Nursefriendly.com: accidental falls

Tuesday, March 29, 2011

Arch Intern Med -- Abstract: Patient Education to Prevent Falls Among Older Hospital Inpatients: A Randomized Controlled Trial, March 28, 2011, Haines et al. 171 (6): 516

Arch Intern Med. 2011;171(6):516-524. doi:10.1001/archinternmed.2010.444
Background Falls are a common adverse event during hospitalizationof older adults, and few interventions have been shown to preventthem.
Methods This study was a 3-group randomized trial to evaluatethe efficacy of 2 forms of multimedia patient education comparedwith usual care for the prevention of in-hospital falls. Olderhospital patients (n = 1206) admitted to a mixtureof acute (orthopedic, respiratory, and medical) and subacute(geriatric and neurorehabilitation) hospital wards at 2 Australianhospitals were recruited between January 2008 and April 2009.The interventions were a multimedia patient education programbased on the health-belief model combined with trained healthprofessional follow-up (complete program), multi-media patienteducation materials alone (materials only), and usual care (control).Falls data were collected by blinded research assistants byreviewing hospital incident reports, hand searching medicalrecords, and conducting weekly patient interviews.

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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 allages, but risk of falls increases markedly with age. Hospitalizationfurther increases risk, yet no evidence exists to support short-stayhospital-based fall prevention strategies to reduce patientfalls.
Objective To investigate whether a fall prevention toolkit (FPTK) using health information technology (HIT) decreasespatient falls in hospitals.
Design, Setting, and Patients Cluster randomized studyconducted January 1, 2009, through June 30, 2009, comparingpatient fall rates in 4 urban US hospitals in units that receivedusual care (4 units and 5104 patients) or the intervention (4units and 5160 patients).
Intervention The FPTK integrated existing communicationand workflow patterns into the HIT application. Based on a validfall risk assessment scale completed by a nurse, the FPTK softwaretailored fall prevention interventions to address patients'specific determinants of fall risk. The FPTK produced bed posterscomposed of brief text with an accompanying icon, patient educationhandouts, and plans of care, all communicating patient-specificalerts to key stakeholders.
Main Outcome Measures The primary outcome was patientfalls per 1000 patient-days adjusted for site and patient careunit. A secondary outcome was fall-related injuries.
Results During the 6-month intervention period, the numberof patients with falls differed between control (n = 87)and intervention (n = 67) units (P=.02). Site-adjustedfall 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 1000patient-days; P = .04). The FPTK was found to be particularlyeffective with patients aged 65 years or older (adjusted ratedifference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days;P = .003). No significant effect was noted in fall-relatedinjuries.
Conclusion The use of a fall prevention tool kit in hospitalunits compared with usual care significantly reduced rate offalls.
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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