Showing posts with label hospital. Show all posts
Showing posts with label hospital. Show all posts

Saturday, December 7, 2013

#Medical-#Surgical Hospital, Acute Care Experience: Is it the best you can get to start your #nursing #career?

#Medical-#Surgical Hospital, Acute Care Experience: Is it the best you can get to start your #nursing #career?:"Carmen Kosicek It used to be that way but now, many of the home health patients are what med surg patients were 5 years ago. Additionally, home health experience shows fantastic time management and rising to the occasion to make all the decisions!"
https://www.facebook.com/groups/230473227128384/230834047092302/


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Discover! "Unconventional Nurse: Going from Burnout to Bliss" Michelle Podlesni, RN @MPodlesni
http://unconventionalnurse.com/al/ 

Discover Rodan & Fields Dermatologists, Take Their Free Online Skin Consultation.
https://www.facebook.com/groups/nurseup/permalink/523614767722544/

Work At Home, RN Jobs, Do You Know Where To Find Them? Ask Nursing Career Coach Carmen Kosicek
https://www.facebook.com/nursefriendly/posts/10202345780396833

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Did you know? Our team of nurses has been researching, indexing healthcare resources for over a decade? If you have questions, need resources, stop here first and search our index. If we don't have it, ask us 

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Andrew Lopez, RN
Nursefriendly National Directories
38 Tattersall Drive 
West Deptford, New Jersey 08051
856-415-9617, Fax: 856-415-9618, info@nursefriendly.com, @nursefriendly
http://www.nursefriendly.com/

Thursday, December 5, 2013

Older Patients Discharged From the Hospital: 10 tips to prevent readmission. Martine Ehrenclou, @med_writer

Older Patients Discharged From the Hospital: 10 tips to prevent readmission. Martine Ehrenclou, @med_writer:"There’s a 1 in 5 chance that an older patient who has had a common surgery will end up in the emergency room within 30 days of their hospital stay, according to a new study in Health Affairs.

Transitions from hospitals to the outpatient setting can be dangerous for many older adults. As patients are still recovering when they are discharged from the hospital, they might not understand or remember instructions about caring for themselves at home. Often, older patients don’t see their primary care doctors for follow up care and don’t take their medications properly.

You can help."
http://martineehrenclou.com/2013/10/older-patients-discharged-from-the-hospital-10-tips-to-prevent-readmission/


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New!

Discover! "Unconventional Nurse: Going from Burnout to Bliss" Michelle Podlesni, RN @MPodlesni
http://unconventionalnurse.com/al/ 

Discover Rodan & Fields Dermatologists, Take Their Free Online Skin Consultation.
https://www.facebook.com/groups/nurseup/permalink/523614767722544/

Work At Home, RN Jobs, Do You Know Where To Find Them? Ask Nursing Career Coach Carmen Kosicek
https://www.facebook.com/nursefriendly/posts/10202345780396833

******************************************************
Did you know? Our team of nurses has been researching, indexing healthcare resources for over a decade? If you have questions, need resources, stop here first and search our index. If we don't have it, ask us 

Join the discussions, ask questions 

Google Plus Forum: https://plus.google.com/u/0/communities/101816071337339988035

Facebook Forum: http://www.facebook.com/groups/nurseup/

Facebook Announcements: https://www.facebook.com/pages/Nursefriendly-National-Directories/127673320580486

LinkedIn Forum: http://www.linkedin.com/groups/Nurseupcom-Nursing-Healthcare-Advocacy-4366517



Andrew Lopez, RN
Nursefriendly National Directories
38 Tattersall Drive 
West Deptford, New Jersey 08051
856-415-9617, Fax: 856-415-9618, info@nursefriendly.com, @nursefriendly
http://www.nursefriendly.com/

Friday, February 18, 2011

Released hospital patients' many unhappy returns

Patients who are released from the hospital too early or without proper planning and instructions often wind up back in the hospital after a few days, a problem that's costly to taxpayers and distressing to patients.

A study released today calculated that reducing hospital stays by a single day for Medicare and Medi-Cal patients in California adds up to $227 million a year.

An estimated 81,000 Medicare patients in California - or 20 percent - end up back in the hospital within 30 days of being discharged for some reason related to the same condition, the study found.

