seven patients were enrolled (118 control, 279 intervention). Seventy-six percent had complete follow up interviews. Nine percent of control and 8% of intervention patients reported a home modification (95% confidence interval on difference, -8.1% to 5.5%). Patients who fell in the prior year had a 2.0 increased odds (95% confidence interval, 0.8-4.6) of making a home modification. The similar home modification rates in the 2 study groups suggest that even minimum discussion (eg, the informed consent procedure) may increase patients' fall prevention activities. The stronger association in patients who fell suggests that a targeted program may have added benefit.     

Knowledge transfer to prevent falls in a cardiovascular setting

The objective of the clinical project was to plan and deploy a knowledge translation approach to prevent falls among elderly patients hospitalized in a unit of cardiovascular medicine. A combination of education strategies built around interactive workshops enabled the implementation of a screening tool and of an up-to-date preventive intervention guide. Twenty-four workshops were conducted in all three work shifts and an implementation follow-up was made. The participation rate was 93% of the unit's active staff The increased use of prevention tools and of an intervention guide to prevent falls suggests an increased level of awareness as a result of the project. The staff expressed their satisfaction on having been consulted and involved early in the implementation process. Moreover, the flexible schedule and focus on a bilateral sharing of knowledge through brief interactive workshops were appreciated.     

Using a range of interventions to prevent falls in hospital

The National Patient Safety Agency (NPSA) has published a report this week on falls in hospital, which suggests that a range of interventions, when used together, could result in an 18% reduction in the number of falls. This article outlines the incidence and cost of falls in hospital and how nurses can help with falls prevention.     

A guide on how to prevent falls injury in hospitals

Falls among inpatients usually arise from a complex combination of risk factors, including the effects of longstanding and acute illness, the ageing process and the side effects of medication, combined with the unfamiliar environment of a hospital. This article outlines the range of interventions that can reduce the likelihood of falls and injury, and explains the value of the Patient Safety First 'How to' guide in supporting nurses to implement them. Patient and service improvement case studies are described.     

Individualized interventions to prevent bed-related falls and reduce siderail use

Five categories of problems that often result in siderail use: memory disorder, impaired mobility, injury risk, nocturia/incontinence, and sleep disturbance. As nursing homes work toward meeting the Health Care Financing Administration's mandate to examine siderail use, administrators and staff need to implement interventions that support safety and individualize care for residents. While no one intervention represents a singular solution to siderail use, a range of interventions, tailored to individual needs, exist. This article describes the process of selecting individualized interventions to reduce bed-related falls.     

Occupational health and safety in physiotherapy: guidelines for practice

Most physiotherapists (91%) experience work related musculoskeletal disorders (WMSDs) at some time, and one in six makes a career change as a consequence. Many of these disorders are attributed to manual handling of patients. This paper proposes guidelines to reduce the risk of WMSDs based on Australian legislative requirements, the results of a survey of Australian physiotherapists and the literature surrounding injury prevention. These guidelines address the areas of environmental and job design, and the personal physical capabilities of physiotherapists, within the context of law. The paper concludes by calling for further research to explore and develop this area of injury prevention in the physiotherapy profession.     

The scope of guidelines to prevent healthcare-associated infections

As care is increasingly delivered in the community rather than acute settings, there has been concern that this might be accompanied by a rise in healthcare-associated infection. Consequently, the National Institute for Clinical Excellence (NICE) has commissioned a set of infection prevention guidelines for healthcare workers in community and primary care. The guideline developers were anxious to concentrate this guidance on the areas of most concern to practitioners, particularly in relation to devices. This article describes how a survey and focus groups were employed to identify the areas for guideline development, namely standard principles, long-term indwelling urinary catheters, enteral feeds and central intravascular devices.     

老年住院患者跌倒防护与干预研究

目的探讨预防老年住院患者跌倒的防护与干预措施。方法将65岁以上的老年住院患者分为实验组720例和对照组724例,实验组通过住院时评估、采取一定干预措施、对患者及陪护进行有针对性的健康教育,对照组只是常规根据医嘱留陪住,分别于出院前统计跌倒发生率。结果实验组跌倒的发生率为0．833％,对照组跌倒发生率为2．62％,两组比较,差异有统计学意义（P〈0．05）。结论对老年住院患者跌倒危险因素进行评估,能全面了解患者的状况,制订有效的干预措施,加强对患者及陪护进行健康教育,能有效防止老年住院患者跌倒事件的发生,有助于提高医护安全性。     

Development of an implementation strategy for physiotherapy guidelines on low back pain

In the Netherlands, clinical practice physiotherapy guidelines are mainly implemented by using passive implementation strategies. It is well known that these strategies are not effective in establishing changes in behaviour of health care professionals. Therefore, a new implementation strategy was developed for the physiotherapy guidelines on low back pain. This paper describes the method for the design of this strategy. A survey was conducted of 100 physiotherapy practices to identify perceived barriers to implementation of the guidelines and the most important discrepancies between current practice and recommendations of the guidelines. The strategy was further developed using a model for changing professionals' behaviour and systematic reviews on the effectiveness of implementation interventions. The most frequently reported barriers for implementation of the guidelines are related to a lack of knowledge or skills of physiotherapists. The most frequently reported discrepancies between physiotherapy practice and guidelines recommendations were related to the focus of the diagnostic process on impairments, the common use of passive physiotherapeutic interventions, the frequent use of a pain-contingent approach, and the expectations of the patient. The new implementation strategy consisted of multiple interventions, namely education, discussion, role-playing, feedback and reminders. The strategy addressed perceived barriers and discrepancies between current practice and the recommendations of the guidelines.