Preventing Falls in Hospitalized Patients

LeLaurin, Jennifer H; Shorr, Ronald I.

doi:10.1016/j.cger.2019.01.007

Cited by 129 publications

(95 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of the included articles, five were systematic reviews (Table 1) [14,37,[47][48][49], three were targeted literature reviews [6,50,51], 10 were randomised controlled trials (RCTs) ( Table 2) [30-32, 34, 38, 52, 53, 55, 57], three were qualitative studies [58][59][60], and three were unpublished theses [61][62][63]. The remaining studies were quasiexperimental trials (n = 18).…”

Section: Study Characteristicsmentioning

confidence: 99%

Hospital falls prevention with patient education: a scoping review

et al. 2020

View full text Add to dashboard Cite

Background: Hospital falls remain a frequent and debilitating problem worldwide. Most hospital falls prevention strategies have targeted clinician education, environmental modifications, assistive devices, hospital systems and medication reviews. The role that patients can play in preventing falls whilst in hospital has received less attention. This critical review scopes patient falls education interventions for hospitals. The quality of the educational designs under-pinning patient falls education programmes was also evaluated. The outcomes of patient-centred falls prevention programs were considered for a range of hospital settings and diagnoses. Methods: The Arksey and O'Malley (2005) framework for scoping reviews was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Eight databases, including grey literature, were searched from January 2008 until February 2020. Two reviewers independently screened the articles and data were extracted and summarised thematically. The quality of falls prevention education programs for patients was also appraised using a modified quality metric tool. Results: Forty-three articles were included in the final analysis. The interventions included: (i) direct face-to-face patient education about falls risks and mitigation; (ii) educational tools; (iii) patient-focussed consumer materials such as pamphlets, brochures and handouts; and (iv) hospital systems, policies and procedures to assist patients to prevent falls. The included studies assessed falls or education related outcomes before and after patient falls prevention education. Few studies reported incorporating education design principles or educational theories. When reported, most educational programs were of low to moderate quality from an educational design perspective. Conclusions: There is emerging evidence that hospital falls prevention interventions that incorporate patient education can reduce falls and associated injuries such as bruising, lacerations or fractures. The design, mode of delivery and quality of educational design influence outcomes. Well-designed education programs can improve knowledge and self-perception of risk, empowering patients to reduce their risk of falling whilst in hospital.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

Hospital falls prevention with patient education: a scoping review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…As a result, restraints are often applied in situations that are not appropriate (14,19,22,44). For example, restraints are used for fall prevention, even though there is growing evidence that restraints are ineffective in preventing falls (16,17). Also, in this study, indications could be found that knowledge in uences the use of restraints, since attending a refresher course is associated with less restraint use.…”

Section: Discussionmentioning

confidence: 80%

“…fall prevention or prevention of therapy interruption) and patient characteristics like cognitive impairment (5,14,15). However, evidence for the effectiveness of restraints for these reasons is lacking (5,16,17). Nevertheless, restraints also seem to be used out of routine according to the tradition on the ward or local habits (18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Does Restraint Use Depend on the Hospital? A Multilevel Analysis of Multicentre Prevalence Measurements

Thomann

Hahn

Bauer

et al. 2021

Preprint

View full text Add to dashboard Cite

Background In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level and b) to examine the impact of organisational factors on restraint use. Methods A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18 + with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. Results The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2,577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.76). By adding the hospital as a random effect, the explained variance of the model increased from 24–55%. Conclusions The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.

show abstract

“…The detailed description of our intervention (i.e. the online training program, pocket guide, and documentation form that facilitates categorization of organizational errors) is consistent with a recent call for improved description of the implementation of fall-risk-reduction interventions in published studies [64]. We conceptualized safety culture as a contextual element that moderates the effectiveness of patient safety practices [33, 39].…”

Section: Discussionmentioning

confidence: 99%

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Jones

Crowe

Allen

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

Background Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. Methods During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. Result Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. Conclusions Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.

show abstract

Preventing Falls in Hospitalized Patients

Cited by 129 publications

References 68 publications

Hospital falls prevention with patient education: a scoping review

Hospital falls prevention with patient education: a scoping review

Does Restraint Use Depend on the Hospital? A Multilevel Analysis of Multicentre Prevalence Measurements

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Contact Info

Product

Resources

About