A literature Review on inpatient falls

A Literature Review on inpatient falls According to the reports published by the Centers for Disease Control and Prevention Injury Centre (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar physical environment (different from their home settings) and because of changes in patients’ medical conditions as related to their physical and psychological health and sensory systems (Tzeng, H., & Yin, C. (2008). The following research articles focused on the nurses’ role in preventing and managing patient falls in hospitals. Study 1:

Barker A, Kamar J., Tyndall T. & HILL K. (2013) reducing serious fall related injuries in acute hospitals: are low-low beds a critical success factor? Literature Search 1: Reducing serious fall related injuries in acute hospitals: are low-low beds a critical success factor? Abstract:

Aim:
This article is a report of a study of associations between occurrences of serious fall-related injuries and implementation of low-low beds at The Northern Hospital, Victoria, Australia. Background:

A 9-year evaluation at The Northern Hospital found an important reduction in fall-related injuries after the 6-PACK fall prevention program was implemented. Low-low beds are a key component of the 6-PACK that aims to decrease fall-related injuries. Design: A retrospective cohort study.

Methods: Retrospective audit of The Northern Hospital inpatients admitted between 1999–2009. Changes in serious fall-related injuries throughout the period and associations with available low-low beds were analyzed using poison regression. Results:

During the observation of 356,158 inpatients, there were 3,946 falls and 1,005 Fall-related injuries of which 60 (59%) were serious (55 fractures and five subdural hematomas). Serious fall-related injuries declined significantly throughout the period. When there was one low-low bed to nine or more standard beds there was no statistically significant decrease in serious fall-related injuries. An important reduction only occurred when there was one low-low bed to three standard beds. Conclusion:

The 6-PACK program has been in place since 2002 at The Northern Hospital. Throughout this time, serious fall-related injuries have decreased. There appears to be an association between serious fall-related injuries and the number of available low-low beds. Threshold numbers of these beds may be required to achieve optimal usability and effectiveness. A randomized controlled trial is required to give additional evidence for use of low-low beds for injury prevention in hospitals. (Barker et al, 2011).

Study 2:
George P. Forrest, (2012) A comparison of the functional independence measure and Morse Fall Scale as tools to assess risk of fall on an Inpatient Rehabilitation Abstract:
Purpose: The purpose of this study was to determine if the Functional Independence Measure (FIM) is as useful as the Morse Fall Scale in determining which patients admitted to an inpatient rehabilitation facility (IRF) are at highest risk for fall. Method: Review of the charts of all patients admitted to an IRF in calendar year 2010. Findings: Low scores on the FIM are as useful as high scores on the MFS in suggesting that a patient is at high risk for fall. Conclusions and Clinical Relevance: Nursing staffs that use the FIM to comply with Centers for Medicare and Medicaid Services (CMS) documentation requirements likely do not benefit by also evaluating and documenting the patients’ score on the MFS. Study 3:

Lamis, Rebecca L. et al. Fall risk associated with inpatient medications
Abstract:
Purpose: The association between fall risk and inpatient medications was evaluated. Methods: A retrospective, case–control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. The hospital defined a fall as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (≥18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay matched each case with one control.

Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. Results: Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. Conclusion: In a sample of hospitalized patients, CNS agents were significantly associated with falls.

References:
Barker, Kamar, Tyndall & HILL (2013) Reducing serious fall related injuries in acute hospitals: are low-low beds a critical success factor? Journal of Advanced Nursing 69(1), 112–121. Doi: 10.1111/j.1365-2648.2012.05997.x Forrest, George P. MD, Eric Chen2, BS, Sara Huss1, MD & Andrew Giesler1, MD, PGY3 A comparison of the functional independence measure and Morse Fall Scale as tools to assess risk of fall on an Inpatient Rehabilitation. November 19, 2012. Doi: 10.1002/rnj.86 Lamis, Rebecca L. and Joan S. Kramer. Fall risk associated with inpatient medications. American Society of Health-System Pharmacists, Inc. 1079-2082/12/1101-1888$06.00 DOI 10.2146/ajhp110723