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Management of Patient Falls Prevention

Background

Clinical safety is pivotal when delivering care to patients in a health institution. Hospitals must strive to identify and eliminate risks that pose a threat to the patients with whom they interact in the healthcare system. Hospital falls are responsible for a high number of accidents within care facilities across the United States. About 50% of these events are avoidable if suitable measures are implemented in a timely manner (Montejano-Lozoya et al., 2020). A hospital fall is described as an incident in which a person inadvertently comes to rest on the floor or a lower level. However, the situation must not be triggered by an overpowering exterior force such as a shove. Making sure that the frequency of falls within healthcare institutions is reduced is vital for the provision of quality care.

Problem Statement

Hospital falls are a serious challenge, particularly in facilities that take care of elderly patients. Epidemiological studies point out that these events occur at a rate of 3-5/1000 bed-days, and an estimated 700,000 to 1 million admitted individuals fall every year (Department of Health & Human Services, 2019). It is critical to point out that approximately a third of hospital falls lead to injuries (Department of Health & Human Services, 2019). In some instances, patients experience head trauma or fractures. The incidence of falls in healthcare facilities is a serious matter given the fact that the Centers for Medicaid and Medicare services do not offer additional reimbursement to health facilities to pay for costs resulting from these events.

Practice Change, Quality Improvement, or Innovation

The proposed change involves the creation of a guideline that allows a clinical nurse leader to assemble an interdisciplinary team whose primary objective will be to reduce the fall rate in the facility’s surgical ward. The practice change incorporates three vital components in its structure. It will include a quality enhancement initiative, a risk evaluation strategy, and homogeneous intentional rounding. The team will be made up of the unit manager, the department’s nurses, patient care technologists, ward unit assistants, and hospitalists. It is crucial to note that the surgical department applies a face-to-face hand-off communication strategy, and the primary physicians conduct multidisciplinary rounds to plan various aspects of routine patient care.

Rationale

Patient falls are an elemental aspect of patient safety in the hospital context. Patients aged between 64 and 75 years stand the highest chance of experiencing falls (Ruby, 2017). Also, the prevalence of falls peaks in the morning and during the night shift. A rise in self-care activities as the patients wake up and reluctance to ask for assistance from nurses are considered to be the main causes of falls among admitted patients (Ruby, 2017). It should be noted that attempting to reach the bathroom or access possessions while in a sitting position often leads to accidents among patients at an elevated risk of falling.

Falls that seldom result in injuries often lead to a number of complications. For instance, affected individuals experience heightened anxiety and distress. In addition, their families and caregivers get stressed as a result of the experience. The aforementioned falls also lead to a negative cycle where patients who fear falling restrict their activities, thus limiting strength and autonomy (Department of Health & Human Services, 2019). It is essential to prevent hospital falls in view of the fact that they are linked to prolonged lengths of stay, negative health outcomes, and heightened consumption of limited healthcare resources (Slade et al., 2017). Also, experiencing fractures and soft tissue injuries is linked to distress, pain, distress, and varying degrees of functional impairment. In older people, falls are the foremost cause of mortality as a result of fall-associated injury (Heng et al., 2020). It is essential to implement strategies designed to reduce the incidence of falls within healthcare institutions.

Ensuring that falls are prevented is important when providing quality healthcare services. Even though the prevention of all falls is a daunting challenge, approximately 20 to 30% of the occurrences can be avoided through the institution of risk assessment strategies and the application of evidence-based interventions (Morris & O’Riordan, 2017). In addition, facilitating a culture of extreme vigilance and safety consciousness by providing continuous feedback is crucial. It is critical to point out that maintaining a precise, intentional rounding program that allows easy access to personal items and eliminates hazards in the patient’s room (Sims et al., 2018). It is vital to note that adhering to the steps in a rounding protocol improves patient outcomes and limits fall incidences.

It is vital to apply a multidisciplinary approach when designing a quality improvement strategy to reduce hospital falls. This is critical, seeing as a proficient team of physicians, nurses, and social workers offers diverse viewpoints and solutions for fall incidents in health facilities (Dhillon et al., 2019). Hajduchová et al. (2019) point out that the Morse Fall Scale, which quickly determines the patient’s chances of falling, is quite effective. In essence, nurses should use the tool to categorize high-risk patients and spend more time assessing their activities. Additional evaluation strategies such as the nurse-led fall-prevention toolkit, which links evidence-based prevention initiatives to precise risk factors, can drastically reduce the frequency of falls (Dykes et al., 2020). Making sure that patients admitted to health facilities avoid falls is vital for their wellbeing.