"Right now, when you go to the hospital, it's the do-it-yourself model. It's up to you to figure out what to do," said David Grant, author of the study for the California Discharge Planning Collaborative, a group of labor, senior and other advocacy organizations.

Patients, especially those who are elderly and lack social support, are often readmitted because they don't understand their discharge instructions, fail to take their medications or have complications that they can't handle.

Click on the "via" link for the rest of the article.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Thursday, January 13, 2011

CMS 30-minute rule for drug administration needs revision, ISMP.org

In our June 17, 2010 newsletter, we covered a precarious topic best known as the “30-minute rule”—a requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines to administer scheduled medications within 30 minutes before or after the scheduled time (see pages 174-175 at: www.cms.gov/manuals/Downloads/som107ap_a_hospitals.pdf). In our July 2010 nursing newsletter, Nurse Advise-ERR, we asked frontline nurses who are most directly affected by the 30-minute rule to weigh in on the issue by completing a short survey. And WOW, did they ever! More than 17,500 nurses responded to our survey, providing more than 8,000 additional comments (see Table 1 on page 2 of the PDF version of the newsletter), making it very clear that the issue is of great significance to nurses.

Respondent profile and compliance rates
Almost half of the responding nurses work on medical/surgical units, and the other half work in critical care, telemetry, or specialty inpatient units. Most nurses feel that the 30-minute rule is unsafe, unrealistic, impractical, and virtually impossible to follow. Approximately three out of four respondents (70%) told us their organization enforces such a policy. Of these nurses, only five of every 100 (5%) were always able to comply with the policy, while more than half (59%) were infrequently or only sometimes compliant (see Graph 1 on page 6 of the PDF version of the newsletter). Why nurses find it difficult to comply with the 30-minute rule was expressed by many (see Table 2 on page 3 of the PDF version of the newsletter), including a nurse who sent a pragmatic yet eloquent account of a Day in the Life of a Nurse (see Sidebar that follows this article). 

Click on the link above to read the full article:

See also http://www.nursefriendly.com/addictions

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Saving Grace (Emergency Department Nurses)- LA Times Magazine

“I heard a guttural scream,” Rich says, “and a man was handing me his lifeless son.”

“How old?” I ask.

“Nine months. We worked on him for over an hour.”

Rich moves his chair, coughs. It’s freezing in the conference room. [Note: For privacy, nurses are mentioned only by first name.] The muffled din of the emergency room is audible through closed metal doors. It’s 7 a.m., and Rich’s 12-hour shift has just ended. “I flashed to something I heard once about how a casket doesn’t weigh very much—just enough to break a father’s heart,” he says, “and I lost it. I’m standing there, between beds one and two holding that dead baby, and I’m sobbing. I am in charge, and I’m crying.”

As an 11-year volunteer in Cedars-Sinai Medical Center’s emergency room, I’ve seen close up what ER nurses deal with. It takes rare emotional courage not to burn out when you know that every time those doors open—whether you are working triage in front, where a guy may stumble in with a heart attack, or in back, where paramedics may race in with a girl who has been knifed or shot—it’s bad news. Then there’s the physical strength required to survive 12-hour shifts with two half-hour breaks and 45 minutes for lunch. ER nurses never sit. But it’s the children—every ER nurse will tell you—who take the biggest toll

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Wednesday, January 12, 2011

Nurse and Doctor, Neighbor and Friend By THERESA BROWN, R.N. - NYTimes.com

“Something there is that doesn’t love a wall,” begins Robert Frost’s poem “Mending Wall,” about two neighbors who meet to repair the gaps and holes in the stone wall separating their properties. They walk on either side of it, picking up and replacing fallen stones as they go.

Theresa BrownJeff Swensen for The New York Times Theresa Brown, R.N.

The poem came to mind one recent day on the oncology floor where I work. It’s a medical oncology floor, where we tend to medical issues that go along with cancer, like giving chemotherapy and dealing with complications of metastatic disease. But it turned out that one of my patients had a serious surgical problem.

Surgical oncology is several flights of stairs below us. Even if they were next door, though, I imagine we’d still be inhabiting different worlds. There’s “med onc” and “surg onc,” and never the twain shall meet.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Monday, January 3, 2011

20 Iconic Nurses Every Nursing Student Should Study | Nursing Schools.net

During your time in nursing school, you're bound to hear the names of countless famous and influential nurses thrown around. But if you're looking for inspiration in your own career or just want to further your education, there are some amazing women and men in the profession you should study. Here are twenty nurses who worked hard, often against the grain of the larger medical community, to change the face of health care in the United States and around the world.

