PICOT Statement

PICOT Statement

Specific question

Does adequate daily fall risk assessment by RN and patient education regarding fall prevention, decrease the incidence of falls among the hospitalized older adults?

Problem

Patient falls are a primary safety problem concern among the elderly hospitalized patients. According to Isomi, Susanne, David and Paul (2013), there lacks a clear definition of what constitutes a fall due to varying research literatures and different views among the older adults on what is a fall. However, there is a common agreement that there is a frequent occurrence of patient falls among older adults and sometimes may cause severe psychological and physical problems (Isomi et al, 2013). The estimated rate at which patient falls occurs in acute hospitals falls between 1.3 to approximately 8.9 per one thousand bed-days. About 30% to 50% of falls among the hospitalized adults cause most of the injuries reported in health care facilities. Between 1% and 2% of inpatient falls cause hip fractures.

Additionally, inpatient falls increases the discharge rates from hospitals to other institutions that provide long-term care services and the length of stay, which in turn results to higher operational costs (Isomi et al, 2013). A recent meta-analysis conducted in several hospitals in Missouri revealed that the operational costs for controlling patients with injuries due to falls were higher by US$13000 relative to those without falls. Furthermore, the length of stay increased by 6.3 days. Isomi et al. (2013) point out that, falls with less severe injuries may cause, depression, anxiety, reduction in patient physical activities, the fear of falling and distress.

Interventions

According to Isomi et al. (2013), most health care institutions use multicomponent prevention mechanisms to prevent in patient falls. However, the individual components evaluated differ in all publicized intervention programs, meaning no similar combination of components have been evaluated in more than one application. Therefore, identifying the evidence for the best prevention intervention components entails describing the commonly used components in the multicomponent intervention programs that have been evaluated. According Rauch, Balascio and Gilbert (2009), two components deemed as successful include, the quality nurse assessment of patients susceptible to risks of falling by utilizing the evidence based assessment tool, patient education and patient orientation to the surroundings and prompt response to patient needs and regular rounding.

Isomi et al. (2013) claim that, in all the evaluated multicomponent intervention programs there is a formal or informal assessment of fall risk patients. Additionally, about 60% of research studies conducted on patient falls, formal assessment of fall risk patients’ tools as an intervention component was used. Such tools include, STRATIFY and Morse Fall Scale. Other single components for fall interventions such as patient education and orientation, improvement in patient assistance or observations and early identification of fall risk patients are effective (Isomi et al., 2013). However, most evidence reviewed indicated that multicomponent interventions or multifaceted interventions are most effective compared to use of individual intervention components.

 Comparison

            The use of multifaceted interventions to prevent falls have significant benefits as the number of incidence rates decreases. According to Rauch (2009), fall risk tool assessment is important because it gives directions for use of multifactorial intervention components proven as key to reduction of hospitalized adults’ risks of falling. Cameron et al., (2010) state that systematic reviews on the effectiveness of the implemented multifaceted fall reduction interventions in hospitals and nursing homes revealed that in out of 6478 participants the rate of falling had reduced by 31% while in out of 4824 participants there was a 27% decline in the incidence rates.

Therefore, the evidence indicates that implementation of the multifactorial intervention programs result to lower or decline in the incidents rates compared to before implementation of the interventions. Adult patients who receive fall education have less fear of falling and have improved self–efficacy due to reduction of anxiety or depression caused by fear of falling (Cameron et al., 2010). Adult patients improve self-efficacy after obtaining fall education thereby the number of incident rates are lower after the intervention compared to before the intervention. Group sessions have proven to be an effective platform for the adult patients to share their experiences, which provide a sense of togetherness, which enables fall patients to recover quickly (Rauch, 2009). As such, the length of stay is reduced and the operation costs mitigated.

Outcomes

            Upon effective implementation of the fall risk tool assessments, patient education and intervention, there is expectation that the rate of falling among the adults will decline and the incident rates will lower (Rauch, 2009). There will be evaluation of the multicomponent interventions to ensure continuous improvement, which will result in achievement of the expected outcome of keeping the rate of fall incidents low, minimizing the length of stay and the operational costs. The targeted group for fall education, which include the patients and their families and the nurses, have received the necessary education to control the risks of falling. This is expected to ensure that there is improved patient satisfaction, which will be a motivation to the hospital staffs that their efforts had positive results.

References

Cameron D, Murray G, Gillespie L, et al. (2010) Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database of Systematic reviews. Art no. CD005465, [PubMed]

Isomi. M, Susanne .H, David. A and Paul. G. (2013). Making Healthcare Safer 11: An updated critical analysis of the evidence for patient safety and practices. Agency for Health Care Research and Quality (US). Rockville (MD). No 211. [PubMed]

Oliver D, Healey F, Haines T. (2010). Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med: 645-92. [PubMed]

Rauch K, Balascio J, Gilbert P. (2009). Excellence in action: developing and implementing a fall prevention program. J Healthic Qual: 36-42. [PubMed]

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