Rehab Nurses Lead Multidisciplinary Efforts in Fall Prevention

At hospitals around the country rehab nurses are playing an essential role in reducing fall risk by educating their colleagues, in addition to their patients, according to an Advanced Healthcare Network for Nurses article.

At the Chicago-based Schwab Rehabilitation Hospital, nurses provide fall risk education to patients who also undergo a fall risk assessment at the time of admission. Schwab also uses stoplight model signs to identify the level of fall risk (green for low; yellow for moderate; and red for high) attached to patients’ beds and wheelchairs.

Additionally, rehab nurses at Schwab meet with hospital staff in other departments, including therapy, dietary, and environmental services, to educate them on the importance of notifying a nurse when a patient is at risk of falling. As a result of these efforts, Schwab has reduced their fall rate from 7.86 to 3.9 per 1,000 patient days over the course of a year.

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.

Special Flooring Could Reduce Fall Injuries Among Patients

Impact-absorbing flooring reduced fall injuries by nearly 60 percent in a new study of women in Swedish nursing homes, reports Reuters Health.

Researchers for the study, which is published in the journal Injury Prevention, collected fall and injury data from a nursing home in Sweden with 60 apartments. Six of the apartments were fitted with 12-millimeter flexible impact absorbing tiles.

During the three-year research period, 57 female nursing home residents participated in the study, with 39 falling at least once. Injuries resulted 30 percent of the time on regular flooring, but only 17 percent of the time with the special flooring. Although falls seemed to occur more often on the special flooring, researchers told Reuters Health that nursing home staff may have moved patients at greater risk for falling into the softer flooring areas. The study did not include bathrooms, where patients frequently fall.

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.

Interprofessional Teamwork Helps to Prevent Patient Falls

Nineteen hospitals in Nebraska are collaborating on an interprofessional, evidence-based approach to decreasing fall risk, reports FierceHealthcare, and they are seeing results.

"We had no process, no structures in place to decrease our fall risk," said Carol Kampschneider in a video posted on Hospitals & Health Networks (H&HN) Daily. Kampschneider is a registered nurse and vice president of clinical and regulatory services at St. Francis Memorial Hospital in West Point, Nebraska.  Prior to joining the collaboration, only falls that resulted in broken bones or head injuries were identified as serious at her hospital and no fall risk assessment was completed during patient admissions.

Through an Agency for Healthcare Research and Quality grant, the 19 hospitals became involved in the Collaboration and Proactive Teamwork Used to Reduce Falls (CAPTURE Falls) program, and began to see improvements. For example, the fall rate at St. Francis dropped from 7.31 per 1,000 patient days to 1.41 per 1,000 patient days, Kampschneider said.

As part of the program interprofessional teams collaborate and use tools to understand risks associated with inpatient falls. If a fall does occur, the teams will conduct a "post-fall huddle" to determine how they can prevent the patient from falling in the future.

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.

 The H&HN Daily video is available here.

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.

Rates of Infections, Falls, Pressure Ulcers, Other Hospital Acquired Conditions Drop

Hospitals saw a nine percent decrease in harms experienced by patients from 2010 to 2012, according to a new report from the U.S. Health and Human Services Department (HHS). There were reductions in adverse drug events, falls, infections, pressure ulcers, and other areas, estimated to have prevented nearly 15,000 deaths and 560,000 cases of patients being harmed in hospitals.

The HHS report also shows that the incidences of hospital-acquired infections dropped from 145 per 1,000 discharges in 2010 to 132 per 1,000 discharges in 2012, resulting in 560,000 few incidents in two years, FierceHealthcare reports. Falls and trauma declined 14.7 percent and pressure ulcers fell 25.2 percent.

In addition to lives saved, the reduction in harm to patients saved $4.1 billion according to the report, which credits factors such as diverse public-private partnerships, active engagement by patients and families, and new tools provided by the Affordable Care Act (ACA), with the improvement. In 2011, under the ACA, HHS launched the Partnership for Patients, a nationwide public private initiative to keep patients from being harmed in hospitals and heal without complication. The Partnership shares best practices with more than 3,700 hospitals enrolled in the initiative.

