Background: Patient falls in hospitals account for a high proportion of adverse events. Assessing patient risk is a vital part of a fall prevention program. When a fall risk assessment tool is used, it is imperative to use one which is suitable for the hospital. Objective: The purpose of this study was to test the predictive validity of the Morse Fall Scale (MFS) by assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) on medicine units in an acute care hospital. Methods: Patient MFS scores were obtained from the medicine units. A total of 500 patient scores were collected along with a number of falls which occurred within 7 days of the fall risk assessment. Data were collected from November 2014 to March 2015. The setting was a large teaching hospital located in Ontario, Canada. Results: Using a cutoff point of 25 on the MFS, the sensitivity was 98% and the specificity was 8%. The PPV was 10% and the NPV was 97%. An MFS cutoff point of 55 provided the most balanced measure of sensitivity (87%) and specificity (34%) for accurate identification of fall risk. Conclusions: Findings suggest a change in practice is warranted as the values showed a poor balance between the sensitivity and specificity range. Recommendations for changes in practice include: changing the screening tool cutoff point from 25 to 55, or removing the use of a screening tool and assessing the risk by using another method.
Background: The increasing number of falls in hospitals precipitates the need to collect and analyze falls data. Hospital falls data have been captured through staff documentation and incident reporting systems. Objective: The purpose of this study was to identify the variables associated with falls and injurious falls in an acute care hospital over the five years from the implementation of the Adverse Event Management System (AEMS). A secondary purpose was to identify problems associated with the AEMS. Methods: Falls data recorded in the AEMS system from February 2009 to February 2014 were analyzed to observe trends of falls and contributing factors occurring in various hospital units. Results: A total of 7,721 falls occurred during the study period. The highest frequency of the falls (901) occurred between 10:00 a.m. and 12:00 p.m. There were 2,275 falls which resulted in an injury. Both total fall and injurious fall rates were highest in Medicine inpatient units and lowest in Ambulatory outpatient units. The falls rate was 4.5 falls per 1,000 patient days in 2009 and 4.4 falls per 1,000 patient days in 2014. The prevalence of falls varied among nursing unit types and the time of day but the fall rate across the hospital did not change over the five year period. Conclusions: Continuous evaluation of falls data and improved staff education is recommended to help reduce falls in acute care hospitals. A province-wide database registry should be considered for future research on incident reporting.
Falls are a constant risk for patients in acute-care hospitals, which can lead to serious consequences. The purpose of this study was to examine hospital fall case studies and to learn the contributing factors for patient falls. This was achieved by conducting a secondary analysis of 11 fall case studies obtained from two previous studies. The fall cases used the Senior Falls Investigative Methodology (SFIM) approach, which provided detailed analysis of the circumstances surrounding the falls. A total of 549 contributing factors were identified in the 11 case studies, where major categories were classified according to the four different layers of defenses using Reason's Swiss Cheese Model of Accident Causation (organizational factors, supervision, preconditions, and unsafe acts). Hospital policies, reduced supervision, disease processes, the environment, and patients transferring without assistance dominated the reasons for increased risk. Additional strategies were recommended for all layers of defense to reduce patient falls.
This paper provides an integrated discussion of the literature that addresses the effect of communication strategies on dementia care and caregiver burden. With the complexity and multiple symptoms associated with dementia, caregivers are exposed to increased burden which can affect their own health and wellbeing. Communication has been found to be a key to reducing burden and improving the quality of life for the person with dementia (PWD) and their caregiver. The literature review examines current and previous literature in order to acknowledge and synthesize the existing work done, and to identify areas for future research. The material was drawn from three databases; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed and PsycINFO. The literature search was restricted to relevant studies published in English and available through electronic sources between 2000 and 2017. The search yielded 22 studies. Fourteen studies met the inclusion criteria. These studies focused on the use of communication strategies within the context of caregiver burden in dementia care. The qualitative and quantitative studies addressed verbal and nonverbal techniques used to guide caregivers in their communication with PWD and to decrease caregiver burden. The results of the review illustrate the importance of using effective communication techniques for PWD. It shows that using specific strategies improves relationships between caregivers and PWD and effective communication techniques reduce caregiver burden. The importance and significance of these findings indicate the need for further research in the effects that communication have on dementia and caregiver burden.
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