Tag Archives: Accidental Falls

Fall prevention in academic medical centers

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For articles on fall prevention in academic medical centers, a search was conducted in PubMed for fall prevention AND academic medical center. There are 34results, all of which can be found here. Below are a few recent articles that offer studies on the topic.
· Moe K, Brockopp D, McCowan D, Merritt S, Hall B. Major Predictors of Inpatient Falls: A Multisite Study. J Nurs Adm. 2015 Oct;45(10):498-502. doi: 10.1097/NNA.0000000000000241.
· Quigley PA, Barnett SD, Bulat T, Friedman Y. Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative. J Nurs Care Qual. 2015 Aug 28.
· Williams T, Szekendi M, Thomas S. An analysis of patient falls and fall prevention programs across academic medical centers. J Nurs Care Qual. 2014 Jan-Mar;29(1):19-29. doi: 10.1097/NCQ.0b013e3182a0cd19.

What medications are associated with high fall rates?

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Among the medications discussed as contributing to higher rates of falls include psychotropics, analgesics, diuretics, and antihypertensives.

See <a href="” target=”_blank”>Falls > Possible Risk Factors > Medication effects.  In:  DynaMed.  References studies documenting medications associated with falls.

Click here to access collection of articles discussing medications and fall rates.

Is there evidence on fall prevention audit tools and how to get nurses engaged in preventing falls?

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Articles are arranged by topic.

Engagement of nurses in fall prevention efforts; these articles cover a variety of techniques

Colon Emeric, Cathleen S, et al. “CONNECT for Better Fall Prevention in Nursing Homes: Results from a Pilot Intervention Study.” Journal of the American Geriatrics Society 61.12 (2013):2150-2159.

Lea, Emma, et al. “Beyond the ‘tick and flick’: facilitating best practice falls prevention through an action research approach.” Journal of clinical nursing 21.13-14 (2012):1896-1905.

Barker, Anna, et al. “The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.” Injury prevention 17.4 (2011):e5-e5.

Bonuel, Nena, et al. “Best practice fall prevention strategies. CATCH!” Critical care nursing quarterly 34.2 (2011):154-158.

Healey, Frances. “A guide on how to prevent falls injury in hospitals.” Nursing older people 22.9 (2010):16-22.

Koh, S L, et al. “Impact of a fall prevention programme in acute hospital settings in Singapore.” Singapore medical journal 50.4 (2009):425-432.

Koh, Serena S L, et al. “Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.” BMC health services research 8(2008):105-105.

Ireland, Sandra, et al. “The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study.” Worldviews on evidence-based nursing 10.2 (2013):95-103.

Saint, Sanjay, et al. “Introducing the patient safety professional: why, what, who, how, and where?” Journal of patient safety 7.4 (2011):175-180.

Tzeng, Huey-Ming. “Nurses’ caring attitude: fall prevention program implementation as an example of its importance.” Nursing forum 46.3 (2011):137-145.

Unruh, Lynn, ManishaAgrawal, and SusanHassmiller. “The business case for transforming care at the bedside among the “TCAB 10” and lessons learned.” Nursing administration quarterly 35.2 (2011):97-109.

Stetler, C B, et al. “Integration of evidence into practice and the change process: fall prevention program as a model.” Outcomes management for nursing practice 3.3 (1999):102-111.

Dean, Erin. “Reducing falls among older people in hospital.” Nursing older people 24.5 (2012):16-16, 19.

Rask, Kimberly, et al. “Implementation and evaluation of a nursing home fall management program.” Journal of the American Geriatrics Society 55.3 (2007):342-349.

Audit

Audit criteria

Chapman, Joanne, Deborah Bach, and Kristiina HyrkÃs. “Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting.” Journal of nursing management 19.1 (2011):133-142.

Poe, Stephanie S, et al. “The Johns Hopkins Fall Risk Assessment Tool: postimplementation evaluation.” Journal of nursing care quality 22.4 (2007):293-298.

Perell, K L, et al. “Fall risk assessment measures: an analytic review.” The journals of gerontology. Series A, Biological sciences and medical sciences 56.12 (2001):M761-M766.

Oliver, D, et al. “Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.” BMJ. British medical journal 315.7115 (1997):1049-1053.

Taylor, Jo A, et al. “A model quality improvement program for the management of falls in nursing homes.” Journal of the American Medical Directors Association 8.3 Suppl (2007):S26-S36.

Milisen, Koen, AnneliesGeeraerts, and EddyDejaeger. “Use of a fall prevention practice guideline for community-dwelling older persons at risk for falling: a feasibility study.” Gerontology 55.2 (2009):169-178.

Wong Shee, Annkarin, BevPhillips, and KeithHill. “Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care.” Archives of gerontology and geriatrics 55.3 (2012):653-659.

Koh, Serena Siew Lin, et al. “Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit.” Journal of evaluation in clinical practice 13.5 (2007):722-727.

Reviewed by John Nemeth 4/14

What is the effectiveness of sitters for preventing patient falls?

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Adams, Jewel, and RobertaKaplow. “A sitter-reduction program in an acute health care system.” Nursing economic$ 31.2 (2013):83-89.

Spiva, LeeAnna, et al. “An evaluation of a sitter reduction program intervention.” Journal of nursing care quality 27.4 (2012):341-345.

Tzeng, Huey-Ming, Chang-YiYin, and JulieGrunawalt. “Effective assessment of use of sitters by nurses in inpatient care settings.” Journal of advanced nursing 64.2 (2008):176-183.

Harding, Andrew D. “Observation assistants: sitter effectiveness and industry measures.” Nursing economic$ 28.5 (2010):330-336.

“Falls/ambulation: Reducing sitter use: Decision outcomes.” Nursing Management 42.12 (2011):37.

Searched CINAHL and PubMed. Keywords: sitter and (fall or falls)

Reviewed by John Nemeth 4/14

Does hourly rounding reduce the risk of accidental falls in a cardiovascular surgical unit?

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A CINAHL search for (rounds OR rounding) AND falls AND (cardiac OR coronary OR cardiovascular) did not retrieve any results.

A search for (rounds OR rounding) AND falls AND (surgical OR surgery OR postoperative) retrieved 13 references, including these studies in medical-surgical units:

Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Woodward JL; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jul-Aug; 23 (4): 200-6.

Hourly Rounding: A Replication Study. Olrich, Todd; Kalman, Melanie; Nigolian, Cindy; MEDSURG Nursing, 2012 Jan-Feb; 21 (1): 23-36.

A search in PubMed found these two additional articles.

Krepper, Rebecca, et al. “Evaluation of a Standardized Hourly Rounding Process (SHaRP).” Journal for healthcare quality 36.2 (2014):62-69.
The first took place in two 32-bed cardiovascular surgery nursing units.

Ciccu Moore, Rita, et al. “Care and comfort rounds: improving standards.” Nursing management 20.9 (2014):18-23.
This study took place in an orthopaedic and surgical rehabilitation ward.

See also Does hourly or intentional rounding reduce the rate of accidental falls in acute care facilities?

See also 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?
This blog entry references a couple of papers in the search  results that include patients with cardiac conditions in their populations.  You might be able to extrapolate strategies to your population.

Reviewed and updated 4/8/2014 ldt

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?

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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?

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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