REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial

Sahota, Opinder; Drummond, Avril; Kendrick, Denise; Grainge, Matthew J.; Vass, Catherine D.; Sach, Tracey; Gladman, John; Avis, Mark

doi:10.1093/ageing/aft155

Cited by 77 publications

(102 citation statements)

References 22 publications

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“…Although conceptually attractive, the use of movement alarms (bed or chair alarms) has not been successful in reducing fall rates. 6 In common with community-based trials, more promising results are seen when the complex multiple components of risk are accounted for in assessment and managed through relevant interventions. Systematic reviews have consistently suggested that multifactorial assessments linked to appropriate interventions may reduce falls in hospital by 20-30%.…”

Section: Can Falls In Hospital Be Prevented?mentioning

confidence: 99%

Prevention of falls in hospital

Morris

O'Riordan²

2017

Clinical Medicine

103

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Falls among inpatients are the most frequently reported safety incident in NHS hospitals. 30-50% of falls result in some physical injury and fractures occur in 1-3%. No fall is harmless, with psychological sequelae leading to lost confi dence, delays in functional recovery and prolonged hospitalisation. Yet falls are not true accidents and there is evidence that a coordinated multidisciplinary clinical team approach can reduce their incidence. Identifi cation of multiple underlying risk factors coupled with clear interventions to ameliorate the impact of each has been shown to reduce the incidence of inpatient falls by 20-30%. The implementation of complex multiprofessional interventions is challenging and successful schemes seek to nurture a culture of vigilant safety consciousness in all staff at the clinical interface. Strong leadership and organisational oversight help to combine this cultural evolution with relevant evidence and rigorous measurement of performance in order to improve patient safety. The results of national audit suggest that NHS acute hospitals could do more to reduce the incidence of falls among inpatients.

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Section: Can Falls In Hospital Be Prevented?mentioning

confidence: 99%

Prevention of falls in hospital

Morris

O'Riordan²

2017

Clinical Medicine

103

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“…Furthermore, recent literature suggests pressure-sensitive devices and alarms have little to no effect on fall-related events in hospitals. 16,17 In the current study, most nursing homes use similar devices and alarms, however one nursing home is currently pilot testing an alarm-free initiative, which seems to be a growing phenomenon. 18,19 …”

Section: Discussionmentioning

confidence: 91%

Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes

et al. 2018

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Background We sought to understand strategies reported by members of the nursing home management team are used to prevent falls in short-stay nursing home patients. Design, Setting, and Subjects Using Donabedian’s model of structure, process, and outcomes we conducted interviewed six-teen managers from four nursing homes in central North Carolina. Results Nursing home managers identified specific barriers to fall prevention among short-stay patients including: rapid changes in functional and cognitive status, staff unfamiliarity with short-stay patient needs and patterns, and policies impacting care. Few interventions for reducing falls among short-stay patients were employed at the structure-level (e.g., specialized units, workload ratio, and staffing consistency); however many process-level interventions were employed (e.g., patient education on problem-solving, self-care/mobility, and safety). Conclusion We described several barriers to fall prevention among short-stay patients in nursing homes. From these descriptions, we propose three interventions that might reduce falls for short-stay patients and could be tested in future research: 1) clustering short-stay patients within a physical location to permit higher staff-patient ratios and enhanced surveillance; 2) population-based prevention interventions to supplement existing individually-tailored prevention strategies (e.g., toileting schedules, medication review for all); and 3) transitional care interventions that transmit key information from hospitals to nursing homes.

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“…A reductionistic focus on one element of a system is insufficient to mitigate a complex adverse outcome such as a patient fall . Consequently, randomized controlled trials of individual processes such as use of bed/chair pressure sensors, low‐low beds, and patient education have not significantly decreased fall risk. Bundling multiple processes may decrease fall risk by 30 percent, but the ideal combination of processes and the most effective implementation structure remains unknown …”

Section: Introductionmentioning

confidence: 99%

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

Jones

Skinner

Venema

et al. 2019

Health Services Research

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Objective To evaluate the implementation and outcomes of evidence‐based fall‐risk‐reduction processes when those processes are implemented using a multiteam system (MTS) structure. Data Sources/Study Setting Fall‐risk‐reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall‐event reporting system to drive improvement. Study Design A one‐group pretest‐posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall‐event reporting system. Data Collection Hospitals used gap analyses to assess the presence of fall‐risk‐reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall‐event data throughout the study. Principal Findings The extent to which hospitals implemented 21 processes to coordinate the fall‐risk‐reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end‐of‐study period (January 2014‐July 2014). Bedside fall‐risk‐reduction processes were not significant predictors of these outcomes. Conclusions Multiteam systems that effectively coordinate fall‐risk‐reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.

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REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial

Cited by 77 publications

References 22 publications

Prevention of falls in hospital

Prevention of falls in hospital

Management Team Perceptions of Risks and Strategies for Preventing Falls Among Short-Stay Patients in Nursing Homes

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

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