Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls—A Quality Improvement Project

Cook, Nicole S.; Komansky, Brittany; Urton, Michael

doi:10.1016/j.jen.2020.03.007

Cited by 4 publications

(21 citation statements)

References 18 publications

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“…Twelve studies assessed delivery of a MFRA as documented in clinical records with improvement postintervention reported in 11 studies (15, 18, 20-22, 28, 29, 31, 32, 35, 42), encompassing paper-based and HIT tools. One study found MFRA delivery was consistent pre-and post-intervention (19). Documentation of a care plan in clinical records was reported in seven studies (15,18,31,32,35,40,42).…”

Section: At Risk Behavioursmentioning

confidence: 98%

“…Nine studies described that the MFRA and care plans were integrated into the Electronic Healthcare Record (EHR), digitising documentation of falls prevention practices (15,19,22,32,33,35,36,41,42).…”

Section: At Risk Behavioursmentioning

confidence: 99%

“…There was a paucity of data detailing staff experiences using MFRA tools, although some studies provided an explanation as to why particular tools were chosen, e.g., to reduce variation in the assessment content by providing a standardised structure (32), and to improve risk identi cation by introducing items tailored to the patient population (17,19,33). Some authors suggested tools may work simply by drawing staff attention to required practices, acting as a prompt (21,26,29).…”

Section: Why and In What Circumstances Do Tools Facilitate Falls Prev...mentioning

confidence: 99%

“…Ten studies described use of published tools such as the Morse Fall Scale (16,18,(23)(24)(25)32), the Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT) (33), the Fall Risk for Older People (FROP) (37) and KINDER 1 (19,41). Seven studies described locally developed tools e.g., developed through review of the falls literature and/or identifying common risk factors on a particular unit (17,21,26,28,(34)(35)(36).…”

Section: Cmoc 1: Facilitation Via Toolsmentioning

confidence: 99%

“…There was some data to suggest that staff responded well to tools that provided space to document clinical judgement, particularly where strati cation (a practice no longer recommended by NICE) was used. For example, a hybrid tool recommended remote video monitoring to patients strati ed as high risk of falls (19). The authors reported that staff felt empowered by a clinical judgement item to allocate this intervention to patients most in need and according to resources available.…”

Section: Why and In What Circumstances Do Tools Facilitate Falls Prev...mentioning

confidence: 99%

See 4 more Smart Citations

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: A realist review

Alvarado

McVey

Wright

et al. 2023

Preprint

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Background Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions. Methods A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOc’s, and (3) following prioritisation of CMOc’s, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration: PROSPERO: CRD42020184458

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Section: At Risk Behavioursmentioning

confidence: 98%

Section: At Risk Behavioursmentioning

confidence: 99%

Section: Why and In What Circumstances Do Tools Facilitate Falls Prev...mentioning

confidence: 99%

Section: Cmoc 1: Facilitation Via Toolsmentioning

confidence: 99%

Section: Why and In What Circumstances Do Tools Facilitate Falls Prev...mentioning

confidence: 99%

See 3 more Smart Citations

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: A realist review

Alvarado

McVey

Wright

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

A short multi-factor screening tool to assess falls-risk in older people presenting to an Australian emergency department: A feasibility study

Fulbrook,

Miles,

McCann

et al. 2023

International Emergency Nursing

View full text Add to dashboard Cite

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review

et al. 2023

View full text Add to dashboard Cite

Background Falls are the most common safety incident reported by acute hospitals. In England national guidance recommends delivery of a multifactorial falls risk assessment (MFRA) and interventions tailored to address individual falls risk factors. However, there is variation in how these practices are implemented. This study aimed to explore the variation by examining what supports or constrains delivery of MFRAs and tailored interventions in acute hospitals. Methods A realist review of literature was conducted with searches completed in three stages: (1) to construct hypotheses in the form of Context, Mechanism, Outcome configurations (CMOc) about how MFRAs and interventions are delivered, (2) to scope the breadth and depth of evidence available in Embase to test the CMOcs, and (3) following prioritisation of CMOcs, to refine search strategies for use in multiple databases. Citations were managed in EndNote; titles, abstracts, and full texts were screened, with 10% independently screened by two reviewers. Results Two CMOcs were prioritised for testing labelled: Facilitation via MFRA tools, and Patient Participation in interventions. Analysis indicated that MFRA tools can prompt action, but the number and type of falls risk factors included in tools differ across organisations leading to variation in practice. Furthermore, the extent to which tools work as prompts is influenced by complex ward conditions such as changes in patient condition, bed swaps, and availability of falls prevention interventions. Patient participation in falls prevention interventions is more likely where patient directed messaging takes individual circumstances into account, e.g., not wanting to disturb nurses by using the call bell. However, interactions that elicit individual circumstances can be resource intensive and patients with cognitive impairment may not be able to participate despite appropriately directed messaging. Conclusions Organisations should consider how tools can be developed in ways that better support consistent and comprehensive identification of patients’ individual falls risk factors and the complex ward conditions that can disrupt how tools work as facilitators. Ward staff should be supported to deliver patient directed messaging that is informed by their individual circumstances to encourage participation in falls prevention interventions, where appropriate. Trial registration PROSPERO: CRD42020184458.

show abstract

Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls—A Quality Improvement Project

Cited by 4 publications

References 18 publications

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: A realist review

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: A realist review

A short multi-factor screening tool to assess falls-risk in older people presenting to an Australian emergency department: A feasibility study

Exploring variation in implementation of multifactorial falls risk assessment and tailored interventions: a realist review

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