Are inpatients with cardiac conditions or on diuretic therapy at risk for falls and is there any evidence of interventions to reduce falls in this population?

PubMed search for falls AND (inpatients OR hospitalization) AND ((drugs AND adverse effects) OR diuretics OR cardiac OR cardiovascular OR heart)

Risk
Several papers report on risk of falling associated with these conditions.
These look at conditions, including cardiac, associated with falls: Belita (2013), Forrest (2012), de Carle (2001), Tutuarima (1997)
These studies report on association of drugs: Williams (2014), de Groot (2013), Butt (2013), Payne (2010), Shuto (2010),  Tanaka (2008), Gales (1995).

Prevention
Belita (2013) describes a project that focused on cardiac-related falls and injuries. Forrest (2012) addresses prevention of falls in patients on a rehabilitation unit, including those with cardiac admission diagnosis.

Williams, Tamara, Marilyn Szekendi, and StephenThomas. “An analysis of patient falls and fall prevention programs across academic medical centers.” Journal of nursing care quality 29.1 (2014):19-29.

de Groot, Maartje, JP van Campen, MA Moek, et al. “The effects of fall-risk-increasing drugs on postural control: a literature review.” Drugs & aging 30.11 (2013):901-920.

Butt, D A, et al. “The risk of falls on initiation of antihypertensive drugs in the elderly.” Osteoporosis international 24.10 (2013):2649-2657.

Belita, Lydia, P Ford, and H Kirkpatrick. “The development of an assessment and intervention falls guide for older hospitalized adults with cardiac conditions.” European journal of cardiovascular nursing 12.3 (2013):302-309.

Payne, Rupert A, et al. “Association between prescribing of cardiovascular and psychotropic medications and hospital admission for falls or fractures.” Drugs & aging 30.4 (2013):247-254.

Forrest, George, “Falls on an inpatient rehabilitation unit: risk assessment and prevention.” Rehabilitation nursing 37.2 (2012):56-61.

Shuto, Hideki, et al. “Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study.” British journal of clinical pharmacology 69.5 (2010):535-542.

Tanaka, Mamoru, et al. “Relationship between the risk of falling and drugs in an academic hospital.” Yakugaku zasshiŒ 128.9 (2008):1355-1361.

de Carle, A J, and R Kohn. “Risk factors for falling in a psychogeriatric unit.” International journal of geriatric psychiatry 16.8 (2001):762-767.

Tutuarima, J A, et al. “Risk factors for falls of hospitalized stroke patients.” Stroke 28.2 (1997):297-301.

Gales B J, and S M Menard. “Relationship between the administration of selected medications and falls in hospitalized elderly patients.” The annals of pharmacotherapy 29.4 (1995):354-358.

Reviewed and updated 4/7/2014 ldt

What is the effectiveness of falls prevention programs?

Bottom line:  In hospitals, multifaceted interventions may be associated with reduced incidence of falls, but evidence in this Cochrane review was inconclusive.  In care facilities, vitamin D supplementation is effective; exercise may be effective but studies have conflicting results; and multifaceted prevention programs may be beneficial but results are inconclusive.  In subacute hospitals, exercise is associated with a reduction in falls.

Details: Cochrane Database Syst Rev. 2012 Dec 12;12:CD005465. doi: 10.1002/14651858.CD005465.pub3. Interventions for preventing falls in older people in care facilities and hospitals. Cameron ID, et al.

Systematic review of 60 randomized controlled trials, N=60,345 (17 in hospitals  29,972 participants.)  Beginning on page 107, the review presents analysis of evidence in the following intervention categories:  vitamin D, exercise, medication review by pharmacist, environmental interventions, social interventions, other single interventions, multiple interventions, and multifactorial intervention programs.  Analysis of data pertaining to hospitals begins at Analysis 12.1 (p. 132.)

Updated 3/1/13

Nurse to nurse accountability on shift change

I searched PubMed on these concepts of shift change and nurse accountability.

Griffin, Terry. “Bringing change-of-shift report to the bedside: a patient- and family-centered approach.” The Journal of perinatal & neonatal nursing 24.4 (2010):348-53.

Powell, Suzanne K. “Handoffs and transitions of care: where is the Lone Ranger’s silver bullet?.” Lipincott’s case management 11.5 (2006):235-237.

Researchers provide new template for more effective handoffs.” Healthcare benchmarks and quality improvement 17.5 (2010):49-52.

Patterson, Emily S, and Robert LWears. “Patient handoffs: standardized and reliable measurement tools remain elusive.” The joint commission journal on quality and patient safety 36.2 (2010):52-61.

 

 

What is some research related to ambulation of patients as it relates to preventing post op ileus?