  1. Florence Nightingale: Even if you weren't in nursing school, you more than likely would have heard of this woman, perhaps the most famous nurse in history. Believing that God has called her to be a nurse, Nightingale went against expectations for aristocratic women at the time, pursuing a career rather than marrying and settling down. She is best known in stories for her nursing in the Crimean War, but should also be credited with laying the foundation for modern nursing with the establishment of the St. Thomas Hospital in London, the first secular school of its kind to train and educate nursing students.
  2. Dorthea Dix: Born in 1802, Dix was one of the loudest voices in America when it came to lobbying Congress to improve the treatment and care for the mentally ill in the United States. Inspired by reforms she saw going on in England, Dix moved to establish new facilities and legislation that helped improve the social welfare of the insane both here and abroad. When the Civil War broke out, Dix was appointed Superintendent of Union Army Nurses, providing care to the wounded on both sides of the conflict.
  3. Helen Fairchild: If you want to learn more about the realities of combat nursing during World War I, read through Helen Fairchild's collection of wartime letters to her family. You'll get vivid stories about the horrors and challenges that nurses faced when trying to care for patients who were the victims of sometimes horrific war injuries. After surviving heavy shelling and mustard gas on the battlefield in France, Fairchild would die from complications during an ulcer surgery after only five years as a nurse.

To read the complete article click on the above link:
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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Wednesday, December 29, 2010

Study: Surgical Delays Have Profoundly Adverse Impact | National Nursing News

A new study emphasizes why caregivers must work to minimize delays in certain elective surgical procedures for patients who have been admitted to the hospital.

Delays substantially increase the risk of infectious complications and raise hospital costs, according to a comprehensive study in the December issue of the Journal of the American College of Surgeons.

Using a nationwide sample of 163,006 patients ages 40 and older between 2003 and 2007, the authors evaluated patients who developed postoperative complications after one of three high-volume elective surgical procedures: coronary bypass graft, colon resections and lung resections.

For each type of procedure, according to the researchers, infection rates increased significantly from those performed on the first day of admission to those performed a day later, two to five days later and six to 10 days later. With each procedure, there was a difference of at least 10 percentage points between infection rates performed on the day of admission and those performed six to 10 days later.

Delays also increased total hospital costs from $36,079 to $47,5237 for CABG, $20,265 to $29,887 for colon resections and $26,323 to $30,571 for lung resections.

The occurrence of infection after surgical procedures remains a major source of ill health and expense despite extensive prevention efforts via educational programs, clinical guidelines and hospital policies, according to the researchers.

The analysis “confirms a direct correlation between delaying procedures and negative patient outcomes,” lead author Todd R. Vogel, MD, MPH, FACS, assistant professor of surgery at the University of Medicine & Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, said in a news release.

“As pay-for-performance models become increasingly prevalent, it will be imperative for hospitals to consider policies aimed at preventing delays and thereby reducing infection rates.”

Patients more likely to experience in-hospital surgical delays were age 80 and older, female and minorities. They had existing health issues such as congestive heart failure, chronic pulmonary disease and renal failure.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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Thursday, December 23, 2010

6 Tips to Survive Your First Year as a Hospital RN - Nursing Link

The first year on the job is often the toughest for new nursing graduates, especially those who work in hospitals. In fact, new nurse graduates account for more than half of the turnover rate in some hospitals, according to a study published in 2007 by Johns Hopkins University School of Nursing researchers.

“There really are multiple reasons for [the first-year exodus],” says Patricia Benner, RN, PhD, professor at the University of California, San Francisco and a senior scholar at the Carnegie Foundation for the Advancement of Teaching. “One is that nursing practice is incredibly complex. Over the past 60 years, the transfer of responsibility to nursing from medicine has been incredible. I think society doesn’t typically recognize that.”

Because the sickest patients are in the hospital, hospital RNs need good clinical judgment and the ability to recognize when a patient needs immediate intervention — challenges that are especially pronounced in a nurse’s first year of employment.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

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Sunday, December 19, 2010

Everything about medicine is now big business, KevinMD

Med­i­cine used to be different. Doc­tors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.

Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas any­more.