Literature Review

Patient Falls

Hospital falls are among the most widespread causes of preventable injuries. According to Dykes et al. (2020), hospitalized patients face an increased risk of falls which may be linked to serious complications such as subdural hematomas, fractures, or the loss of life. According to Coe et al. (2017), non-fatal falls are a serious health challenge in view of the fact that they predispose affected individuals to serious economic and social burdens. For instance, 2.8 million emergency department visits in 2013 were linked to preventable falls, with approximately a third of the affected individuals requiring hospital admission resulting in 34 billion dollars in healthcare costs (Coe et al., 2017). Dykes et al. (2020) further note that falls associated with injuries increase hospital stay for a period of between 6 and 12 days.

Falls are a serious global health problem in addition to being the foremost cause of hospital injuries. Falls are linked to a variety of long-term consequences such as the loss of independence, morbidity, and loss of life. Hopewell et al. (2020) point out that the risk factors associated with patient fall include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. Medications are an important risk factor for falls among patients admitted to healthcare institutions. Seppala et al. (2019) recommend using the Reduce the Use of Fall-Risk-Increasing Drugs (FRIDs) guideline to limit the incidence of falls. It is essential to avoid the inappropriate use of medication among members of the population at risk. Using tools such as the Medication Appropriateness Index helps support a clinician’s clinical decision-making skills.

Environmental factors such as the absence of handrails, uneven surfaces, poor footwear, and poor lighting increase the incidence of falls. According to Slade et al. (2017), there are approximately 424000 fall deaths globally every year, which accounts for 17 million disability-adjusted life years. In addition, adults over sixty-five years of age stand the highest risk of falling, with most experiencing hip fractures (Slade et al., 2017). It should be pointed out that the financial impact of falls is immense. Slade et al. (2017) note that in 2014, the United States spent approximately 31 billion dollars in annual Medicare costs resulting from fall injuries.

A study by Hajduchová et al. (2019) revealed that most patient falls occurred in subsequent care wards, and 46.5% of the patients affected had been hospitalized for between 1 to 7 days. In addition, the average age of patients who experienced a fall was 76.9 years, and most of the incidents occurred in the rooms (Hajduchová et al., 2019). A study by Hajduchová et al. (2019) showed that a medical worker was absent in 93.3% of the cases and that the time of day when most of the events occurred was between 10 pm and 6 am. Developing effective mechanisms to address patient falls in hospitals is essential. A review by Avanecean et al. (2017) showed that patient-centered interventions coupled with patient education have the capacity to reduce patient falls. However, there is little high-quality evidence showing the effectiveness of patient-centered interventions. Therefore, Avanecean et al. (2017) propose that novel solutions should be sought to address the high rate of patient falls.

The uptake of fall prevention strategies is low in a number of healthcare institutions. According to Clemson et al. (2017), the execution of fall deterrence initiatives depends on the accessibility of referral pathways and the facilitation of collaborative partnerships that encourage knowledge transfer. It is vital to build capacity and engineer improved outcomes for patients at risk of fall-related injuries. A number of programs have been instituted in an attempt to reduce the incidence of hospital falls. According to Heng et al. (2020), initiatives that include patient education effectively reduce the frequency of falls and resultant injuries such as fractures and lacerations. Heng et al. (2020) note that the mode of delivery, design, and quality of the educational material impact outcomes.

Effective initiatives improve the patient’s self-perception of risk and increase knowledge. In effect, individuals are empowered to reduce their susceptibility to falls while admitted to the healthcare facility. It is vital to note that educational interventions aimed at nurses play a critical role in reducing hospital falls. According to Montejano-Lozoya et al. (2020), offering advanced fall prevention training to nurses drastically improved patient outcomes. The study demonstrated that the patients who received the intervention had a lower incidence of falls. The length of stay of the individual’s age had no impact on the outcome. Montejano-Lozoya et al. (2020) conclude their findings by stressing that nurses must undergo advanced fall-prevention training as a way of improving the quality of care in health facilities.

