Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices

Abstract

Problem: Rehabilitation nurses know the impact of injury on function, independence, and quality of life, complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, and social and financial resources. Multidisciplinary teams are essential to provide expert, age specific health care delivery to this vulnerable population across settings of care. Purpose: The purpose of this article is to apply level of evidence rating scales to identify the best practice interventions to prevent falls on rehabilitation units. Key Findings and Clinical Relevance: The evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Current state of fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation

“…Our results indicated that fall prevention/management policies and procedures in SCI rehabilitation were similar to those implemented in acute care settings [22]. Fall prevention/management policies and procedures from the organizations sampled were formed at an organizationallevel, as there was limited evidence for unit-level or population-specific fall prevention/management strategies [3,23]. However, it has been suggested that the current fall prevention evidence fails to support the specialty needs of rehabilitation, and specifically SCI rehabilitation [12,23].…”

“…The lack of direction for assessing the risk of falls in rehabilitation settings [23] is demonstrated in our analysis. For instance, all sites used different risk assessments.…”

“…Fall prevention/management policies and procedures from the organizations sampled were formed at an organizationallevel, as there was limited evidence for unit-level or population-specific fall prevention/management strategies [3,23]. However, it has been suggested that the current fall prevention evidence fails to support the specialty needs of rehabilitation, and specifically SCI rehabilitation [12,23]. Higher rates of falls in rehabilitation settings compared to acute care are suggestive of a need for high quality fall prevention research in rehabilitation units.…”

“…Another difference we noted between fall prevention/ management policies and procedures in SCI rehabilitation settings was related to the classifications of falls. A classification of a fall is needed to understand the root causes, and to tailor interventions [23,28]. Inconsistent fall classifications can be a barrier to comparing falls between organizations.…”

“…Our document review suggested that falls in SCI rehabilitation were regularly tracked on incident reports and discussed in post-fall debriefs. In addition to informing individualized fall prevention plans [23], incident reports can inform fall prevention improvement efforts within the parent organization. For example, the analysis of incident reports could identify fall hazards and identify the targets for fall prevention initiatives [25].…”