Los Angeles City College Patient Safety Discussion

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Zryry

Health Medical

Los Angeles City College

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In this assignment, you will research best practices to identify an effective intervention for your selected problem. Your goal is to gather evidence form scholarly literature to support the most effective intervention strategy.

The performance appraisal tools in this week’s learning activities will help you determine appropriate scholarly sources of evidence to cite this week.

Locate at least 3 original research articles that provide evidence for your proposed solution to your selected problem.

The articles must be peer reviewed, published within the past 5 years, and statistically significant.

Write a 350-word summary of each article in which you:

  • Identify current guidelines or best practices relating to your proposed solution, or if there are protocols, the current standard of care.
  • Define your proposed intervention(s) to address the problem.
  • Explain how the intervention will result in a solution to the problem.

Include PDFs of the articles as well as a reference pages with an APA-formatted citation for each article.

TOPIC FALLS

Explanation & Answer:
1050 Words
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Explanation & Answer

View attached explanation and answer. Let me know if you have any questions.

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Patients Fall Articles’ Summary
Student’s name
Institution affiliation
Course
Instructor
Due date

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Patients Fall
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients. Clinics in
Geriatric Medicine, 35(2), 273-283. https://doi.org/10.1016/j.cger.2019.01.007
Patient falls are a significant threat to patient safety in many hospitals, and many
strategies in the literature explain how to prevent these falls. Quality improvement programs
have been initiated in the prevention of these falls. According to LeLaurin and Shorr (2019),
various interventions can be deployed to prevent patient falls. They include patient education,
fall risk identification, sitters, non-slip socks, environmental modification, and alarm use fall
risk prediction is one of the mechanisms for risk assessments, prediction tools, and screening
tools. These assessments and tools help identify that patient at risk for falls, and appropriate
measures can be instilled to prevent this fall. In their article, “Preventing falls in hospitalized
patients”, LeLaurin and Shorr explain that this prediction method has been criticized by the
Agency for Healthcare Research and Quality and placed patients above 65 of age at risk for a
fall.
The sitter is a method that entails the patient having a companion by the bedside to
prevent falls. Although the technique is effective as the needs of the patients can be elicited
and avoid the occurrence of falls, it is also expensive. The alarm system entails alerting the
staff when the patient tries to get out of bed without assistance. The alarms also act as
reminders for the patients to call for assistance when needed. The patient can use the alarm
when needs arise, which helps the healthcare providers attend to the patient's needs before
they try to help themselves, resulting in a fall. There are various types of alarms, including
wearable devices, pressure mats, and cord-activated alarms. Patient education is another
strategy that can be used to prevent falls in hospitals (LeLaurin & Shorr, 2019). Together
with other interventions, patient education has proven effective against fall patients. The

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patient is educated on the risks associated with patient falls and how to prevent them. Even
though this method effectively prevents falls, it cannot be applied in patients with cognitive
impairment. Several environmental factors have contributed to patients' falls, and
environmental modifications such as visual cues, lighting, and unique rooms for the patients
at risk of falls reduce inpatient falls. Non-slip socks help in the traction of which without the
traction it would lead to patient falls (LeLaurin & Shorr, 2019).
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2020). Hospital
falls prevention with patient education: A scoping review. BMC
Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01515-w
Hospital falls are a common problem that is experienced by the world today. In the
article “Hospital Falls Prevention With Patient Education: A Scoping Review” published in 2020,
Heng et al. focus on various falls prevention strategies, including the hospital systems and
medications reviews, clinician education, assistive devices, and environmental modifications.
Apart from these strategies patient's role in the prevention of falls has been undermined.
Patient education can reduce patient falls as it assists the patient in self-manage their risk of
falls. It is an essential factor as there can be confusion between the real and perceived fall
risks. Heng et al. (2020), most patients may engage in risk-taking behaviors that may increase
the occurrence of falls. These risks may include not pressing the bell when in need, not
waiting for the nurse's help in order to mobilize, and walking without supervision. Other
patients may feel secure by virtue because they are in the hospital environment.
Patient education aims to enhance the awareness of the patient on the fall risks and
derive various interventions to prevent the occurrence of falls. Heng et al. (2020) explain the
various education methods that can be employed, including handouts, assistive devices such
as bed alarms, wrist bands, sensors, videotape, posters, and fall risk communication alerts.
Face-to-face communication can be done concerning the proper footwear to use. Although

