This study piloted a hospital-based delirium and falls education program to investigate the impacts on staff knowledge and practice plus patient falls. On a medical ward, staff knowledge was compared before and after education sessions. Other data -collected a day before and after program implementation -addressed documentation of patients' delirium and evidence of compliance with falls risk minimization protocols. These data, and numbers of patient falls, were compared before and after program implementation. Almost all ward staff members participated in education sessions (7 doctors, 7 allied health practitioners, and 45 nurses) and knowledge was significantly improved in the 22 who completed surveys both before and after session attendance. Patients assessed as having delirium (5 before implementation, 4 afterwards) were all documented as either confused or delirious. Small changes eventuated in adherence with falls risk management protocols for confused patients and the number of falls decreased. The program merits a stronger emphasis on staff activities relating to the detection, documentation, and management of delirium to inter-professional roles and communication. Evidence of practice enhancement from program implementation should precede rigorous testing of impacts upon falls.

Objective: To reduce the time between arrival at hospital of a patient with acute myocardial infarction and administration of thrombolytic therapy (door to needle time) by the introduction of nurse initiated thrombolysis in the accident and emergency department. Methods: Two acute chest pain nurse specialists (ACPNS) based in A&E for 62.5 hours of the week were responsible for initiating thrombolysis in the A&E department. The service reverts to a "fast track" system outside of these hours, with the on call medical team prescribing thrombolysis on the coronary care unit. Prospectively gathered data were analysed for a nine month period and a head to head comparison made between the mean and median door to needle times for both systems of thrombolysis delivery. Results: Data from 91 patients were analysed; 43 (47%) were thrombolysed in A&E by the ACPNS and 48 (53%) were thrombolysed in the coronary care unit by the on call medical team. The ACPNS achieved a median door to needle time of 23 minutes (IQR=17 to 32) compared with 56 minutes (IQR=34 to 79.5) for the fast track. The proportion of patients thrombolysed in 30 minutes by the ACPNS and fast track system was 72% (31 of 43) and 21% (10 of 48) respectively (difference=51%, 95% confidence intervals 34% to 69%, p<0.05). Conclusion: Diagnosis of acute myocardial infarction and administration of thrombolysis by experienced cardiology nurses in A&E is a safe and effective strategy for reducing door to needle times, even when compared with a conventional fast track system.

Background: Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of interprofessional collaboration. Methods: Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. Results: From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. Conclusion: Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.

Older patients in hospitals are at high risk of falls. Patient sitters are sometimes employed to directly observe patients to reduce their risk of falling although there is scant evidence that this reduces falls. The primary aim of this pilot survey (n = 31) was to explore the patient sitters' falls prevention capability, self-efficacy and the barriers and enablers they perceived influenced their ability to care for patients during their shifts. Feedback was also sought regarding training needs. Most (90%) participants felt confident in their role. The most frequent reasons for falls identified were patient-related (n = 91, 64%), but the most frequent responses identifying preventive strategies were environment-related (n = 54, 64%), suggesting that the sitters' capability was limited. The main barriers identified to keeping patients safe from falling were patient-related (n = 36, 62%) such as cognitive impairment. However, opportunities that would enable sitters to do their work properly were most frequently categorized as being staff-related (n = 20, 83%), suggesting that the sitters have limited ability to address these barriers encountered. While 74% of sitters reported they had received previous training, 84% of participants would like further training. Patient sitters need more training, and work practice needs to be standardized prior to future research into sitter use for falls prevention.

Rationale, Aims, and Objectives: Patient sitters provide one-to-one care for hospital patients at high risk of falls. The study aimed to explore patient sitters' task readiness to assist in fall prevention on hospital wards. Method:We conducted a cross-sectional survey. Respondents were patient sitters working in five hospitals providing medical, surgical, and aged care. The survey was developed using a theory of health behaviour change and used closed and openended items. Qualitative data were analysed using deductive content analysis.Results: Participants (n = 90) identified that patient factors, such as confusion, were the most frequent cause of falls (n = 338, 74%); however, the most frequent strategies identified to prevent falls were focused on the environment (n = 164, 63%). The most frequent barrier participants identified to preventing falls (n = 124, 67%) also pertained to patients, including aggressive patient behaviours. In contrast, staff factors, such as handovers being adequate, were identified as the main enabler for sitters being able to complete their tasks effectively (n = 60, 81%). Participants strongly suggested (71%) that further, preferably practical, training would be helpful, even though 84% reported receiving prior fall prevention training. Nearly all participants (98%) were motivated to prevent their patients from falling. Conclusions:There is a gap between what patient sitters report as the cause of falls (patient factors) and what was suggested to prevent falls (environment factors). Education and practical training addressing challenging patient behaviours may improve sitters' task readiness to assist in preventing falls on wards. Improving communication and cooperation between patient sitters and nursing staff is also important.