After witnessing our “health­care reform” process you must have seen that almost every­thing about med­i­cine is now big business. If you don’t know that by now, you’re not paying attention.

Yes there are still some “little guys” out there, but they’re playing by big business’ rules. What does that mean for you? Hang on, I’m coming to that.

Now it’s often said ” the first rule of business is to stay in business.” It’s not wrong either.

Click on the link above for the full article

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Andrew Lopez, RN
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38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Wednesday, December 15, 2010

Cancer patients die too often in hospitals, study says - The Boston Globe

Researchers at the Dartmouth Atlas Project in Lebanon, N.H., analyzed the records of 235,821 Medicare patients ages 65 and older who died between 2003 and 2007. Overall, the researchers found that one-third of patients spent their last days in hospitals and intensive-care units. But there was a big range. At one end was Manhattan, where 46.7 percent died in the hospital. In contrast, 7 percent of cancer patients died in the hospital in Mason City, Iowa.

While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher — more than 10 percent — in some places, the researchers found.

Similarly, more than 18 percent of cancer patients were placed on a feeding tube or received cardiopulmonary resuscitation in their last two weeks of life in Manhattan, compared with less than 4 percent in Minneapolis.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

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Sunday, December 5, 2010

Hospitals should not ban access to social media

by Howard Luks, MD

“Instead of focusing on treating him, an employee said, St. Mary nurses and other hospital staff did the unthinkable: They snapped photos of the dying man and posted them on Facebook.”

What can you say about an article like this? I bet there is not a single physician or nurse who are not reasonably conversant about the basic tenets of the health care privacy laws under which they practice.

Stupid is as stupid does. Perhaps more appropriately, stupidity is demonstrated by the actions of the one — or in the case, the many.

It still amazes me that people do not realize what the implication of hitting the “Enter” or “Post” or “Like” button is in our connected global society. In the health care space it is obvious that there are still a handful of doctors, nurses, orderlies, and ancillary providers who still don’t get it.

But what should an institution’s policy be? Ban access on the network? Perhaps naive, but my answer to that is a resounding no. Most people still have smart phones with WiFi or 3G access and can just as easily post to Facebook or Twitter and I doubt that the hospital’s liability is diminished.

Hospitals need to embrace social media, develop a comprehensive social media engagement policy, educate their staff, set acceptable parameters, track or monitor usage, remain vigilant and continue with the education process in perpetuity as social media is fluid and evolving and changing everyday.

Education, clarity, transparency and engagement is the key.  Not banning access.

Howard Luks is an orthopedic surgeon who blogs at The Orthopedic Posterous.

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856-415-9617, (fax) 415-9618

Wednesday, November 17, 2010

Children's Hospital launches 'zero errors' initiative

Reeling from the deaths of two children due to medication errors, the staff of Seattle Children's Hospital devoted Saturday to special training designed to prevent a recurrence of the tragedies.

"It's so very important that we never forget that we harmed these children," said Pat Hagan, president of Children's Hospital. "We were all devastated by this when it happened. It struck us at our core."

Hagan said the patient deaths have been a "great, great tragedy for these families," and "a profound tragedy" for the hospital staff.

"We never want to forget how this feels. That feeling is going to be what drives us to continue to find ways to improve what we do here," he said.

Over 550 doctors, nurses, pharmacists and other staff members gathered at Children's for a special Patient Safety Day to address the medication errors that caused two deaths over the past 18 months.

More than 28 patient safety sessions were held, including 11 devoted to medication safety.

But first, participants gathered together in the morning to remember the two small patients who died.

"How we emerge from this situation today and over the coming months will be the real test of us as an organization," said Thomas Hansen, the hospital's CEO. "As I look around this room, I'm confident that we have the best and brightest people to rise to this challenge."

He told the staff "we must strive for zero errors, this must be our promise."

The day's sessions included topics such as decreasing verbal orders and increasing the safety of verbal orders when they are necessary, standardizing medications located on care units, ordering, dispensing and administration of high-risk medications, interruptions, provider-to-provider hand-offs and communication, ambulance transport and patient safety training using simulation.

Hospital spokesperson Louise Maxwell said Children's also is fully cooperating with state investigations of the recent medication errors and has made a number of improvements to decrease the chance of errors.

