Fall prevention through a systems approach: SEIPS, AcciMap and HTA findings from patient safety specialists

Background/Objectives: Falls in nursing homes significantly affect residents' health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains scarce. Nursing homes provide long-term care for residents with high levels of dependency, presenting unique challenges in managing fall risks. Nevertheless, unlike hospitals, nursing homes face operational constraints, such as limited resources and staffing. These factors necessitate a tailored approach to fall risk management. This study aimed to summarize the current knowledge of fall risk assessment and prevention methods in nursing homes, clarify practical insights for implementation, and identify research gaps based on studies published over the past five years. Methods: This narrative review targeted studies published between 2019 and 2024 on fall risk assessment and prevention methods in nursing homes. A literature search was conducted using the PubMed and CINAHL databases, combining keywords such as "Accident Prevention", "Fall Risk Assessment", "Nursing Homes", "Long-Term Care", and "Aged". The inclusion criteria allowed the inclusion of peer-reviewed academic articles on fall risk assessment or prevention interventions in long-term care facilities published in English within the past five years. Studies focusing on community-dwelling older adults, hospitalized older adults, and review articles were excluded. Results: This review analyzed 55 studies; among them, 27 studies focused on fall risk assessment and 28 focused on fall prevention. Regarding fall risk assessment, widely used tools, such as the Morse Fall Scale, which is also utilized in medical settings, have been extensively examined. In addition, new predictive methods utilizing electronic health records (EHR) and wearable devices have been introduced. However, the limited number of reports highlights the potential challenges in developing indicators that consider the unique characteristics and feasibility of LTC facilities. Regarding fall prevention, studies have examined indirect approaches, such as environmental modifications, and direct interventions, such as exercise programs. Furthermore, staff education and organizational initiatives are crucial in implementing preventive measures. However, most studies have been conducted in experimental settings, with limited empirical research available to assess the practical applications of these strategies in real-world nursing home environments. Conclusions: Fall risk assessments in nursing homes lack practical indicators tailored to the specific characteristics of long-term care facilities. Although various digital technologies have been explored for fall prevention, empirical studies that validate their real-world applicability are lacking.

Risks, roles and responsibilities: Evaluating falls in inpatient mental healthcare settings for older people

Decades of research have been conducted on the risk, prevention, and management of falls. Extensive research addresses the identified intrinsic and extrinsic fall risks and the importance of screening for these risks. The emphasis for patient safety interventions surrounding falls and injury prevention must be on patient-centered, multifactorial, individualized care plans that are population-based. Yet the link between risk assessment and the effectiveness of population-based interventions remains weak. Early efforts focused on risk factors for prevention of falls in the elderly, largely ignoring interventions and also considering all fallers as one single group. Research then moved into fall screening and risk assessment, but these two processes were often intermingled, leading to confusion about linking risk to specific interventions. Still the focus was on fall prevention and the elderly, lumping all fallers into one single group. Next, research focused on interventions, but the focus was on fall prevention and the elderly, again lumping all fallers together. A new agenda begins to question this focus on fall prevention and addresses fall protection and injury prevention, emphasizing therapeutic risk associated with activity and community participation. This new agenda also recognizes the need to segment high-risk patient populations to identify unique risks and tailor interventions (e.g., peripheral neuropathy, wheelchair fallers) using new three-dimensional techniques to assess gait and balance as well as other key risk factors. The new agenda also goes beyond fall screening and fall risk assessment, emphasizing the need to screen individuals, follow up with in-depth risk assessment protocols, and link interventions to specific modifiable risk factors. As more evidence is available to clinicians, for translational research efforts are needed to develop clinical tools to make it easier for clinicians to provide evidence-based practice and to explore more effective and efficient strategies for implementing evidence-based programs across clinical settings and facilities. To advocate for evidence-based practice in fall prevention and fall protection, the Veterans Integrated Service Network (VISN) 8 Patient Safety Center of Inquiry held its second international call across professions and experts to articulate the state of the science, elucidate research priorities, and facilitate the translation of research into practice. In April 2007, fall experts from the United States and Canada participated in a three-day national conference, Transforming Fall Prevention Practices. After presenting state-of-the-art knowledge and practices in fall prevention, risk assessment, and interventions, they joined with invited research methodologists and expert clinicians over another half day for the research agenda-setting session. Participants reached consensus on the research needed to advance both science and clinical practice. Priorities were grouped into three research domains: * Clinical interventions. * Biomechanics. * Implementation/translation. The criteria used for selecting research priorities were the-- * Need for consensus among all members. * Feasibility of the research being conducted within 5 years. * Presence of an existing program of research on which to build. * Fit with the mission and vision of the Veterans Health Administration (VHA) in primary health promotion, patient safety, function, and independence. This editorial focuses solely on clinical intervention. We examined the current state of the science relevant to clinical intervention research and developed a research agenda for studies that can be conducted as 5-year research programs likely to result in new discoveries, improved clinical practice, reduced variations in practice, and improved patient outcomes. Clinical intervention research is needed to test the effects of specific interventions related to special populations, medication prescribing, clinical units and staffing, and interdisciplinary approaches to fall prevention [1]. …

