Meta‐analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population

Abstract

BACKGROUND:Inpatient falls are common adverse events that lead to inpatient injury, increased length of stay, healthcare costs, litigation, and are a focus of patient safety and healthcare quality. Fall prevention methods are currently evolving to address the problem.PURPOSE:To examine the available data evaluating multidisciplinary fall prevention strategies in the acute inpatient setting.DATA SOURCES:A complete literature search of MEDLINE, CINAHL, EMBASE and the Cochrane Library through December 2011 was used. The bibliographies of all systematic reviews and meta‐analyses were hand searched.STUDY SELECTION:Only primary research studies relating to acute care inpatient hospital multidisciplinary fall prevention were included. Selected papers were assessed for quality by 2 authors using a 20‐point scale previously used in the fall literature.DATA EXTRACTION:Each selected study was carefully hand searched by 2 authors for the purposes of data extraction. Study results, in fall rate per 1000‐patient days, and the characteristics of the interventions used were extracted for analysis.DATA SYNTHESIS:Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random‐effects meta‐analysis.CONCLUSIONS:Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

Validation of the STRATIFY Falls Risk Assessment Tool in a Japanese Acute Care Hospital Setting

“…The rate of falls showed an almost two-fold difference between the hospitals with the lowest and highest rates. Previous studies indicated that the rates of falls in acute care hospitals varied between the hospitals, ranging from 2 to 10 per 1,000 patient-days (DiBardino, Cohen, & Didwania, 2012). The difference in the rate of falls among the four hospitals might again be due to the differences in patient background, fall prevention program performed in the hospitals, and underreporting bias of the falls.…”

Not All “Continuous Femoral Nerve Blocks” Are Equivalent

“…[2][3][4] It is a limitation of studies using administrative databases that important information, such as practice management strategies, is often lacking. The lack of association between PNB and in-patients falls in our study may very well relate to systems issues and perhaps selection bias: those hospitals that have had previous problems with falls or lack training in the safe use of PNB may be less likely to use PNB for arthroplasty patients; and those hospitals that use PNBs regularly for arthroplasty may have systems in place to make them work while keeping patients safe, including multidisciplinary fall prevention programs.…”

“…Finally, an additional metaanalysis including 4 randomized, controlled trials and one retrospective cohort study, Johnson et al calculated an odds ratio of 3.9 (p < 0.01) of falling for subjects with a continuous femoral or posterior lumbar plexus block of greater than 12 h (incidence = 2.2%) compared with subjects with either no block, a single-injection block, or a perineural infusion of less than 12 h (incidence = 0.5%). 4 To my knowledge, there are no data contradicting these findings when single-injection and continuous PNBs are differentiated.…”

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

“…High rates of poly-pharmacology have been reported in psychiatric hospitals [38]. Medication with strongest links to an increased risk of falling includes serotonin reuptake inhibitors and tricyclic antidepressants [39], antipsychotic agents [40], benzodiazepines and anticonvulsants [25].…”