Nurses Lead Fall Prevention Trials for NIH/PCORI and NC Initiatives

The National Institutes of Health and the Patient Centered Outcomes Research Institute (PCORI) are launching a new study to prevent fall-related injuries that utilizes “fall care managers,” typically nurses or nurse practitioners, who will evaluate patients’ risk and create individualized plans to avoid falls, Bloomberg’s Businessweek reports.

The study will track 6,000 elderly patients at risk for falling at 80 clinics. At half of the clinics the “fall care managers” will tailor specific interventions to patients’ needs, while patients at the other 40 clinics will continue to receive standard treatment. The fall care managers will take a more custom approach to each patient, such as adjusting medication to decrease dizziness, encouraging physical therapy to improve balance, or prescribing new glasses to improve vision. Funding for the five-year trial is provided by PCORI under the Affordable Care Act.

In related news, New Hanover Regional Medical Center in Wilmington, North Carolina found success with a similar nurse-led approach to preventing patient falls, Fierce HealthCare reports.

New Hanover formed a patient safety services fall team to examine the underlying causes of falls and develop a system to prevent them. The team found that many patients fell while trying to reach the bathroom, because they were medicated or disoriented and had physical impairments. As a result, nurses at New Hanover now check on patients every hour and try to anticipate bathroom visits. They also administer medication at strategic times, so that patients are more likely to sleep through the night. Other preventative measures include visual markers that highlight high-risk patients and having patients sign a "fall prevention partnership" agreement with nursing staff. These and other measures led to a fall decrease of 22 percent estimated and a savings of more than $500,000, according to a New Hanover blog post.

INQRI grantees Patti Dykes and Blackford Middleton created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.