Human Factors and Systems Engineering Approach to Patient Safety for Radiotherapy

Falls prevention education between older adults and healthcare providers during transition from hospital to community-living

BackgroundExisting evidence on the association between exposure to bullying and sleep is limited and inconclusive. The aims of this planned systematic review and meta-analysis are therefore (1) to determine whether exposure to workplace bullying is related to changes in sleep function and (2) to establish mediating and moderating factors that govern the relationship between bullying and sleep.MethodsA systematic review and meta-analysis will be conducted. Electronic databases will be searched using predefined search terms to identify relevant studies. Eligible studies should report empirical findings on the association between exposure to workplace bullying and at least one indicator of sleep. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between bullying and sleep problems will evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3.DiscussionThis review and meta-analysis will be among the first to systematically explore and integrate the evidence available on the association between exposure to bullying and sleep, as well as on the mediating and moderating factors that can govern this associations. By gathering and summarizing information about potential factors that can explain when and how bullying is related to sleep, the findings from this study will provide directions for future research and provide practitioners and clinicians with an understanding about the nature and consequences of workplace bullying and point to directions for relevant interventions.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018082192).

Significance and backgroundFalls are multifactorial in medical oncology units and are potentiated by an older adult’s response to anxiolytics, opiates and chemotherapy protocols. In addition, the oncology patient is at...

Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention

End-stage renal disease (ESRD) is a global public health problem as same as in Thailand the number of patients undergoing hemodialysis treatment is getting higher every year. In frequently cases has many impacts and affect the reduction of functional conditions. The objective of this study is to conduct a systematic review and meta-analysis of research into the effects of resistance exercise on end stage renal disease patients undergoing hemodialysis and to analyze the effect size of resistance exercise on patients. A systematic literature search was conducted using the database of Science direct, Wiley Online Library, Scopus, PubMed, EBSSCO host and the Thai-Journal Citation Index Center, looking for randomized controlled trials between 2009 and 2020. Combined effect sizes were calculated using Review Manager Version 5.3. Eight articles met the inclusion criteria and in the effect size analysis. Results showed that resistance exercise improved the ability to function and increased muscle strength, improved body composition and quality of life in chronic renal failure patients undergoing hemodialysis treatment.
 HIGHLIGHTS
 
 The effectiveness of resistance exercise interventions improves physical performance, quality of life (QOL), muscle strength and body composition
 The characteristic of exercise has shown to be high beneficial for many health aspects and easily modifiable lifestyle factor with virtually no negative side effects
 This meta-analysis might help to develop early intervention strategies for physical and psychological outcome both of patients with chronic diseases
 
 GRAPHICAL ABSTRACT

The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre–post implementation study in the U.S.

Background Patient safety is of paramount importance in healthcare delivery. This is especially so in the high-risk and complex environment of the operating theatre. Objectives The purpose of this narrative review is to illustrate the risks that patients are exposed to in the operating theatre and the measures in place to mitigate preventable harn, including the nationwide Ensure Safer Systems programme. Methods A literature search was conducted utilising sources such as PubMed, Scopus, Cochrane Library, Google Scholar and Web of Science between 2010 and 2024. ‘Patient safety’, ‘surgical safety’, ‘operating theatre’, ‘operating room’ and ‘systems approach’ were combined using Boolean operators. Selected guidelines and position statements from professional medical societies and government websites were also reviewed. Results This narrative review is informed by the analysis of qualitative and quantitative articles from the literature review. While there are numerous interventions addressing patient safety, many of these efforts target specific harms. In order to make a significant impact, it is crucial to adopt a systems approach that underpins these initiatives. Although the Ensure Safer Systems programme is a hospital-wide initiative, its scrutiny and oversight of operating theatre processes enhances patient safety in the operating theatre. Conclusions The establishment of a safety system comprising strong leadership commitment, safety culture and robust process improvement is vital to achieving sustained improvement in patient safety.