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patient education has proven to be an effective method of reducing patient falls, the education
design and delivery needs should consider individual fall risks and the environmental context.
It also needs to combine various education methods such as face-to-face discussions,
handouts, and assistive devices to be more effective rather than relying on one modality. The
combination method may vary from one hospital to the other. According to Heng et al.
(2020), the falls education intervention should further help design and incorporate
educational principles and behavioral changes. The education may entail using alarms when
in need, and they should not try to get out of bed without help. Besides, an active learning
design should be included to engage most patients. In addition, the guidelines should be
followed in order to improve quality care and provide transparent information in hospital
research.
Wang, L., Xue, Z., Ezeana, C. F., Puppala, M., Chen, S., Danforth, R. L., Yu, X., He, T.,
Vassallo, M. L., & Wong, S. T. (2019). Preventing inpatient falls with injuries using
integrative machine learning prediction: A cohort study. npj Digital Medicine, 2(1).
https://doi.org/10.1038/s41746-019-0200-3
Patient falls in hospitals may result in injuries and become an obstacle to patient
safety. According to Wang et al. (2019), hospital falls lead to an increased hospital stay,
increased medical costs, litigation, and sometimes death. The existing falls prevention
methods aim to identify the patients at risk without determining the severity of the injuries
due to patients' falls. Wang et al. (2019) focus on assessing the severity of inpatient falls
based on a machine learning classifier integrating multi-view ensemble learning and modelbased missing data imputation method. The methods help in the prediction of the severity of
falls. The multi-view ensemble learning with missing values classifier calculates the
identified patients at risk of getting severe injuries if they fall. This prompts the need for
additional interventions to prevent falls.

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According to Wang et al. (2019), using the robust and generalized model of
integrative machine learning technique helps evaluate the severity of the injuries in cases
where a patient falls. The multi-view ensemble learning with missing values could be used
when a patient is admitted, and essential information, including diagnosis, can be collected.
This tool is critical as it would help healthcare providers focus on the patients with increased
severe injuries when they fall. Wang et al. (2019) state that the effectiveness of this tool is
measured when an assessment is made and the risks identified early. The severity of injury
tools is done together with a fall assessment because when a threat is specified, the severity
of the injury is determined using the tool. The tools allow the health care providers to come
up with the cost-effective implementation of falls prevention strategies that are efficient and
timely. They can provide for all patients at risk beyond standard-of-care interventions. This
method can be incorporated into the electronic medical record and a risk score placed on each
patient. This is essential as it alerts the health care providers. For patients with a high risk for
severe falls, the prevention strategies should be followed strictly (Wang et al., 2019). They
should be placed around the clock, observed, and monitored with the available nursing
resources. This will not only help in the reduction of falls but also severe injuries that are
associated with patient falls.


HHS Public Access
Author manuscript
Author Manuscript

Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.
Published in final edited form as:
Clin Geriatr Med. 2019 May ; 35(2): 273–283. doi:10.1016/j.cger.2019.01.007.

Preventing Falls in Hospitalized Patients: State of the Science
Jennifer H LeLaurin, MPH1 and Ronald I Shorr, MD, MS, FACP2
1.Health

Science Specialist, Center of Innovation on Disability and Rehabilitation Research
(CINDRR), Malcom Randall VA Medical Center, 1601 SW Archer Rd., CINDRR (151B),
Gainesville, FL 32608, Jennifer.LeLaurin@va.gov
2.Director,

Author Manuscript

Geriatric Research Education and Clinical Center (GRECC) and Research Professor of
Epidemiology, University of Florida, Malcom Randall VA Medical Center, 1601 SW Archer Rd.,
GRECC (182), Gainesville, FL 32608, Rshorr@ufl.edu

Keywords
accidental falls; hospitals; prevention; aged; alarms; restraints; nursing

1.

