A search of PubMed and CINAHL for combinations of these concepts…
Patient care plans
Aware* OR engage* OR understand* OR participat*
Communication OR patient professional relations
…did not reveal any studies assessing patient’s awareness or understanding of their daily care plan.
Bottom line: There is no evidence that cleaning the perineal area with chlorhexidine prior to catheter insertion reduces the rate of CAUTI.
Summary: Identified documents using JBI+COnNECT (Joanna Briggs Institute)
Review of results led to CDC CAUTI guidelines, 2009.
Page 43 references two studies that found no difference between cleaning with chlorhexidine v. water prior to catheter insertion. There are also studies referenced in that section that address intermittent care.
A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections
Page 702 – describes 1 RCT of 436 patients admitted to obstetrical unit who were randomized to periurethral cleaning with water v. chlorhexidine prior to insertion of catheter. No significant difference in rates of CAUTI between the groups.
The RCT of 436 patients is also referenced in this best practice summary: Management of short-term indwelling urethral catheters to prevent urinary tract infections
Readmission to psychiatric units of acute care hospitals
Healthc Q. 2007;10(2):30-2.
Madi N, Zhao H, Li JF. Hospital readmissions for patients with mental illness in Canada.
In Canada, during the years 2002-2004, 37% of patients discharged with a mental illness diagnosis were readmitted at acute care hospitals within a one year period.
Readmission to psychiatric hospitals
Psychol Rep. 2003 Dec;93(3 Pt 1):816-8.
Feigon S, Hays JR. Prediction of readmission of psychiatric inpatients.
Prospective study of 943 patients admitted to an urban psychiatric hospital. Over 5 years of follow up, 33% of the patients (all ages) had at least one readmission.
Aust N Z J Psychiatry. 2011 Jul;45(7):578-85.
Zhang J, et al. Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study.
Retrospective study of 286 randomly selected admissions over 12 month period. Of the 178 patients involved in these admissions, 46% were readmitted during this 12 month period.
Readmission to geriatric psychiatry inpatient unit
J Geriatr Psychiatry Neurol. 2006 Dec;19(4):226-30.
Woo BK, et al. Factors associated with frequent admissions to an acute geriatric psychiatric inpatient unit.
Study included 424 consecutive admissions to a university-based geriatric psychiatry inpatient unit over a 20-month period. Mean age of patients was 79.4 years. 35.6% were readmissions.
Systematic reviews
Mechanical restraint-which interventions prevent episodes of mechanical restraint?-a systematic review. Bak J, Brandt-Christensen M, Sestoft DM, Zoffmann V. Perspect Psychiatr Care. 2011 Apr 19.
Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: a systematic review. Kynoch K, Wu CJ, Chang AM. Worldviews Evid Based Nurs. 2011 Jun;8(2):76-86.
Special care units for dementia individuals with behavioural problems. Lai CK, Yeung JH, Mok V, Chi I. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006470.
Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature. Scanlan JN. Int J Soc Psychiatry. 2010 Jul;56(4):412-23.
Changing the practice of physical restraint use in acute care. Park M, Tang JH.
J Gerontol Nurs. 2007 Feb;33(2):9-16
A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments. Nelstrop L, et al. Worldviews Evid Based Nurs. 2006;3(1):8-18.
Other recent studies on reducing restraint use:
The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial. Testad I, Ballard C, Brønnick K, Aarsland D. J Clin Psychiatry. 2010 Jan;71(1):80-6.
A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Huizing AR, Hamers JP, Gulpers MJ, Berger MP. J Am Geriatr Soc. 2009 Jul;57(7):1139-48.
Bottom line: No published research has been identified on the use of color in hospital settings to reduce falls other than to alert healthcare staff, but there is research on the ability to perceive color in adults with visual impairment, which affects many older patients.
Summary: For a review of perception of color and discussion of implications for healthcare environments, see
J Clin Nurs. 2009 Feb;18(3):366-72.
Källstrand-Ericson J, Hildingh C. Visual impairment and falls: a register study.
Discussion on p. 369 includes review of literature on color perception in visual impairment.
Searched Joanna Briggs, PubMed, CINAHL, and Web of Science
Reviewed 4/9/2014 ldt
Observational studies:
Enloe M, et al. Falls in Acute Care: An Academic Medical Center Six-Year Review. J Patient Safety. 2005; 1(4): 208-214.
Retrospective study of falls at an academic medical center over 6 years. RESULTS: Table 2 shows the unadjusted annual fall rates were 5.86/1,000 patient days on the psychiatry units and Table 3 shows that broken down by age (regardless of service the patient was on), the fall rate for patients age 55-74 was 2.90/1,000 patient days and the rate for patients ages 75 and older was 4.08/1,000 patient days.
Schwendimann R, et al. Characteristics of hospital inpatient falls across clinical departments. Gerontology. 2008;54(6):342-8
Prospective study at 1,300 bed academic hospital over 13 weeks. RESULTS: Rate of falls on geriatrics units was 10.7/1,000 patient days.
Kerzman H, et al. Characteristics of falls in hospitalized patients. J Adv Nursing 2004; 47(2), 223–229.
Retrospective study of falls at a 2000-bed medical center in 1998. RESULTS: The rates of falls was 115/1,000 hospital admissions in the geriatric wards and 91 per 1,000 admissions in the psychiatric wards. Rates per 1,000 inpatient days were not reported.
CINAHL is a useful database for researching this professional practice issue. Here is a list of relevant papers:
Evidence Matters 