Research Phase IV

Applying New Interventions to Prevent Falls in the Inpatient Setting :

Applying N ew Interventions to Prevent Falls in the Inpatient S etting School of Nursing Lindsay Johnson, Samantha Lewis, Bethany Adams, Cameron Beatty

Clinical Problem :

Clinical Problem Inpatient falls - Consistently compose the largest single category of reported incidents in hospitals 6 - Perceived as an indicator that could be improved through nurse-led safety strategies or interventions reflecting on quality improvement and research efforts 6 .

Significance of the Problem :

Significance of the Problem T hird most common cause of unintentional injury or death across all age groups 8 F irst leading cause among people 65 years and older 6 M orbidity, mortality and financial burdens attributed to patient falls in hospitals 8 Resulting in a serious injury incurred an additional $13,300 in operating costs I ncreased length of stay by 6.27 days 5

Significance of the Problem :

Significance of the Problem Deaths from falls climbed from 16, 257 in 2002 to 17, 229 in 2003 7 H ospital charges over $4,200 higher than patients who do not fall 6 Patient satisfaction declines with patient falls 5

Purpose :

Purpose Examining new intervention strategies used to prevent falls and their e ffectiveness

PICO Question :

PICO Question For patients at risk for falls does applying new intervention strategies have a greater impact on the safety of inpatients within the hospital and reduce the number of falls as compared to strategies used in the past?

Sample:

Sample 4 acute, adult inpatient units over a 14 month period 1 One of the investigators was the subject (5ft 6in) 2 9 of 40 nurses currently working in the acute, medical adult unit 3 23 RNs, 38 patient care technicians (PCAs/Nurse aids), and 2 housekeeping staff members working on a adult acute care surgical 4

Level of Evidence:

Level of Evidence -Level IV (1) -Level IV (2) -Level VII (3) -Level VI (4)

Summary of Findings:

Summary of Findings The theme throughout all four articles is related to patient care and safety. The surgical unit had the highest call light use rate per patient-day and had the highest patient satisfaction scores 1 The prone position is safer and results in less fear of falling 2 24 different themes that cause falls were identified 3 Staff found 3 aspects of falls were improved with the use of folding chair commodes

Quality of Evidence:

Quality of Evidence Weak to Moderate Threats to internal Validity Selection bias 1, 4 Sampling bias 2 Attrition/mortality 2 Threats to External validity Selection effects 4 Reactive effects 4

Recommendation for Practice:

Recommendation for Practice -Nurse-led safety strategies or interventions reflecting on quality improvement and research efforts can help to reduce inpatient falls

CLINICAL PRACTICE IMPLICATIONS :

CLINICAL PRACTICE IMPLICATIONS Decrease injuries sustained by falls Provide folding commode chairs in patient rooms 4 Implement interventions previously established by the Joint Commission 3 Have patients use the prone position to stand up from bed 2 Provide faster call light response time 1

QUALITY PRACTICE IMPLICATIONS:

QUALITY PRACTICE IMPLICATIONS Increase patient satisfaction Provide faster call light response time 1

COST OUTCOME IMPLICATIONS :

COST OUTCOME IMPLICATIONS Shorten length of stay by using old and new interventions Lower hospital costs by decreasing inpatient falls Implement interventions previously identified by the Joint Commission 3 Have patients use the prone position to stand up from bed 2 Provide folding commode chairs in patient rooms 4 Provide faster call light response time 1

Implications for Practice Change: Interdisciplinary Implications :

Implications for Practice Change: Interdisciplinary Implications Pharmacy Physicians Physical Therapy

Possible Further Research :

Possible Further Research Use of different types of patient identifiers Affect of dementia and delirium on fall rates Medication assessment and falls Falls risk assessment on admission Areas where falls occur most in hospital setting Interdisciplinary collaboration and fall rates

Article References:

Article References 1.) Tzeng , H.M., & Yin, C.Y. (2008). Are call light use and response time correlated with inpatient falls and inpatient dissatisfaction? Journal of Nursing Care Quality , 24(3), 232-242. 2.) Tzeng , H-M., & Yin, C-Y. (2008). Innovation in patient safety: a new task design in reducing patient falls. Journal of Nursing Care Quality, 23 (1), 34-42. Retrieved from http:// ovidsp.tx.ovid.com.cuhsl.creighton.edu 3.) Tzeng , H. & Yin, C. (2008). Nurses’ Solutions to Prevent Inpatient Falls in Hospital Patient Rooms. Nursing Economics$ , 26(3), 179-187. 4.) Tzeny , H. M. (2011). A Feasibility Study of Providing folding commode chairs in patient bathrooms to reduce toileting-related falls in an adult acute medical-surgical unit. Journal of Nursing Care Quality, 26 (1), 61-68. Retrieved from https:// blueline.creighton.edu /section/ default.asp?id =201140%5FNUR%5F493%5FA

Additional References :

Additional References 5.) Leighty , J. (2011). You called? Hourly rounding cuts call lights. Nursing Spectrum. Retrieved from www. studergroup.com 6.) Tzeng , H-M. & Yin, C-Y. (2008). Nurses’ solutions to prevent inpatient falls in hospital patient rooms. Nursing Economics, 26(3), 179-187. 7.) Wong, C. A. (2011) The cost of serious fall-related injuries at three Midwestern hospitals. The Joint Commission Journal on Quality and Patient Safety, 37(2), 81-87. 8.) Premier Inc., Fall prevention introduction and scope (2011). Retrieved from http://www.premierinc.com