Fall Prevention Team Research Articles

Design and Implementation of an Inpatient Fall Risk Management Information System.

Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital's fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post-fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers.

The Role for Health Technology Managers on Fall Prevention Teams

Health technology managers (HTMs) play a pivotal role in ensuring that the devices involved in protecting vulnerable patients from suffering falls are functional and safe for use. Patient falls are common events in healthcare settings, with between 700,000 and 1,000,000 patients suffering falls annually in the United States (Agency for Healthcare Research and Quality. Preventing falls in hospitals. Updated July 2018. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html). The experience and expertise of HTMs in handling devices throughout their entire lifecycle provide unique perspective and can help to establish proactive measures to ensure the risks of patient falls are mitigated as much as possible. This article will explore, using several real case examples submitted to Food and Drug Administration's MedSun, the many ways that hospitals can best use their HTMs in enhancing their fall prevention teams and overall patient fall mitigation strategies. Among these effective strategies are preadmission risk assessments and education, fostering a no-blame culture of reporting adverse events and device malfunctions, and regular interdisciplinary fall prevention team meetings where best practices can be discussed and implemented.

Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention

IntroductionFalls in the emergency department pose an important challenge for patient safety. Multifactorial fall prevention bundles have been associated with a reduction in patient falls in the inpatient setting. The purpose of this project was to tailor and implement a comprehensive fall prevention bundle in our emergency department. MethodsFall bundle components for this intervention were selected on the basis of a review of fall prevention research and included fall risk assessment, safe ambulation, safe toileting, staff communication, early warning, and patient education. The fall risk assessment was tailored to the emergency department through an appraisal of select inpatient fall risk assessments, literature search for ED-specific fall risk factors, and a site-specific chart review, after which pertinent fall risk factors were integrated into a modified screening. Fall prevention materials that were both practical and applicable to the emergency department and facilitated patient safety along each bundle domain were selected for implementation at our site. ResultsThe tailored fall prevention bundle was championed by the interdisciplinary ED Fall Prevention Team and implemented over the course of 5 months in 1 emergency department. Education on fall prevention equipment was delivered in a peer-to-peer format, and an online module was designed to guide staff through the new fall risk assessment. The fall prevention bundle was adopted into clinical practice after staff education was completed, and the fall risk screening was merged into the electronic medical record. DiscussionED fall prevention requires a comprehensive bundled approach, which includes a fall risk screening and multifactorial interventions that are tailored to the ED setting. Successful implementation relies on the involvement of front-line staff from the design through the delivery of the bundled fall prevention measures. Continued inquiry and innovation in ED fall prevention will help provide a safer health care environment and improve patient outcomes.

Individualized Fall Prevention Program in an Acute Care Setting: An Evidence-Based Practice Improvement.

A 245-bed community hospital established patient fall prevention as its patient safety priority. The hospital's fall prevention program was not consistently effective. The baseline fall rate was 3.21, higher than the National Database of Nursing Quality Indicators' median of 2.91. An interprofessional fall prevention team evaluated the hospital's fall program using the evidence-based practice improvement model. A clinical practice guideline with 7 key practices guided the development of an individualized fall prevention program with interventions to address 4 fall risk categories and an algorithm to identify interventions. Interventions included nurse-driven mobility assessment, purposeful hourly rounding, and video monitoring for confused and impulsive fall-risk patients. The fall rate decreased to 1.14, with a 72% expense reduction based on decreased sitter usage. An interprofessional team successfully reduced falls with an evidence-based fall prevention program.

The Experience and Perception of Physiotherapists in Nigeria re: Fall Prevention in Recurrent-Faller Older Adults

Background: Effective fall prevention practices are essential for reducing falls among older adults. Rehabilitation professionals like physiotherapists are essential members of the fall prevention team, yet little is known about the experiences of physiotherapists practicing fall prevention in developing nations. Objective: To explore the experiences of physiotherapists in Nigeria who practice fall prevention among older adults. Method: We adopted a phenomenological approach to the traditional qualitative design in this study. We purposefully selected and conducted face-to-face interview with twelve physiotherapists who have treated at least one older adult who reported falling two or three times within last six months. Data was analyzed using thematic analysis. Results: Four themes emerged from our participants: characteristics of recurrent fallers, fall prevention practices, hindrances to fall prevention, and strategies to promote fall prevention practices. In practice, understanding the characteristics (risk factors) of older adults with a history of recurrent falls is important for effective fall prevention practices among physiotherapists. Among other characteristics, our participants believed that older adults who have patronized “traditional bone setters/healer” are at the higher risk of having multiple falls. Conclusion: This study adds to the sparse amount of literature concerning the experience of physiotherapist in fall prevention practices in the developing world. More importantly, the findings of this study will strengthen or stimulate discussion around development of fall prevention strategies specific to the developing world context.