Introduction

Author Manuscript

Although hospital falls have been decreasing over the past several years, they remain a
significant problem.1 Patient falls are the most common adverse events reported in hospitals.
2–5 Each year, roughly 700,000 to 1 million patient falls occur in U.S. hospitals resulting in
around 250,000 injuries and up to 11,000 deaths.6 About 2% of hospitalized patients fall at
least once during their stay.7,8 Approximately one in four falls result in injury, with about
10% resulting in serious injury.9
Inpatient falls result in significant physical and economic burdens to patients (increased
injury and mortality rates and decreased quality of life) as well as to medical organizations
(increased lengths of stay, medical care costs, and litigation).10,11 In 2008, Centers for
Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for fall-related
injuries.12 Given significant financial pressure, hospitals are seeking a “silver bullet” to fall
prevention.13

Author Manuscript

Hospitals employ various “guidelines” for fall prevention.14–16 In general these include: 1)
identify patients who are at high risk of falling and 2) use clinical judgment to decide which
of a multitude of fall prevention strategies to utilize to reduce fall risk. Not surprisingly,
there is considerable heterogeneity among the guidelines which adds to confusion on the
“right approach” to fall prevention; this is promoting the uptake of time- and labor- intensive

*

Corresponding author (RIS).
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
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Disclosures:
Dr. Shorr serves as an expert witness in hospital falls cases.

LeLaurin and Shorr

Page 2

Author Manuscript

approaches to fall prevention into “standard of care.”17 The lack of clarity of prevention
guidelines may add to the cognitive burden of patient care and potentially increases patient
risk.18–20
Although there is a growing body of research on fall prevention in community dwelling
elderly, findings from these studies are not necessarily generalizable to the hospital
environment.17 Hospital patients have a myriad of acute and chronic illnesses which limit
judgement and mobility and they must navigate a new and unfamiliar environment.
Furthermore, staffing and even unit design considerations may play into fall risk. Short
lengths of stay offer a brief window of time to conduct interventions, rendering some
strategies (e.g. exercise programs) impractical. The unique organizational culture and
leadership structures of hospitals require specific implementation strategies. Thus, it is
imperative to examine fall prevention intervention strategies specific to the hospital setting.

Author Manuscript

2.

Study designs
While this manuscript is by no means a complete review of study designs, the goal is to
familiarize the reader with the strengths and limitations of the types of research often used to
test fall prevention interventions.

2.1.

Quality Improvement Studies

Author Manuscript

Many studies on fall prevention in hospitals take the form of a quality improvement (QI)
study. The goal of QI studies is not to generate generalizable knowledge but to share the
results of a programmatic change on health outcome such as falls.21 Many QI studies
employ an uncontrolled before-after design conducted on single nursing unit (or group of
units).

Author Manuscript

There are several reasons why most QI studies should not be viewed as “evidence” of
effectiveness of a fall prevention strategy. First, these studies are in general less rigorous
than research studies. Pronovost and Wachter state QI studies “commonly lack clarity
regarding the study population, interventions and co-interventions, outcome measurement
and definitions…and what data are available may be poor in quality.”22 QI interventions
frequently contain multiple components, often not well described, which can change
thorough the study. In addition, many of these interventions are led by a “champion” and it
is difficult to know how much the intervention was dependent on the “champion.” Also,
without a control group it is difficult to distinguish the effect of intervention from underlying
secular trends in falls. Finally, the incentive to publish a negative QI study is low, so the
possibility of publication bias is high. This may explain why Hempel found the intervention
effect for fall prevention across historical control studies (often QI) was 0.77 (95%
Confidence Interval = 0.5–1.18) whereas the intervention effect for fall prevention in studies
with concurrent controls (often research) was 0.92 (95% Confidence Interval = 0.65–1.30).23
In sum, we view QI studies as analogous to “case reports.” These studies are important for
hypothesis generation they do not serve as “evidence” that a fall prevention strategy is
effective outside of the context of the quality improvement initiative.

Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.

LeLaurin and Shorr

2.2.

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Research: Randomized Studies

Author Manuscript

Controlled trials represent a much stronger study design. Randomization and outcome
assessment can occur at the patient level or at a larger level—often the nursing unit. Such
designs are referred to as cluster randomized controlled trials (cRCTs). Traditionally cRCTs
were conducted using a parallel design, meaning once randomized, study units remain
intervention and control conditions through the duration of the study. A stepped wedge is a
newer design where all units in the study transition from control to experimental conditions
at regular intervals, called “steps,” which controls for underlying secular trends.24 This type
of design is particularly advantageous when evaluating a clinical or policy strategy has been
“made” but can be rolled out at flexible dates.