The hospital has also initiated a re-evaluation of the entire medication delivery system and launched a detailed analysis to determine why usual safety processes failed in each of the medication error cases.

Hospital officals said Saturday's special training did not affect care for patients or others needing urgent or emergency services.

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Tuesday, November 16, 2010

Hospital care fatal for some Medicare patients - USATODAY.com

An estimated 15,000 Medicare patients die each month in part because of care they receive in the hospital, says a government study released today.

The study is the first of its kind aimed at understanding "adverse events" in hospitals — essentially, any medical care that causes harm to a patient, according to the Department of Health and Human Services' Office of Inspector General.

Patients in the study, a nationally representative sample that focused on 780 Medicare patients discharged from hospitals in October 2008, suffered such problems as bed sores, infections and excessive bleeding from blood-thinning drugs, the report found. The federal Agency for Healthcare Research and Quality called the results "alarming."

"Reducing the incidence of adverse events in hospitals is a critical component of efforts to improve patient safety and quality care" in the U.S., the inspector general wrote.

The findings "tell us exactly what some of us have been afraid of, that we have not made much progress," said Arthur Levin, director of the independent Center for Medical Consumers and a member of an Institute of Medicine committee that wrote a landmark 1999 report on medical errors. "What more do we have to do to make sure that sick people can rest assured that they're not going to be harmed by the care they're getting?"

Among the findings in the report obtained by USA TODAY:

•Of the 780 cases, 12 patients died as a result of hospital care. Five were related to blood-thinning medication.

Two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from oversedation.

•About one in seven Medicare hospital patients — or about 134,000 of the estimated 1 million discharged in October 2008 — were harmed from medical care.

•Another one in seven experienced temporary harm because the problem was caught in time and reversed.

About 47 million Americans are enrolled in Medicare, a government health insurance program for people 65 and older and those of any age with kidney failure.

The adverse events found in the study weren't necessarily due to medical mistakes, said Lee Adler, a University of Central Florida medical professor who was involved in the study. For example, he said, an allergic reaction to a penicillin injection is an adverse event, but it's a medical error only if the patient's allergy was known prior to the shot.

Among the problems identified in the report were Medicare patients who had excessive bleeding following surgery or a procedure. For example, one patient had excessive bleeding after his kidney dialysis needle was inadvertently removed, which resulted in circulatory shock and an emergency insertion of a tube to allow breathing.

When the tube was removed the next day, the patient inhaled foreign material into his lungs and needed lifesaving medical help, the report said.

Peter Pronovost of Johns Hopkins University, co-author of the book Safe Patients, Smart Hospitals, said medical mistakes are "an enormous public- health problem."

"We spend two pennies trying to deliver safe health care for every dollar we spent trying to develop new genes and new drugs," Pronovost said. "We have to invest in the science of health care delivery."

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Monday, November 15, 2010

JAMA -- Abstract: Fall Prevention in Acute Care Hospitals: A Randomized Trial, November 3, 2010, Dykes et al. 304 (17): 1912

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Fall Prevention in Acute Care Hospitals

A Randomized Trial

Patricia C. Dykes, RN, DNSc; Diane L. Carroll, RN, PhD, BC; Ann Hurley, RN, DNSc; Stuart Lipsitz, ScD; Angela Benoit, BComm; Frank Chang, MSE; Seth Meltzer; Ruslana Tsurikova, MSc, MA; Lyubov Zuyov, MA; Blackford Middleton, MD, MPH, MSc

JAMA. 2010;304(17):1912-1918. doi:10.1001/jama.2010.1567

Context  Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls.

Objective  To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals.

Design, Setting, and Patients  Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).

Intervention  The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients' specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.

Main Outcome Measures  The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.

Results  During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries.

Conclusion  The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.

Trial Registration  clinicaltrials.gov Identifier: NCT00675935


Author Affiliations: Partners HealthCare System (Drs Dykes and Middleton, Ms Benoit, and Messrs Chang and Meltzer), Brigham and Women's Hospital (Drs Dykes, Hurley, Lipsitz, and Middleton, and Ms Tsurikova), Harvard Medical School (Drs Dykes, Lipsitz, and Middleton), and Massachusetts General Hospital (Dr Carroll and Ms Zuyov), Boston.

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Themes of Aging: Preserving Function, Improving Care
Winker
JAMA 2010;304:1954-1955.
FULL TEXT  


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