The high incidence of fall rates across America has prompted a variety of trials designed to address the issue. Reuben et al. (2017) note that the Patient-Centered Outcomes Research Institute (PCORI), in association with the National Institute on Aging, funded a trial designed to reduce the frequency of falls in healthcare facilities. It featured five specific components that were delivered by nurses tasked with handling fall risk in association with patients. It is believed that the suggested strategies will reduce the frequency of falls in healthcare facilities. Several programs have been developed to assess the quality of patient education initiatives in fall prevention. For instance, Cuttler et al. (2017) assessed the effectiveness of patient education videos and visual signaling icons in fall prevention among hospitalized patients in a public health institution. The researchers noted a 20% decrease in the rate of falls while falls with trauma declined by 40% during the research period (Cuttler et al., 2017). Patient education and bed exit alarms proved beneficial in reducing fall rates in the facility.

Falls are particularly common among the elderly in hospital settings. Leggett et al. (2017) note that people over sixty-five years of age are the most affected, and the terror of falling drastically reduces the quality of life. It is vital to note that individuals identified to have balance and gait challenges should undergo a multifactorial fall assessment and intervention plan (Leggett et al., 2017). These include balance and strength training, medication review, and vision assessment.

Multidisciplinary Team Approach

A multidisciplinary approach is useful in the reduction of falls within a healthcare institution. Dhillon et al. (2019) note that multidisciplinary teams have the capacity to reduce hospital falls in a cost-effective manner. In addition, they promote critical thinking with regard to fall prevention. A study by Dhillon et al. (2019) in a psychiatric health facility proved that the multidisciplinary approach significantly reduced patient fell when the rate declined from 4.22 per 1000 patient days to 2.24 per 1000 patient days over a six-month period. Falls occur as a result of various behavioral and biological factors caused by specific environmental and socio-economic conditions. Hyndman (2018) points out that comprehensive multi-strategy interventions are necessary to address both extrinsic and intrinsic factors associated with hospital falls. Creating a multidisciplinary team is useful because it facilitates the incorporation of a variety of perspectives in the formulation of solutions.

Falls are harmful in view of the fact that they are associated with a number of psychological sequelae that result in loss of confidence and prolonged hospital stay. According to Morris & O’Riordan (2017), a coordinated multidisciplinary approach facilitates the decline in the frequency of falls within a hospital. Morris & O’Riordan (2017) note that the timely identification of risk elements and the implementation of clear programs intended to limit risk reduce the frequency of patient falls by approximately 20 to 30%. Well-designed multi-professional interventions have the capacity to improve patient wellbeing and safety.

Standardized Intentional Rounding

Evidence-based interventions must be applied to keep patients safe in healthcare institutions. Ruby (2017) highlights the importance of a multidisciplinary approach in the creation of a safe environment that includes an effective fall prevention program. Among the strategies that have shown significant results include hourly rounding, which helps patients feel safe in addition to reducing apprehension. Ruby (2017) notes that effective rounding must address vital aspects such as pain, possessions, position, and toilet needs. These four key areas are intended to prevent falls by offering assistance and supervision when needed.

Rounding is an essential aspect of patient care because it improves patient experiences and safety. According to Langley et al. (2017), the premise of rounding is the belief that responsiveness coupled with a strong nursing presence is essential for meeting patient needs. The Meade protocol of nurse-led rounding has specific steps designed to improve patient safety. The initial step is to assess the patient’s pain to limit the usage of the call bell for pain medication. It is essential to check if the patient needs other medications and offer toileting help (Langley et al., 2017). The next step involves the assessment of the client’s position and comfort and making sure that the bell is within their reach. It is vital to ensure that the bedside table is correctly positioned and that tissues and water are easily accessible. It is critical to ask if there is anything else that the patient needs before leaving the room. It is also critical to clarify that a member of the nursing staff will pass by the room after two hours (Langley et al., 2017). Langley et al. (2017) noted in their study that intentional rounding markedly improved patient outcomes and reduced the incidence of accidents.

Intentional rounding has a number of advantages in a hospital setup. According to Sims et al. (2018), the consistent and comprehensive implementation of intentional rounding enhances the quality of care while limiting potential harms. In addition, ensuring that intentional grounding is practiced routinely facilitates the incorporation of an allocated time of care in health facilities. Sims et al. (2018) also point out that documentation during intentional rounding increases accountability which is essential when standardizing care. The increased contact with patients increases the awareness of patient needs and addresses emergent safety concerns that may increase incidences of falls. In a research study designed to assess the effects of intentional rounding on patient and nursing outcomes, Christiansen et al. (2018) noted that there was a drastic drop in falls in institutions that applied the strategy. In addition, there was a significantly positive attitude among nurses in the studies evaluated. Despite the fact that the caliber of the studies was poor, there was a positive correlation between the implementation of intentional rounding and low fall rates.