Author Manuscript

There are several advantages to employing a cluster- rather than a patient-randomized study
for hospital fall prevention. First, the possibility of contamination of the intervention onto
control patients is lessened when conducted by geographically separated staff. Second,
although an intervention may be effective at the patient-level (e.g., none of the patients fell
who had the intervention), the total number of falls a unit experiences may remain the
unchanged because the intervention was not applied to the “right” patients or so much
attention was paid to the intervention patients on the unit that “different” patients fell. Thus
an intervention could be efficacious for individual patients but not effective in practice.

Author Manuscript

In a cRCT units should be followed for several months prior to randomization to establish
baseline rates and then randomized to intervention and control conditions using methods that
would assure baseline fall rates are similar between intervention and control units. Followup should be long enough to minimize the study novelty, and to allow units to establish
stable fall rates. To minimize ascertainment bias is important that the visibility of the study
remain approximately equal between intervention and control units. To address secular
trends in fall rates the effect of the intervention should be tested using the interaction of the
slope of the rate of falls in the unit type (intervention or control) and the time (before and
after the initiate the intervention).
2.3.

Research: Non-randomized studies
Although randomized controlled studies yield the highest level of evidence, some
universally applied interventions (e.g., national policy changes) cannot be studied in a
controlled manor.25 In such cases, useful evidence can be derived from large, credible
parallel or before-and-after studies where the effect size cannot easily be attributable to
confounders, and where efforts have been made to control for secular trends.26

Author Manuscript

3.
3.1.

Single Fall Prevention Interventions
Fall risk identification
The use of fall risk prediction tools is widespread, but their value in hospital fall prevention
interventions is questionable.27–29 First, it is important distinguish between fall risk
assessments and fall prediction or screening tools. Risk assessments usually consist of a
checklist of risk factors for falls, but do not provide a score or value for the patient’s fall

Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.

LeLaurin and Shorr

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Author Manuscript

risk. Predictive tools use these known risk factors to calculate a score for the patient’s risk of
falling, with established cutoffs to identify risk level.
Some tools have demonstrated acceptable sensitivity and specificity in single studies, but the
reported predictive values of these tools vary by study design, setting, and population.27,28,30
Further, a patient’s risk for falling is transitory, requiring periodic reassessment. Few tools
have been validated specifically with older hospital patients, and a recent systematic review
concluded that existing tools do not have sufficient specificity and sensitivity to be
effectively used in this population.31

Author Manuscript

The lack of evidence supporting the use of predictive tools led to 2013 National Institute for
Health and Care Excellence (NICE) guidelines which explicitly recommended against the
routine use of fall prediction tools, instead advising that all inpatients over the age of 65 be
considered at high-risk.32 The Agency for Healthcare Research and Quality (AHRQ)
cautions that it is more important to identify and address a patient’s specific fall risk factors
than to determine their risk for falling.3 Despite this, fall risk screening tools are frequently
used to identify patients for intervention,23 often, relying on “home-made” tools without
established psychometric properties.4 While these tools have the potential to tailor fall
prevention strategies to specific patient risk factors,33 they predict falls no better than
nursing judgement.34
3.2.

Alarms

Author Manuscript

Alarm systems are designed to reduce falls by alerting staff when patients attempt to leave a
bed or chair without assistance. They can also function as a reminder to patients to call for
assistance before getting up. There are several types of alarm systems in use, including
pressure mats, infrared movement detectors, cord-activated alarms, and wearable devices.35
Alarms are disruptive and may be especially disturbing to cognitively impaired patients,
contributing to confusion and agitation. They also restrict mobility and independence; in US
nursing homes, alarms are considered a type of restraint and facilities can be penalized for
indiscriminate use of the devices.36

