Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study

Duckworth, Megan; Adelman, Jason S.; Belategui, Katherine; Feliciano, Zinnia; Jackson, Emily; Khasnabish, Srijesa; Lehman, I-Fong Sun; Lindros, Mary Ellen; Mortimer, Heather; Ryan, Kasey; Scanlan, Maureen; Spivack, Linda Berger; Yu, Shao; Bates, David W.; Dykes, Patricia C.

doi:10.2196/10008

Cited by 34 publications

(111 citation statements)

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“…This translated into a clinically significant patientcentered Fall TIPS intervention in all study units. 20 In the adjusted analysis, the overall fall rate in study units decreased from 2.92 falls per 1000 In the adjusted analysis, the overall injurious fall rate in study units decreased from 0.73 injurious falls per 1000 patient-days (95% CI, 0.59-0.92 falls per 1000 patient-days) before implementation to 0.48 injurious falls per 1000 patient-days (95% CI, 0.34-0.70 falls per 1000 patient-days) in the postintervention period. After adjustment for demographics in the Poisson regression model, study units achieved a 34% reduction in overall falls with injury in the postintervention period (adjusted RR, 0.66; 95% CI, 0.53-0.88; P = .003).…”

Section: Resultsmentioning

confidence: 99%

“…Problem analysis: learn about the needs and preferences of patients and providers and other social-technical factors that relate to fall prevention 4. Implementation: conduct a pilot test of fall TIPS and compare for effectiveness in engaging patients and families in the 3-step fall prevention process 15,20 Laminated paper poster 2. Design and 3.…”

Section: Introductionmentioning

confidence: 99%

“…Design and 3. Development: implement content, display, and workflow integration strategies most likely to address requirements and overcome barriers 18,19 EHR Downloaded From: https://jamanetwork.com/ on 11/25/2020 rapid prototyping, computer modeling, and simulation methods to construct the patient-centered Fall TIPS tool kit 18,19 ; (4) implementation and pilot testing of the tool kit in patient care units 19,20 ; and (5) evaluation of the association of the tool kit with patient activation. 21 The end result was a tool kit that included high-tech and low-tech Fall TIPS modalities, can be used by nursing staff and integrated into various hospital workflows, and supports patient activation and engagement in the 3-step fallprevention process.…”

Section: Introductionmentioning

confidence: 99%

“…20,21 Modalities included (1) a laminated paper poster, 19 (2) a tool kit integrated with the electronic health record (EHR), 13 and (3) an electronic bedside screen (e-bedside) display. 20 From September 2014 to September 2015, unit staff were involved in developing, refining, and piloting the intervention, testing its association with patient activation in the fall-prevention plan (phases 1-5 above and Figure 1) and selecting the modality they would implement. At the end of this period, the laminated paper poster and the refined EHR-integrated tool kit modalities were complete.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…3 Recent studies have shown that adequate selfmanagement may minimize the impact of falls in older adults. [9][10][11][12][13][14][15][16] However, research is lacking on why some older adults engage in self-management actions and behaviors to prevent falls while others do not. 15 Research is needed to explore possible barriers and facilitators to engaging older patients in preventing falls post-hospitalization.…”

Section: Introductionmentioning

confidence: 99%

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

Tzeng

Okpalauwaekwe

Lyons

2020

CIA

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Purpose: Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods: We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results: Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COMB dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion: This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.

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Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program

et al. 2023

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ImportanceThere is insufficient research on the costs of patient falls in health care systems, a leading source of nonreimbursable adverse events.ObjectiveTo report the costs of inpatient falls and the cost savings associated with implementation of an evidence-based fall prevention program.Design, Setting, and ParticipantsIn this economic evaluation, a matched case-control study used the findings from an interrupted time series analysis that assessed changes in fall rates following implementation of an evidence-based fall prevention program to understand the cost of inpatient falls. An economic analysis was then performed to assess the cost benefits associated with program implementation across 2 US health care systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adults hospitalized in participating units were included in the analysis. Data analysis was performed from October 2021 to November 2022.InterventionsEvidence-based fall prevention program implemented in 33 medical and surgical units in 8 hospitals.Main Outcomes and MeasuresPrimary outcome was cost of inpatient falls. Secondary outcome was the costs and cost savings associated with the evidence-based fall prevention program.ResultsA total of 10 176 patients who had a fall event (injurious or noninjurious) with 29 161 matched controls (no fall event) were included in the case-control study and the economic analysis (51.9% were 65-74 years of age, 67.1% were White, and 53.6% were male). Before the intervention, there were 2503 falls and 900 injuries; after the intervention, there were 2078 falls and 758 injuries. Based on a 19% reduction in falls and 20% reduction in injurious falls from the beginning to the end of the postintervention period, the economic analysis demonstrated that noninjurious and injurious falls were associated with cost increases of $35 365 and $36 776, respectively. The implementation of the evidence-based fall prevention program was associated with $14 600 in net avoided costs per 1000 patient-days.Conclusions and RelevanceThis economic evaluation found that fall-related adverse events represented a clinical and financial burden to health care systems and that the current Medicare policy limits reimbursement. In this study, costs of falls only differed marginally by injury level. Policies that incentivize organizations to implement evidence-based strategies that reduce the incidence of all falls may be effective in reducing both harm and costs.

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Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study

Cited by 34 publications

References 15 publications

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

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

<p>Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review</p>

Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program

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