Delaney, C P Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterology and motility 2004 vol:16 Suppl 2 pg:61 -66

Zutshi, Massarat Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. The American journal of surgery 2005 vol:189 iss:3 pg:268 -272

Delaney, Conor Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Diseases of the colon & rectum 2003 vol:46 iss:7 pg:851 -859

van Bree, Sjoerd H W New therapeutic strategies for postoperative ileus. Nature reviews. Gastroenterology & hepatology 2012 vol:9 iss:11 pg:675 -683

Thompson, Melissa Management of postoperative ileus. Orthopedics 2012 vol:35 iss:3 pg:213 -217

Lubawski, James Postoperative ileus: strategies for reduction. Therapeutics and Clinical Risk Management 2008 vol:4 iss:5 pg:913 -917

Reviewed JKN 4/14

What are some studies on managing and mandatory patient discharge?

Braet A. Weltens C. Vleugels A. Effectiveness of discharge interventions from hospital to home to reduce readmissions: a systematic review. . Joanna Briggs Institute EBP Database.

Yifan Xue MBBS MPH. Patient: Discharge from Hospital. [Recommended Practices]

Domingo G. Johnson P. Reyes F. Thompson F. Shortridge- Baggett L. Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review. [Systematic Review]

Hall WA ; Carty EM. Managing the early discharge experience: taking control. Journal of Advanced Nursing, 1993 Apr; 18(4): 574-82

Mandatory checklists at discharge may have the potential to prevent readmissions. Critical care medicine 2010 vol:38 iss:4 pg:1226

Campagna V. News from CCMC. Managing patient throughput: case managers contribute to successful discharge planning. Care management [1531-037X] yr:2007 vol:13 iss:3 pg:20

Reviewed JKN 4/14

What are some strategies for reducing wrong blood in tube errors?

Ansari, S ‘Wrong blood in tube’: solutions for a persistent problem. Vox sanguinis 2011 vol:100 iss:3 pg:298 -302

Goodnough, Lawrence Quality management in the transfusion service: case studies in process improvement. Transfusion 2011 vol:51 iss:3 pg:600 -609

Doctor, Jason Detecting ‘wrong blood in tube’ errors: Evaluation of a Bayesian network approach. Artificial intelligence in medicine 2010 vol:50 iss:2 pg:75 -82

Grimm E ; Friedberg RC ; Wilkinson DS ; AuBuchon JP ; Souers RJ ; Lehman CM Blood bank safety practices: mislabeled samples and wrong blood in tube-a Q-probes analysis of 122 clinical laboratories. Archives of Pathology & Laboratory Medicine (ARCH PATHOL LAB MED), 2010 Aug; 134(8): 1108-15

Goodnough, Lawrence Tim Operational, Quality, and Risk Management in the Transfusion Service: Lessons Learned. Transfusion Medicine Reviews, 2012 Jul; 26(3): 252-61

MacIvor D ; Triulzi DJ ; Yazer MH Enhanced detection of blood bank sample collection errors with a centralized patient database. Transfusion, 2009 Jan; 49(1): 40-3

Dzik WS ; Beckman N ; Selleng K ; Heddle N ; Szczepiorkowski Z ; Wendel S ; Murphy M Errors in patient specimen collection: application of statistical process control. Transfusion, 2008 Oct; 48(10): 2143-51

Reviewed JKN 4/14

What are the barriers to implementing family presence during resuscitation?

Paplanus L. Salmond S. Jadotte Y. Viera D. A Systematic Review of Family Witnessed Resuscitation and Family Witnessed Invasive Procedures in Adults in Hospital Settings Internationally. [Systematic Review]
Part I: Perspectives of Patients and Families
Part II: Perspectives of Healthcare Providers

Madden E ; Condon C Emergency nurses’ current practices and understanding of family presence during CPR. Journal of Emergency Nursing , 2007 Oct; 33(5): 433-40

Briguglio A. RN. Should the family stay? TN. 2007 May;705):42-8; quiz 49.

Nykiel L, Denicke R, Schneider R, Jett K, Denicke S, Kunish K, Sampson A, Williams JA. Evidence-based practice and family presence: paving the path for bedside nurse scientists. J Emerg Nurs. 2011 Jan;37(1):9-16. Epub 2010 Mar 20.

Basol R, Ohman K, Simones J, Skillings K. Using research to determine support for a policy on family presence during resuscitation.Dimens Crit Care Nurs. 2009 Sep-Oct;28(5):237-47; quiz 248-9.

Clark AP, Aldridge MD, Guzzetta CE, Nyquist-Heise P, Reverend Mike Norris, Loper P, Meyers TA, Voelmeck W. Family presence during cardiopulmonary resuscitation. Crit Care Nurs Clin North Am. 2005 Mar;17(1):23-32, x.

Critchell CD, Marik PE. Should family members be present during cardiopulmonary resuscitation? A review of the literature.Am J Hosp Palliat Care. 2007 Aug-Sep;24(4):311-7.

Reviewed JKN 4/14