Fall prevention in hospitals and nursing homes: Clinical practice guideline

Abstract

Background: Falls and their consequences are particularly common in older adults in hospitals and long-term care (LTC) facilities. Aim:To avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed. Methods:The development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta-analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions. Results: A total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low-floor beds in hospitals, or body exercise interventions in frail residents.Linking Evidence to Action: During the development of this guideline, particular attention was paid to collecting evidence-based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling.Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low-floor beds, alarm sensor systems, medication review, and staff education in hospitals.

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen

“…The second issue is the nurses’ decision to use a bed alarm. Systematic reviews indicated that the use of bed alarms did not reduce the rate of falling [ 40 , 41 ], or even increased it [ 42 ]. As indicated in the findings, a bed alarm is difficult to manage, especially for those who attempt to escape from it (e.g., by disconnecting the alarm).…”

Analyzing a Multifactorial Fall Prevention Program Using ARIMA Models

“…A multifactorial approach to the fall prevention program was used and contributed to a decrease in falls over time 8. The results suggest that the July 2017 intervention of tailoring universal fall precautions to include the ABCs and standardized nursing education had the largest immediate effect on total fall rates (−1.029) 8. The ABCs promoted a simple bundled approach to fall prevention that was universal (applying to each patient) and improved awareness of a patient's fall risk.…”

“…7 Another clinical practice guideline strongly recommended multifactorial interventions, body exercise interventions, and staff education interventions. 8 Multifactorial interventions were defined as interventions that consisted of more than 2 fall prevention measures. 8 Understanding risk factors will inform fall prevention strategies to reduce recurrent falls.…”

“…8 Multifactorial interventions were defined as interventions that consisted of more than 2 fall prevention measures. 8 Understanding risk factors will inform fall prevention strategies to reduce recurrent falls. After analyzing 25 510 inpatient falls, the common risk factors were cognitive impairment, ambulating assistance, altered elimination, and dizziness, the most common factor being ambulating to the bathroom.…”

“…Most guidelines strongly recommend performing risk assessments, risk stratification, multifactorial interventions, medication reviews, exercise promotion, environmental modifications, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions 7. Another clinical practice guideline strongly recommended multifactorial interventions, body exercise interventions, and staff education interventions 8. Multifactorial interventions were defined as interventions that consisted of more than 2 fall prevention measures 8.…”