Patient safety is a top priority in many healthcare settings. Harris et al. (2019) conducted a national survey that demonstrated that communication and multidisciplinary teamwork played a critical role in improving patient safety. Their inquiry indicated that the efficacy of intentional rounding is dependent on a multiplicity of factors. There was concern that intentional rounding simplifies nursing and promotes a transactional approach which diminishes rational nursing care. In addition, it stresses accountability and risk management over personal, responsive care.

Risk Evaluation Strategies

An exhaustive fall risk assessment offers vital information that can be used to prevent falls. According to Chang et al. (2017), fall risk scales are effective when used to screen and evaluate risk factors. They also facilitate the creation of individualized intervention plans which significantly reduce the incidence of hospital falls. It is worth noting that a majority of risk assessment tools are coupled with standardized prevention strategies. However, Chang et al. (2017) note that overestimating a patient’s fall risk may significantly hamper their mobility and independence while admitted to a facility. Therefore, assessment tools must be highly sensitive and specific to facilitate the delivery of quality care.

There are a variety of fall risk assessment strategies employed in a variety of healthcare settings. Van Vost Moncada & Mire (2017) propose an assessment strategy that has several key stages of evaluation. First, it is critical to screen for fall risk by asking if the patient fell in the past year. It is essential to ascertain the exact number of times and whether or not injuries were sustained. In addition, it is vital to note is the patient feels unsteady when walking or standing. The next step involves the assessment of gait, balance, and strength. Van Vost Moncada & Mire (2017) recommend a time-up-and-go test to assess the aforementioned parameters. Patients without strength, gait, or balance problems are rated as low risk and should be educated on the potential for falls and should be referred for balance and strength exercises.

In the event a balance, strength, or gait problem is noted, specific measures must be taken. According to Van Vost Moncada & Mire (2017), individuals without a history of a fall or those with one fall without injury are considered moderate-risk patients. These patients should be put on individualized fall intervention programs, and their medications should be reviewed. In addition, they should be sent to a physical therapist for poise, gait, and strength exercises. Individuals who have experienced more than two incidents in the last year or had one fall with an injury are considered to be high-risk patients. Van Vost Moncada & Mire (2017) note that it is vital to conduct a multifactorial risk evaluation among these patients by assessing their footwear, conducting a cognitive screen, and evaluating their visual acuity.

High-risk patients should be referred to a physical therapist for balance, gait, and strength exercises. Their medications must be modified, their vision optimized, and any associated medical conditions addressed. A study by Barmentloo et al. (2021) revealed that a significant percentage of adults with an elevated fall risk had a poor quality of life. In addition, they had serious mobility problems in addition to various comorbidities. Barmentloo et al. (2021) point out that over 50% of patients screened during the study took specific steps to reduce their fall risk. However, they did not necessarily adhere to the outlined protocols. Most of the patients responded by having their eyes checked and enrolling in exercise programs to improve strength and balance.

Quality Improvement Models

Fall prevention quality improvement models must address the factors that predispose individuals to falls. According to Duan & Zou (2017), a comprehensive model involves carrying out a root cause analysis and the provision of fall prevention education for patients. However, the process may be ineffective if it does not include adequate collaboration between disciplines and excludes individuals at risk of falling (Duan & Zou, 2017). Therefore, it is vital to conduct a monthly interdisciplinary meeting and the expansion of education initiatives to people who are not at risk of falling. Many health institutions take issues regarding patient falls and associated injuries seriously. According to King et al. (2018), the resultant intense messaging from the institution’s administration to ensure that each department achieves zero falls leads to an intensified fear of falls among the staff. They consequently protect themselves and their units by restricting fall-risk patients from engaging in routine activities in an attempt to meet the institution’s goals (King et al., 2018). Therefore, the fall prevention strategies must be tailored to address the staff’s needs and ensure that they are comfortable implementing the proposed strategies.

A variety of quality enhancement initiatives have been implemented with the intention of reducing the frequency of falls in healthcare facilities. A review by Tricco et al. (2019) revealed that team changes were a significantly superior modality for the diminution of traumatic falls when compared to standard care. In addition, Tricco et al. (2019) noted that patient reminders, combined case management, and personnel education markedly reduced the incidence of falls in healthcare institutions.