185Evaluation of an Interdisciplinary Falls Prevention Team in Residential Care for Older Adults including Older Adults with an Intellectual Disability

185Evaluation of an Interdisciplinary Falls Prevention Team in Residential Care for Older Adults including Older Adults with an Intellectual Disability

A Multi-disciplinary approach to falls prevention in the elderly

Northern Ireland South Eastern Integrated Care Partnership – Multi-agency Falls Prevention Strategy Background: Falls are the most frequent and serious accident in people over 65. Falls are the MAIN cause of disability & death in people over 75. FEAR of falling dramatically reduces quality of life Strokes/TIAs and heart attacks are falling. Fractures from falls are RISING. Fragility fractures cost UK over £2billion/year. Large and rising elderly population Preventing Falls: NICE (2013) recommend that all older people who have had a fall or are identified as having gait or balance problems should have a multifactorial falls assessment and a multifactorial intervention plan. NICE have identified the following interventions as being common to successful multifactorial interventions: Strength and Balance training – shown to reduce Falls by 55% Home hazard assessment and intervention Vision assessment and referral Medication review with modification/withdrawal Implementation of evidence base requires a multi-professional and multi-agency approach to care provision and raised awareness among public and professionals. SE ICP Falls Multi-professional working group/partnership committee membership Patient & Carer representatives Falls Co-ordinator Community/voluntary representative Local Council representative Physiotherapists OTs GPs Pharmacists NIAS ( Northern Ireland Ambulance Service) ICP Project Manager Problems Identified: Lack of Follow up of patients who fall and call NIAS (N.I. Ambulance Service) Poor Access to Falls Prevention Services/ Strength & Balance Programmes Lack of Awareness of benefits of Fall Prevention Services Strength & Balance Programmes Actions: 12 month pilot to provide a co-ordinated Falls service across the entire south eastern locality in conjunction with NIAS (5 day and enhanced weekend service). Referrals made directly from NIAS to the service and all patients referred receive a multifactorial screening assessment by a Falls Assessor in their own home within 24hrs of a fall. If necessary onward referrals made to AHP, nursing, GP and voluntary sector services to address identified need. Patients also receive a medication review within 72hrs of the initial referral. Provision of Strength/Balance Programmes in a wide range of community settings including community centres and a GP surgery Outcomes: 170 NIAS referrals to Falls Prevention Team 1284 assessments completed April 2015-16 Strength & Balance Programmes for those at risk of Falls Raising awareness of programme benefits: Pharmacies/GPs/Community/Carers/ Reducing Falls, Reducing Fear, Reducing Fractures Saving NHS Resources Benefits of the service: Clients completing the strength & balance programme 67% improve on FES-I (fear of falling outcome measure) 54% improve on TUAG (balance and mobility outcome measure) Pharmacy – Medication review 61% recommendations made to GP by falls pharmacist were implemented Patient Experience: 73 year old lady referred from GP. No history of falls but significant fear of falls. Completed 12 week strength and balance program. “My confidence has grown, my balance is so much better now and I don’t have the same fear of falling. Since starting the class I can get to the bathroom in time.” Next Steps: Further expansion of strength/balance programme in a range of community settings-massive potential to address unmet need and produce significant health gain.

Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals.

Thirty-eight hospitals participated in falls prevention team training, followed by coaching and mentoring over 3 months to develop unit-based initiatives to reduce falls. Initiatives centered on fall risk assessment, rounding, or postfall assessment. Paired t test of the pre-/postintervention fall rates of 23 of the hospitals revealed reduced fall rates (P < .01). The estimated mean decrease was 1.7 falls per 1000 patient days (95% confidence limits of 0.7-2.7).

The clinical relevance of orthostatic hypotension in elderly patients

Orthostatic hypotension (OH) is highly prevalent in old age. The impact of OH on orthostatic complaints and falling is questionable. We wondered if the consensus definition of OH plays an essential role in the accuracy and direction of the prediction of these endpoints. We aimed to explore the relation between different definitions of OH, including relative decrease of blood pressure, and orthostatic complaints and falling. A cross-sectional study was performed with 1415 participants aged ≥65 years visiting a mobile fall-prevention team. The CAREFALL Triage Instrument and data on blood pressure, orthostatic complaints and previous fall incidents were collected. Multivariate binary logistic regression analyses were performed to assess the association of different definitions of OH and orthostatic complaints or falling. Ten different definitions of OH based on different relative declines of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were defined. The 2011 consensus definition of OH was not related to orthostatic complaints (Odds Ratio (OR) 1.07 (95 % Confidence Interval (CI) 0.68-1.69)) or previous fall incidents (OR 1.08 (95%CI 0.83-1.41)). A ≥ 25 % SBP decrease was significantly related to orthostatic complaints (OR 2.81 (95%CI 1.31-6.05)) and a ≥ 25 % DBP decrease was related to previous fall incidents (OR 2.56 (95%CI 1.08-6.09)). With the exception of a decrease of ≥25 % SBP or DBP, the clinical relevance of incidental OH blood pressure measurements seems very limited with respect to orthostatic complaints or fall incidents in elderly patients. Using relative decreases may be more appropriate in clinical practice. Geriatr Gerontol Int 2017; 17: 1881-1885.

