Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

Abstract

Abstract-The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veterans' nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.

Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review

“…‘Technology improvements have increased alarm efficacy’ was a theme also mentioned often, in 16 out of 57 total occurrences (28.1%) [11,12,13,14,15,16,17,20,21]. Many aspects of alarms that were undesirable are beginning to evolve with improvements in alarm technology [12,13,14,16,17,21]. Alarm devices are becoming more accurate due to improvements in infrared and wearable technology, which allows engineers to reduce the incidence of false positives [11,13,14,15,16,17,20].…”

“…Bed and chair alarm technology is constantly changing and improving [18]. Alarms are becoming more efficient and even wearable [11,12,13,14,15,16,20,21]. Improvements in type and the implementation of new alarm systems require sufficient staff training [19].…”

“…‘Technology improvements have increased alarm efficacy’ was a theme also mentioned often, in 16 out of 57 total occurrences (28.1%) [11,12,13,14,15,16,17,20,21]. Many aspects of alarms that were undesirable are beginning to evolve with improvements in alarm technology [12,13,14,16,17,21].…”

“…Many aspects of alarms that were undesirable are beginning to evolve with improvements in alarm technology [12,13,14,16,17,21]. Alarm devices are becoming more accurate due to improvements in infrared and wearable technology, which allows engineers to reduce the incidence of false positives [11,13,14,15,16,17,20]. Smaller and more comfortable alarm devices also have the capability of sending a direct alert to a specific caregiver [11,12,16].…”

“…Technology is a large area of focus today. The use of technology in the prevention of falls has met with much interest as technology continues to improve and we are beginning to see improved outcomes from its use [11,12,13,14]. Improved technology is reducing many of the “fear factors” of alarming/alerting devices of the past, such as false positives, decreased accuracy, or inappropriate reporting [11,14,15,16,17].…”