Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries

Abstract

IMPORTANCE Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. OBJECTIVE To assess whether a fall-prevention tool kit that engages patients and families in the fallprevention process throughout hospitalization is associated with reduced falls and injurious falls. DESIGN, SETTING, AND PARTICIPANTSThis nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. INTERVENTIONS A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. RESULTS During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P = .01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P = .003). CONCLUSIONS AND RELEVANCEIn this nonrandomized controlled trial, implementation of a fallprevention tool kit was associated with a significant reduction in falls and related injuries. A patientcare team partnership appears to be beneficial for prevention of falls and fall-related injuries.

Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety

“…Both studies were conducted in acute care hospitals in the United States of America and both reported decreased falls and positive findings about using video to engage patients. Similarly, Duckworth et al 31 and Dykes et al 55 evaluated the addition of a multimodal approach (laminated, electronic or bedside display) to present information of a person-centred falls prevention plan (Fall-TIPS) in three large hospitals in the United States of America 31,55 (see Table 1 for effectiveness data).…”

“…50 Promoting confidence and safety proactively: The benefit of increasing patient confidence or empowering patients underpinned the implementation success of the interventions across the continuum of engagement. 30,36,37,49,51,54 The advantages of a proactive approach to enhance safe care were emphasized, 49,51,54,55 along with the need for cultural awareness and sensitivity. 51 Organisational sponsorship: All papers identify the need for an organisational culture that supports transparency and values health consumer input.…”

Development of an algorithm for assessing fall risk in a Japanese inpatient population

“…Clinical nurses need to be sensitive to changes in patient status and judge the risk of falls appropriately. They perform preventive interventions with assessment skills and clinical insights while maintaining clinical vigilance that is commensurate with medical standards 31 . Therefore, a fall risk assessment tool that enables nurses to identify the risk of falls appropriately and quickly in patients, and easily detect changes in patient’s risk is desirable.…”

Effect of baduanjin on the fall and balance function in middle-aged and elderly people

“…In the meta-analysis, the primary outcome measure to evaluate the effect of Baduanjin on fall and balance function in middle-aged and elderly people is fall rate. [ 16 ]…”