It is vital to note that a comprehensive fall prevention initiative does not guarantee the care team’s participation in all the elements vital for the reduction of fall incidences. Vonnes & Wolf (2017) note that the Fall Risk and Prevention Agreement is seldom initiated at admission. It is essential to include patients and their families in fall prevention initiatives through collaborative communication (Vonnes & Wolf, 2017). The encouragement of family participation ensures that the acute care experience is safe and free of falls. Fall prevention strategies are designed to limit complications or injuries associated with falling. Miranda-Duro et al. (2021) note that a number of studies demonstrate how a majority of falls can be avoided through effective assessment and intervention. Some of the most efficient initiatives include vitamin D supplementation, the use of gait stabilizing footwear, and cognitive monitoring (Miranda-Duro et al., 2021). It is vital to note that the risk of falling increases in the context of multiple risk factors. Therefore, multifactorial interventions should blend exercise and individualized risk assessment initiatives.

Best Practices

Addressing Risks Due to Medicines

There are various best practice initiatives that must be implemented to reduce the incidence of falls. For instance, Seppala et al. (2019) recommend using the Reduce the Use of Fall-Risk-Increasing Drugs (FRIDs) guideline to limit the incidence of falls. It is essential to avoid the inappropriate use of medication among members of the population at risk. In addition, using tools such as the Medication Appropriateness Index helps support a clinician’s clinical judgment.

Designing Interventions

The design of interventions aimed at reducing patient fall risks must meet specific criteria. For instance, a review by Avanecean et al. (2017) showed that patient-centered interventions coupled with patient education have the capacity to reduce patient falls. In addition, Heng et al. (2020) note that interventions that incorporate patient education effectively reduce the frequency of falls and associated injuries such as fractures and lacerations. Effective initiatives improve the patient’s self-perception of risk and increase knowledge. In effect, individuals are empowered to reduce their susceptibility to falls while admitted to the healthcare facility.

The Multi-disciplinary Approach

It is essential to include all members of the care team in interventions designed to reduce patient falls. A study by Dhillon et al. (2019) in a psychiatric health facility proved that the multidisciplinary approach significantly reduced patient falls when the rate declined from 4.22 per 1000 patient days to 2.24 per 1000 patient days over a six-month period. Creating a multi-disciplinary team is useful because it facilitates the incorporation of a variety of perspectives in the formulation of solutions. It is vital to conduct a monthly interdisciplinary meeting and the expansion of education initiatives to individuals who are not at risk of falling.

Intentional Rounding

Rounding is an essential aspect of patient care because it improves patient experiences and safety. The Meade protocol of nurse-led rounding has specific steps designed to improve patient safety. The initial step is to assess the patient’s pain to limit the usage of the call bell for pain medication. The next step involves the assessment of the client’s position and comfort and makes sure that the bell is within their reach. It is essential to ensure that the bedside table is correctly positioned and tissues and water are easily accessible. It is critical to ask if there is anything else that the patient needs before leaving the room. It is also critical to clarify that a member of the nursing staff will pass by the room after two hours (Langley et al., 2017). The aforementioned protocol ensures that the patient environment is safe and the incidence of falls is reduced.

Risk Assessment

Risk assessment is essential because it helps determine each individual’s degree of risk. Vonnes & Wolf (2017) highlight the importance of initiating a Fall Risk and Prevention Agreement at admission. It outlines the measures and steps to be taken to prevent falls while admitted to the institution. According to Van Vost Moncada & Mire (2017), individuals with no history of a fall or those with one fall without injury are considered moderate-risk patients. These patients should be put on individualized fall intervention programs, and their medications should be reviewed. In addition, they should be referred to a physical therapist for balance, gait, and strength exercises.

Individuals who have experienced more than two falls in the past year or had one fall with an injury are considered to be high-risk patients. Van Vost Moncada & Mire (2017) note that it is essential to conduct a multifactorial risk assessment among these patients by assessing their footwear, conducting a cognitive screen, and evaluating their visual acuity. High-risk patients should be referred to a physical therapist for balance, gait, and strength exercises. Their medications must be modified, their vision optimized, and any associated medical conditions addressed. It is vital to note that encouraging the patient’s family to participate in the care initiatives ensures that the acute care experience is safe and free of falls.

