<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Abstract

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.

Point of Care Nucleic Acid Testing for SARS-CoV-2 in Hospitalized Patients: A Clinical Validation Trial and Implementation Study

“…10 Inappropriate isolation is a large drain on staff and resources due to the need for repeated deep cleaning, additional personal protective equipment (PPE) utilization and the distress and risk to patients from repeated bed moves. 23 As expected, we observed a significant increase in the availability of isolation or single-occupancy rooms following POC introduction, and patients who tested negative were able to be placed in low-risk areas of the hospital and have interventions and procedures expedited.…”

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

“…Hospital falls prevention strategies include patient education, clinician education, environmental adaptations, the use of assistive devices, therapeutic exercises, medication reviews, optimal nutrition, management of cognitive impairment and falls mitigation policies, systems and leadership [ 1 , 12 , 13 ]. Some examples of systems include post-fall team ‘huddles’ [ 14 ], falls reports at nursing handover [ 15 ], auditing [ 16 ] and reporting monthly falls [ 12 ]. Some of these interventions have been investigated in isolation eg.…”

Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study

“…Furthermore, information about the quality of implementation was not captured through the survey (eg, whether educational interventions were passive vs active). Our survey also did not capture risk factors for falls, such as environmental factors or hospital practices regarding bed moves 48–50. It is also unclear whether the low quality of evidence for many fall prevention interventions11–14 partially explains hospital variation in fall prevention strategies.…”