Author Manuscript

There is now strong evidence that alarms are ineffective as a fall prevention maneuver in
hospitals.37,38 A large cRCT tested the effectiveness of bed/chair alarm systems to prevent
falls in 16 general medical, surgical and specialty units in a US community hospital.37
Although the intervention successfully increased alarm use, there was no significant effect
on falls or physical restraint use. In an RCT performed in three acute wards in a UK
hospital, Sahota et al. found that alarms did not reduce fall rates and were not cost-effective.
38 AHRQ has cautioned there is an overreliance on alarms on alarms as a fall prevention
measure,3 yet alarms remain in use by over 90% of nurse managers.39
There are a few possible explanations for the ineffectiveness of alarms as a fall prevention
strategy. Reliance on alarms assumes staff have enough time to intervene prior to a fall,
which could be only a matter of seconds. Alarms may decrease vigilance by giving staff a
false sense of security. Finally, the Joint Commission has expressed concerns about
excessive hospital noise leading to general “alarm fatigue”.40

Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.

LeLaurin and Shorr

Page 5

Author Manuscript

Although the current body of evidence does not support the effectiveness of alarms as a fall
prevention measure in hospitals, there is promising new technology that may better predict
and prevent falls.41,42 These new systems and devices have the potential to serve as effective
and sustainable fall prevention strategies.
3.3.

Sitters
Sitters, also known as companions or ‘specials’, are a potentially effective yet costly fall
prevention strategy. Sitters provide one-to-one surveillance for patients deemed at high risk
for falls and may additionally provide therapeutic care. Guidelines for the use of sitters and
their duties, qualifications, and training vary among hospitals.43,44

Author Manuscript

There is indirect evidence of sitter effectiveness, but no RCTs of sitters as a single
intervention have been performed to date. The evidence supporting effectiveness of sitters
has been limited to small observational studies conducted in a single hospital—each with its
own definition of what constitutes a sitter.45–48 In addition to the limited evidence of
effectiveness, there is the possibility that sitters may have an adverse effect on patient care;
for example, to save on costs, existing staff may be utilized as sitters, potentially placing
other patients at risk. Despite the lack of evidence, sitters are recommended in numerous fall
prevention guidelines.49
Sitters represent a considerable expense, with annual costs of over $1 million reported.45,50
These costs are rising and are typically not reimbursable by third-party payers.45,51 Due to
their expense, hospitals are increasingly interested in reducing sitter use without negatively
impacting patient safety. Several initiatives have successfully reduced sitter use without
increasing fall rates.43,52

Author Manuscript

In sum, patient sitters are costly and hospitals discourage their use. Although not studied
rigorously, whether sitters prevent falls is not well established.43 Feil found that more than 4
of 5 falls which occurred with a sitter present were unassisted,49 reinforcing the hypothesis
that sitters are not a panacea for hospital falls.
3.4.

Intentional Rounding

Author Manuscript

In an effort to increase patient satisfaction and reduce patient harm, many hospitals have
instituted intentional rounding. Rounding is a proactive approach to meeting patient needs
that involves bedside checks at regular intervals, usually every one to two hours. The quality
of evidence for rounding is weak, with most of the literature consisting of QI studies.53,54
Difficulties with adherence and sustainability of rounding initiatives are widely reported,
55–57 and introduction of the practice is often perceived as a top-down approach which
restricts staff autonomy.57 Other barriers include increased workload, competing priorities,
poor documentation, inadequate education, and lack of staff buy-in.55,56 Thus, even if
stronger evidence supporting the effectiveness of rounding is produced, the feasibility of the
strategy as a sustainable fall prevention practice is uncertain.

Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.

LeLaurin and Shorr

3.5.

Page 6

Patient Education

Author Manuscript

There is some evidence that education is an effective component of multifactorial
interventions,58 but the body of evidence on their effectiveness as a single intervention is
limited. Haines et al. performed an RCT of a multimedia education intervention combined
with one-on-one follow up from a health professional. While the intervention did not
significantly reduce fall-related outcomes overall, subgroup analysis of cognitively intact
patients who received the intervention showed a 50% reduction in fall rates.58 When the
same intervention was tested in a cluster RCT in 8 hospital rehabilitation wards, a significant
reduction in rates of falls and falls resulting in injury.59 These results may be explained by
the fact that patients in rehabilitation wards tend to be more cognitively intact than those in
acute settings. Thus, although patient education is potentially effective in reducing hospital
falls for certain patients, it is not suitable for patients with cognitive impairment—a common
risk factors for inpatient falls.60

Author Manuscript

3.6.