Evidence Summary

Fall Risk Factors

Hospitalized patients face an increased risk of falls which may be associated with serious complications such as subdural hematomas, fractures, or the loss of life. Falls are linked to a variety of long-term consequences such as the loss of independence, morbidity, and loss of life. Hopewell et al. (2020) point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. According to Slade et al. (2017), there are approximately 424000 fall deaths globally every year, which accounts for 17 million disability-adjusted life years. According to Chang et al. (2017), fall risk scales are effective when used to screen and evaluate risk factors. They also facilitate the creation of individualized intervention plans which significantly reduce the incidence of hospital falls. A study by Barmentloo et al. (2021) revealed that a significant percentage of adults with a high fall risk had a poor quality of life. In addition, they had serious mobility problems in addition to various comorbidities. Therefore, it is vital to implement measures that address the risk of falls.

Preventive Measures

It is essential to institute measures designed to reduce the incidence of falls. Miranda-Duro et al. (2021) note that a number of studies demonstrate how a majority of falls can be avoided through effective assessment and intervention. Some of the most effective strategies include vitamin D supplementation, the use of gait stabilizing footwear, and cognitive monitoring (Miranda-Duro et al., 2021). According to Montejano-Lozoya et al. (2020), offering advanced fall prevention training to nurses drastically improved patient outcomes. Sims et al. (2018) note that the consistent and comprehensive implementation of intentional rounding improves the quality of care while limiting potential harms. In a systematic mixed-method review designed to assess the impact of intentional rounding on patient and nursing outcomes, Christiansen et al. (2018) found that there was a significant reduction of falls in institutions that applied the strategy. In addition, there was a significantly positive attitude among nurses in the studies evaluated. In essence, fall prevention strategies are widely accepted since they improve the patients’ quality of life and boost morale among staff who participate in the improvement of patient lives.

Dykes et al. (2020) further note that falls associated with injuries increase hospital stay for a period of between 6 and 12 days. Hopewell et al. (2020) point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. A systematic review by Tricco et al. (2019) revealed that team changes were a significantly superior modality for the reduction of injurious falls when compared to standard care. In addition, Tricco et al. (2019) noted that patient reminders, combined case management, and personnel education markedly reduced the incidence of falls in healthcare institutions. While the desire to eliminate falls is admirable, several institutions employ aggressive tactics in meeting this goal. King et al. (2018) state that the resultant intense messaging from the institution’s administration to ensure that each department achieves zero falls leads to an intensified fear of falls among the staff.

Recommendation

The best recommendation for the prevention of hospital falls is the development of guidelines that define three essential components. The first is a quality improvement model, the second is a risk evaluation strategy, and the final one is standardized intentional rounding. The team defined in the guidelines will be made up of a nursing unit manager, the department’s registered nurses, care technicians, unit assistants, and hospitalists. It is vital to note that the guidelines are designed to address concerns in the hospital’s surgical ward. The team will facilitate leadership rounding in patient rooms. In addition, the multidisciplinary team will assess the effectiveness with which the hospital’s staff transmits fall prevention initiatives to the patients and their families. It is vital to note that conducting risk assessments and instituting policy changes are vital steps that will ensure that patients get the best care while hospitalized in healthcare facilities.

Appendix A

Author(s)
(Formatted as in-text citation)
Database
(CINAHL, EBSCO, Cochrane, Pro-Quest)
Peer-Reviewed(Yes/No) Applicability

(Yes/No)

Evidence Grade(Strength/ Hierarchy) Appraisal
(Brief summary of findings; how findings inform your project?)
Inclusion

(Yes/No)