Utilizing quality improvement methods to prevent falls and injury from falls: Enhancing resident safety in long-term care

Background Fall prevention is essential for hospitalized patients. However, traditional teaching methods often fail to effectively engage nurses or translate guidelines into clinical practice. Summary of work We designed a card game, inspired by the classic “Old Maid” or “Old Bachelor” game to reinforce fall prevention knowledge among nurses. The game includes 30 pairs of cards illustrating fall prevention strategies, such as frequent monitoring, clutter-free walkways and muscle-strengthening exercises, and 25 pairs illustrating fall risk factors, such as sedative use, oversized clothing and wet floors. The unmatched card features a patient falling. Players match pairs while identifying whether they represent fall prevention or risk. The player left with the "falling patient" card participates in a simulated scenario, identifying fall risks and applying appropriate measures. Since March 2023, this game has been used in our ward. Additionally, we identified the top three high-risk patients upon admission and designed targeted prevention strategies. The monthly fall rate was calculated by dividing the number of falls, retrieved from the Taiwan Patient-Safety Reporting System, by the total patient days and multiplying by 1,000. The Wilcoxon rank-sum test compared the monthly fall rate between two periods. Summary of Results From March 2023 to December 2024, the monthly fall rate per 1,000 patient days (median, 0.855; range, 0-2.545) was lower than the rate from January 2022 to February 2023 (median, 1.247; range, 0-2.404), showing borderline significance ( p =0.083). Nurses provided positive feedback, describing the game as interesting, engaging and helpful for reinforcing knowledge. Discussion and Conclusion The implementation of this card game demonstrated a trend toward reducing falls, emphasizing its potential as a tool for improving patient safety. By gamifying the learning process, the game reinforced nurses’ knowledge and increased attentiveness in identifying risks and implementing preventive measures. While statistical significance was not achieved, the trend toward fall reduction and the positive feedback suggest that this innovative approach can contribute to patient safety. Take Home Message Promoting patient safety requires innovative and engaging strategies. This fall prevention card game provides nurses with an interactive way to learn, apply, and internalize fall prevention guidelines, contributing to safer care environments and better patient outcomes.

Purpose – The purpose of this paper is to suggest the application of systemic methodologies, such as Soft Systems Methodology (SSM), to develop sustainability strategies and solve problems involving the sustainability of organizations and their operations. The sustainability paradigm implies the need for changes in current production systems, societal organization and use of the natural resources that are essential to all life forms. Sustainability, as a new paradigm, modifies the way in which organizations operate to make companies responsible for sustainable development and ensure that resources are available for future generations. Sustainable development requires a broad new development strategy that encompasses political, economic, social, technological and environmental dimensions. Design/methodology/approach – As a method of analysis the research will use the application of SSM in a case study from the sugarcane industry. The basic scientific thought paradigm, inherited from Bacon and Descartes, no longer holds in modern society, which requires a new way of perceiving the world by following a systemic and integrated approach to address complex problems. Findings – This study advances the understanding of how the systemic approach can aid the development of corporate sustainability strategies. Originality/value – The basic pillar of the new sustainability paradigm is the systemic view. The systemic approach should guide the development of corporate strategies. This study followed a qualitative approach to better understand how organizations can use the systemic approach in the development of sustainability strategies.

Globally, falls are the second leading cause of unintentional injury. In Canada, falls that occur in hospitals have been ranked second as an area of patient safety concern. Many Canadian hospitals seeking to achieve patient safety, accreditation and resource containment goals are implementing evidence-based practices in fall prevention. However, best practices are reported to be only variably effective in reducing hospital fall rates, indicating a potential gap in our understanding of the implementation process. This study was designed to provide insight into the real world of implementation of best practices in fall prevention in acute care Canadian hospitals. Using case study methodology, ninety-five administrative and point-of-care nurses at three hospitals participated in interviews or focus groups and provided documents and artifacts that described their implementation of a falls prevention guideline. Four recommendations with potential to guide others in fall prevention were identified: (1) the need to listen to and recognize the expertise and clinical realities of staff, (2) the importance of keeping the implementation process simple, (3) the need to recognize that what seems simple becomes complex when meeting individual patient needs, and (4) the need to view the process as one of continuous quality improvement.