Environmental Modifications

Author Manuscript

The physical environment can be an important contributor to falls. Of a total of 538 hospital
falls resulting in death or permanent loss of function that were reviewed by The Joint
Commission, 209 (39%) identified the physical environment as part of the root cause.8 Small
studies have explored the impact of a variety of environmental modifications. One RCT
found fewer falls occurred on vinyl flooring compared to carpet, but the findings were
limited by a small sample size and low fall rate during the 9-month trial.61 A cRCT found no
evidence that low-low beds reduced rates of falls or injuries from falls.62 Other interventions
have included visual cues (e.g. signage, wristbands), lighting, and the use of special rooms
for high-risk patients.63–65 Some of these fall prevention efforts have resulted in patient
harm; for example, in 2005 the FDA issued a recall of enclosed beds after reports of patient
injury and death from entrapment.66
3.7.

Physical Restraints
There is considerable controversy surrounding the use of physical restraints in hospital
settings.5,67 Patients who require restraints suffer a loss of dignity and autonomy;
furthermore, restraints may also cause agitation, delirium, pressure ulcers, deconditioning,
strangulation and death.68,69 Data suggest that restraints may not protect, but actually
increase risk of falling, or sustaining an injurious fall.70–72

Author Manuscript

Unfortunately, on the part of both health professionals and patients, there is a perception that
restraints reduce the risk of falling, and they are often employed as a “last resort” to protect
patients from falling.67,73,74 This perception of physical restraint effectiveness as a strategy
to prevent falls has persisted despite the increasingly restrictive regulations and standards
from CMS and The Joint Commission limiting their use.75,76
3.8.

Non-Slip Socks
Non-slip socks are often provided to hospitalized patients under the assumption that they
will provide additional traction to prevent patient falls. In contrast to manufacturers’ claims,
research has cast doubt on the slip-resistant properties of these products.77 The small body
of research on non-slip socks has not provided evidence of their efficacy as a fall prevention
Clin Geriatr Med. Author manuscript; available in PMC 2020 May 01.

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strategy.78 Further, non-slip socks carry the risk of spreading drug-resistant infection in
hospitals.79 Given the lack of evidence of effectiveness and potential to spread infection, a
patient’s own footwear remains the safest option for fall prevention.

4.

Multifactorial Interventions

Author Manuscript

Given the multitude of factors contributing to falls, it is intuitive that multi-component
interventions would be most effective in improving fall outcomes. Although fall prevention
guidelines typically recommend the use of multicomponent interventions,3,14,16,32 there
have been relatively few controlled trials of multi-component interventions. Of these, some
have found a reduction in fall rates80,81 while others reported no intervention effect.82,83
Barker et al. recently conducted the largest cRCT of a hospital fall prevention intervention to
date in 24 wards in 6 Australian hospitals (n=46,245 admissions). Despite successful
implementation of the 6-PACK program, the intervention did not produce lower rates of falls
or fall-related injuries.83

Author Manuscript

The limited number of high-quality studies and heterogeneity among intervention sites make
it challenging to combine studies for quantitative overviews. In a 2012 Cochrane review84,
pooled analysis of four small multicomponent RCTs revealed an overall reduction in fall rate
ratio (0.69, 95% CI 0.49–0.96) but not injurious falls. However, three of the cited studies
included subacute care units and the fourth was conducted in a single geriatric orthopedic
unit. A 2012 meta-analysis of six acute care interventions found a statistically significant,
but small reduction in fall rates (OR 0.9, CI 0.83–0.99) (DiBardino).85 A 2013 updated
review2 supported the evidence for multicomponent interventions, additionally identifying
factors associated with successful. It should be noted that none of these analyses did not
include the most recent negative results of the 6-PACK trial; this information will be
included in a forthcoming Cochrane Review.
The current body of evidence on multi-factorial interventions is limited in several respects.
The heterogeneity of components, delivery characteristics, and target populations make it
difficult to identify which specific components are effective. Implementation is a key
component of any successful patient safety initiative, but there is a lack of reporting on how
interventions were implemented in published studies.23 Finally, the body of evidence also
tends to be limited to older populations with a longer length of stay.5

5.

Conclusion

Author Manuscript

Although decreasing, hospital falls are a significant patient safety proble...


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