Avanecean et al., 2017 Pro-Quest Yes Yes 2/Randomized Control Trial The review showed that patient-centered interventions coupled with patient education have the capacity to reduce patient falls. However, there is little high-quality evidence showing the effectiveness of patient-centered interventions. Therefore the researchers propose that novel solutions should be sought to address the high rate of patient falls. Yes
Barmentloo et al., 2021 Pro-Quest Yes Yes 2/Randomized Control Trial The study revealed that a significant percentage of adults with a high fall risk had a poor quality of life. In addition, they had serious mobility problems in addition to various comorbidities. They point out that over 50% of patients screened during the study took specific steps to reduce their fall risk. Yes
Chang et al., 2017) CINAHL Yes Yes 2/Randomized Control Trial Fall risk scales are effective when used to screen and evaluate risk factors. They also facilitate the creation of individualized intervention plans which significantly reduce the incidence of hospital falls. Yes
Christiansen et al., 2018 CINAHL Yes Yes 5/Systematic Review In a systematic mixed-method review designed to assess the impact of intentional rounding on patient and nursing outcomes, the researchers found that there was a significant reduction of falls in institutions that applied the strategy. In addition, there was a significantly positive attitude among nurses in the studies evaluated. In essence, fall prevention strategies are widely accepted since they improve the patients’ quality of life and boost morale among staff who participate in the improvement of patient lives. Yes
Clemson et al., 2017 Yes Yes 2/Randomized Control Trial The implementation of fall prevention programs depends on the accessibility of referral pathways and the facilitation of collaborative partnerships that encourage knowledge transfer. It is vital to build capacity and engineer improved outcomes for patients at risk of fall-related injuries. Yes
Coe et al., 2017 Pro-Quest Yes Yes 4/Non-experimental Designs Non-fatal falls are a serious health challenge in view of the fact that they predispose affected individuals to serious economic and social burdens. For instance, 2.8 million emergency department visits in 2013 were linked to preventable falls, with approximately a third of the affected individuals requiring hospital admission resulting in 34 billion dollars in healthcare costs. Yes
Cuttler et al., 2017 Cochrane Yes Yes 2/Randomized Control Trial Researchers assessed the effectiveness of patient education videos and visual signaling icons in fall prevention among hospitalized patients in a public health institution. The researchers noted a 20% decrease in fall rates while falls with injuries declined by 40% during the study period. Patient education and bed exit alarms proved beneficial in reducing fall rates in the facility. Yes
Department of Health & Human Services, 2019 Cochrane No No 7/Expert opinion Epidemiological studies point out that these events occur at a rate of 3-5/1000 bed-days, and an estimated 700,000 to 1 million admitted individuals fall every year. It is critical to point out that approximately a third of hospital falls lead to injuries. No
Dhillon et al., 2019 Cochrane Yes Yes 5/Meta-Synthesis A proficient team of physicians, nurses, and social workers offers diverse viewpoints and solutions for fall incidents in health facilities. Yes
Duan & Zou, 2017 Pro-Quest Yes Yes 4/Non-experimental designs A comprehensive model involves carrying out a root cause analysis and the provision of fall prevention education for patients. However, the process may be ineffective if it does not include adequate collaboration between disciplines and excludes individuals at risk of falling. Yes
Dykes et al., 2020 Pro-Quest Yes Yes 3/Quasi-experimental design Evaluation strategies such as the nurse-led fall-prevention toolkit, which links evidence-based prevention initiatives to precise risk factors, can drastically reduce the frequency of falls. Yes
Hajduchová et al., 2019 Cochrane Yes Yes 3/Quasi-experimental design The study revealed that most patient falls occurred in subsequent care wards, and 46.5% of the patients affected had been hospitalized for between 1 to 7 days. In addition, the average age of patients who experienced a fall was 76.9 years, and most of the incidents occurred in the rooms. Yes
Harris et al., 2019 Pro-Quest Yes Yes 4/Non-experimental designs Researchers conducted a national survey that demonstrated that communication and multidisciplinary teamwork played a critical role in improving patient safety. Their study showed that the effectiveness of intentional rounding is dependent on a variety of factors. There was concern that intentional rounding simplifies nursing and promotes a transactional approach which diminished rational nursing care. In addition, it stresses accountability and risk management over personal, responsive care. Yes
Heng et al., 2020 Cochrane Yes Yes 4/Non-experimental designs Interventions that incorporate patient education effectively reduce the frequency of falls and associated injuries such as fractures and lacerations. Effective initiatives improve the patient’s self-perception of risk and increase knowledge. In effect, individuals are empowered to reduce their susceptibility to falls while admitted to the healthcare facility. Yes
Hopewell et al., 2020 CINAHL Yes Yes 5/Systematic Review The researchers point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. Yes