Integrating Physical and Mental Health staff in a care home in reach team: Evaluation of a redesigned service

There are 35 million people with dementia worldwide, many of whom live in care homes. For example, in the UK one third of people with dementia live in care home facilites, and a large proportion of these individuals have moderate or severe dementia and have highly complex care needs resulting from a combination of cognitive, functional and communication impairments, neuropsychiatric symptoms and medical comorbidity. The aim of the redesigned care home in-reach service in Oxfordshire is to improve the quality of care and health outcomes for people with dementia and enable family and paid carers to feel better supported to deliver their caring role. The model of care combines new ways of working which incorporates a biopsychosocial approach which has been effective in large scale research trials (Fossey, 2006;. Ballard, 2009) and to evaluate the effectiveness of the implementation in a routine NHS setting in the UK. The redesigned service integrates an established Care Home Support Service (physical health/ falls prevention team) with a mental health service which can work with all 102 care homes in the county in a responsive and preventative manner. The evaluation of this service uses the RE-AIM framework (Glasgow 1999) to determine the impact on - Reach of the service for indiivudals and services in the county - Effectiveness in terms of : o Health and well-being for people with dementia who receive the service using routine service outcome data for individuals . o County- wide Service use data – diagnosis rates for dementia, referrals to other services,admissions and length of stay o Family/carer satisfaction - Implementation , Adoption and maintenance factors o By thematic analysis of focus groups of staffs’ perception of benefits and difficulties of new model o Service quality data - Economic impact of this model of care This presentation will outline to key elements of the service redesign and initial findings arising from this 12 month study.

Risk factors associated with visiting or not visiting the accident &amp; emergency department after a fall

BackgroundLittle is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group).MethodsTwo cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument.ResultsThe mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (p<0.01). All risk factors were present in both groups but were more prevalent in the A&E group, except for the risk factors of balance and mobility (equally prevalent in both groups) and orthostatic hypotension (less prevalent in the A&E group). The risk factors of polypharmacy, absence of orthostatic hypotension, fear of falling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department.ConclusionAll modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.

Postpartum Safety

Falls in the perinatal setting have received minimal attention and have not been well documented. Women are at risk for falling following vaginal or cesarean birth, especially during initial attempts at ambulation. Recently, a women's hospital that averages over 500 births per month recorded a postpartum fall rate that exceeded the national mean for adult surgical patient falls. A fall prevention team (FPT) of five nurses was formed with a goal to decrease the incidence of postpartum patient falls to zero within the following 7 months. A patient-centered fall prevention strategy was developed. The results of this project have laid the foundation for additional research of a program that will consider not only prevention of falls in a healthy population but also the development of a risk assessment tool specific to women in the immediate postpartum period.

A break‐even analysis of a community rehabilitation falls prevention service

To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centre-based care needs to treat to allow the service to reach a 'break-even' point. A break-even analysis was undertaken for each of two models of care for a multidisciplinary community rehabilitation falls prevention service. The two models comprised either a centre-based group exercise and education program or a similar program delivered individually in the client's home. The service consisted of a physiotherapist, occupational therapist and therapy assistant. The participants were adults aged over 65 years who had experienced previous falls. Costs were based on the actual cost of running a community rehabilitation team located in Brisbane. Benefits were obtained by estimating the savings gained to society from the number of falls prevented by the program on the basis of the falls reduction rates obtained in similar multidisciplinary programs. It is estimated that a multi-disciplinary community falls prevention team would need to see 57 clients per year to make the service break-even using a centre-based model of care and 78 clients for a domiciliary-based model. The service this study was based on has the capability to see around 300 clients per year in a centre-based service or 200-250 clients per year in a home-based service. Based on the best available estimates of costs of falls, multidisciplinary falls prevention teams in the community targeting people at high risk of falls are worthwhile funding from a societal viewpoint.

A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT)

to evaluate the effectiveness of a multifactorial intervention on incidence of falls in psychogeriatric nursing home patients. cluster-randomised controlled 12-month trial. psychogeriatric wards in 12 nursing homes in The Netherlands. psychogeriatric nursing home patients (n = 518). a general medical assessment and an additional specific fall risk evaluation tool, applied by a multidisciplinary fall prevention team, resulting in general and individual fall prevention activities. falls. there were 355 falls in 169.5 patient-years (2.09 falls per patient per year) in the intervention group and 422 falls in 166.3 patient-years (2.54 falls per patient per year) in the control group. Intention-to-treat analysis with adjustment for ward-related and patient-related parameters, and intra-cluster correlation, showed that the intervention group had a significantly lower mean fall incidence rate than the control group (rate ratio = 0.64, 95% CI = 0.43-0.96, P = 0.029). Subgroup analyses showed that fall risk declined further as patients participated longer in the intervention programme. the introduction of a structured multifactorial intervention to prevent falls in psychogeriatric nursing home patients significantly reduces the number of falls. This reduction is substantial and of high clinical relevance.

Falls Prevention at Mayo Clinic Rochester

Falls prevention is a complex problem. Following in the footsteps of an earlier fall prevention team, the Safe Landings Fall Prevention Team used many strategies for implementing a fall prevention/reduction program. The tactics we used to prevent falls combined with the adoption of a fall assessment risk model are shared.