INQRI grantees have conducted a number of studies into how nurses can lead efforts to reduce medical errors and patient harm, including:

• Reducing central line-associated bloodstream infections was the focus of an INQRI-funded study led by David Thompson and Jill Marsteller. Their study, involving 45 intensive care units in 35 hospitals in 12 states, tested a nurse-led intervention that used a bundle of evidence-based practices to reduce infections. The intervention was successful in significantly reducing infections and also highlighted the importance of promoting a culture of safety and communication. It also established that nurses should play a central role in quality improvement interventions.
• The INQRI funded project “Interdisciplinary Mobility Team Approach to Reduction of Facility-Acquired Pressure Ulcers” developed a sustainable, system-wide program for pressure ulcer prevention that enhances mobility of long-term care (LTC) residents. The primary goal, under nursing's leadership, was to reduce LTC facility-acquired pressure ulcer incidence by 50 percent using a cost-effective innovative program to increase resident active or passive movement. The team, which developed and implemented a program that involved using musical cues to remind residents to move or staff to help residents move, was led by Tracey Yap, a nurse researcher, and Jay Kim, an engineer.
•  INQRI grantee Patti Dykes worked with a team to develop the Falls: Tailoring Interventions for Patient Safety (Falls TIPS) online tool kit to educate patients and families about how they can work with nurses and other providers to prevent falls. The toolkit was developed based on the Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls study, which involved developing and validating a set of icons designed to communicate fall risk status, and developing tailored interventions to prevent patient falls in hospitals.

The full HHS report is available here.

Hypertension Medication May Lead to Increased Risk of Fall-Related Injuries

Patients taking medication to treat high blood pressure may be at an increased risk of serious injury from falling, including hip fractures and head injuries. This risk is particularly high for older patients who have been injured in previous falls, according to a new study by Mary E. Tinetti of the Yale School of Medicine, covered on Nurse.com.

The study examined the association between blood pressure medication use and serious injury from a fall in nearly 5,000 patients over the age of 70. During a three-year period, nine percent of patients studied had serious fall-related injuries. The risk of serious injury was up to 40 percent higher for patients who used blood pressure medication. Additionally, the risk was more than twice as high for patients who had a previous fall-related injury.

One of the key lessons learned is that to prevent injuries, clinicians should pay greater attention to fall risk for older adults with hypertension, particularly those with a previous injury, researchers said.

The study abstract is available at: http://archinte.jamanetwork.com/article.aspx?articleid=1832197.
 
INQRI grantee Patti Dykes worked with a team to develop the Falls: Tailoring Interventions for Patient Safety (Falls TIPS) online tool kit to educate patients and families about how they can work with nurses and other providers to prevent falls. The toolkit was developed based on the Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls study, which involved developing and validating a set of icons designed to communicate fall risk status, and developing tailored interventions to prevent patient falls in hospitals.

Higher Risk of Head Injuries Due to Falls Among Elderly in Long-Term Care

Seniors who fall while in long-term care facilities are at high risk for traumatic brain injuries, with nearly 40 percent of those who fall striking their heads, according to a study published in the October 7th Canadian Medical Association Journal. Of 227 falls reported at two long-term care facilities in the British Columbia province of Canada from April 2007-June 2010, more than a third (37 percent) involved residents hitting their heads. Twenty out of 59 falls with head impact resulted in a report of head injury.

The study shows that direction of a fall and landing position were significantly associated with likelihood of head impact. When falling, patients tended to twist backward, lowering the risk of head impact. Participants trying to use their hands to stop falls did not significantly lower the likelihood of head impact. To reduce the risk of head injuries, the researchers suggest improved screening for fall risk factors, improved facility design and flooring, and better fall prevention programs, Nurse.com reports.

INQRI grantee Patti Dykes worked with a team to develop the Falls: Tailoring Interventions for Patient Safety (Falls TIPS) online tool kit to educate patients and families about how they can work with nurses and other providers to prevent falls. The toolkit was developed based on the Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls study, which involved developing and validating a set of icons designed to communicate fall risk status, and developing tailored interventions to prevent patient falls in hospitals.