Hyndman, 2018 CINAHL Yes Yes 3/Quasi-experimental design The researchers note that comprehensive multi-strategy interventions are necessary to address both extrinsic and intrinsic factors associated with hospital falls. Creating a multi-disciplinary team is useful because it facilitates the incorporation of a variety of perspectives in the formulation of solutions. Yes
King et al., 2018 Pro-Quest Yes Yes 5/Systematic Review Intense messaging from the institution’s administration to ensure that each department achieves zero falls leads to an intensified fear of falls among the staff. They consequently protect themselves and their units by restricting fall-risk patients from engaging in routine activities in an attempt to meet the institution’s goals. Yes
Langley et al., 2017 Cochrane Yes Yes 4/Non-experimental designs The premise of rounding is the belief that responsiveness coupled with a strong nursing presence is essential for meeting patient needs. The Meade protocol of nurse-led rounding has specific steps designed to improve patient safety. The initial step is to assess the patient’s pain to limit the usage of the call bell for pain medication. It is essential to check if the patient needs other medications and offer toileting help. Yes
Leggett et al., 2017 Cochrane Yes Yes 3/Quasi-experimental design People over 65 years of age are the most affected, and the fear of falling significantly reduces the quality of life. It is vital to note that individuals identified to have balance and gait challenges should undergo a multi-factorial fall assessment and intervention plan. These include balance and strength training, medication review, and vision assessment. Yes
Miranda-Duro et al., 2021 Pro-Quest Yes Yes 3/Quasi-experimental design A number of studies demonstrate how a majority of falls can be avoided through effective assessment and intervention. Some of the most effective strategies include vitamin D supplementation, the use of gait stabilizing footwear, and cognitive monitoring. Yes
Montejano-Lozoya et al., 2020 Pro-Quest Yes Yes 4/Non-experimental designs Offering advanced fall prevention training to nurses drastically improved patient outcomes. The study demonstrated that the patients who received the intervention had a lower incidence of falls. The length of stay of the individual’s age had no impact on the outcome. The researchers conclude their findings by stressing that nurses must undergo advanced fall-prevention training as a way of improving the quality of care in health facilities. Yes
Morris & O’Riordan, 2017 Cochrane Yes Yes 4/Non-experimental designs A coordinated multidisciplinary approach facilitates the reduction in the incidence of falls within a hospital. The researchers note that the timely identification of risk factors and the implementation of clear interventions designed to limit risk reduce the frequency of patient falls by approximately 20 to 30%. Yes
Reuben et al., 2017 Cochrane Yes Yes The researchers note that the Patient-Centered Outcomes Research Institute (PCORI), in partnership with the National Institute on Aging, funded a trial aimed at reducing the incidence of falls in healthcare facilities. It featured five specific components that were delivered by nurses tasked with managing fall risk in partnership with patients. It is believed that the proposed strategies will reduce the incidence of falls in healthcare institutions. Yes
Ruby, 2017 Pro-Quest Yes Yes 4/Non-experimental designs The author highlights the importance of a multidisciplinary approach in the creation of a safe environment that includes an effective fall prevention program. Among the strategies that have shown significant results include hourly rounding, which helps patients feel safe in addition to reducing apprehension. Yes
Seppala et al., 2019 Pro-Quest Yes Yes 5/Systematic Review The researchers recommend using the Reduce the Use of Fall-Risk-Increasing Drugs (FRIDs) guideline to limit the incidence of falls. It is essential to avoid the inappropriate use of medication among members of the population at risk. In addition, using tools such as the Medication Appropriateness Index helps support a clinician’s clinical judgment. Yes
Sims et al., 2018 Yes Yes 4/Non-experimental designs Facilitating a culture of extreme vigilance and safety consciousness by providing continuous feedback is crucial. It is critical to point out that maintaining a precise, intentional rounding program that allows easy access to personal items and eliminates hazards in the patient’s room Yes
Slade et al., 2017 Pro-Quest Yes Yes 4/Non-experimental designs The researchers note that there are approximately 424000 fall deaths globally every year, which accounts for 17 million disability-adjusted life years. In addition, adults over 65 years of age stand the highest risk of a fall, with most experiencing hip fractures. Yes
Tricco et al., 2019 Pro-Quest Yes Yes 5/Systematic Review The authors revealed that team changes were a significantly superior modality for the reduction of injurious falls when compared to standard care. In addition, they noted that patient reminders, combined case management, and personnel education markedly reduced the incidence of falls in healthcare institutions. Yes
Van Vost Moncada & Mire, 2017 Pro-Quest Yes Yes 3/Quasi-experimental design The researchers note that it is essential to conduct a multifactorial risk assessment among these patients by assessing their footwear, conducting a cognitive screen, and evaluating their visual acuity. Yes
Vonnes & Wolf, 2017 Pro-Quest Yes Yes 3/Quasi-experimental design The researchers highlight the fact that the Fall Risk and Prevention Agreement is seldom initiated at admission. It is essential to include patients and their families in fall prevention initiatives through collaborative communication. Yes

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