Two Sides to Every Fall: Patient and Nurse Perspectives

2020 ◽  
Vol 40 (6) ◽  
pp. 33-41
Author(s):  
Linda M. Hoke ◽  
Rachel T. Zekany
Keyword(s):  
Risk Factors ◽  
Content Analysis ◽  
Acute Care ◽  
Fall Prevention ◽  
Analysis Approach ◽  
Cardiac Care ◽  
Prevention Strategies ◽  
Factors Associated ◽  
Two Sides ◽  
Cardiac Care Unit

Background Despite vast evidence describing risk factors associated with falls and fall prevention strategies, falls continue to present challenges in acute care settings. Objective To describe and categorize patient and nurse perspectives on falls and nurses’ suggestions for preventing falls. Methods To improve transparency about the causes of falls, nurses interviewed patients in a 48-bed progressive cardiac care unit who had experienced a fall. A content analysis approach was used to examine responses to 3 open-ended items: why patients said they fell, why nurses said the patients fell, and nurses’ reflections on how each fall could have been prevented. Results Over a 2-year period, 67 falls occurred. Main themes regarding causes of falls were activity (41 falls, 61%), coordination (16 falls, 24%), and environment (10 falls, 15%). Patients said they fell because they slipped, had a medical issue, were dizzy, or had weak legs. Nurses said patients fell because they had a medical issue or did not call for assistance. Conclusions Nurses and patients agreed on the causes of assisted falls but disagreed on the causes of unassisted falls. Nurses frequently said that the use of a bed alarm could have prevented the fall.

The Relative Contribution of Physical and Cognitive Fall Risk Factors in People With Parkinson’s Disease

2013 ◽  
Vol 28 (3) ◽  
pp. 282-290 ◽  
Author(s):  
Serene S. Paul ◽  
Catherine Sherrington ◽  
Colleen G. Canning ◽  
Victor S. C. Fung ◽  
Jacqueline C. T. Close ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Muscle Strength ◽  
Fall Prevention ◽  
Fall Risk ◽  
Freezing Of Gait ◽  
Prevention Strategies ◽  
Relative Contribution ◽  
Leg Muscle

Background. In order to develop multifaceted fall prevention strategies for people with Parkinson’s disease (PD), greater understanding of the impact of physical and cognitive performance on falls is required. Objective. We aimed to identify the relative contribution of a comprehensive range of physical and cognitive risk factors to prospectively-measured falls in a large sample of people with PD and develop an explanatory multivariate fall risk model in this group. Methods. Measures of PD signs and symptoms, freezing of gait, balance, mobility, proprioception, leg muscle strength, and cognition were collected on 205 community-dwelling people with PD. Falls were monitored prospectively for 6 months using falls diaries. Results. A total of 120 participants (59%) fell during follow-up. Freezing of gait ( P < .001), dyskinesia ( P = .02), impaired anticipatory and reactive balance ( P < .001), impaired cognition ( P = .002), reduced leg muscle strength ( P = .006), and reduced proprioception ( P = .04) were significantly associated with future falls in univariate analyses. Freezing of gait (risk ratio [RR] = 1.03, 95% confidence interval [CI] = 1.00-1.05, P = .02), impaired anticipatory (RR = 1.01, 95% CI = 1.00-1.02, P = .03) and reactive (RR = 1.26, 95% CI = 1.01-1.58, P = .04) balance, and impaired orientation (RR = 1.28, 95% CI = 1.01-1.62, P = .04) maintained significant associations with falls in multivariate analysis. Conclusion. The study findings elucidate important physical and cognitive determinants of falls in people with PD and may assist in developing efficacious fall prevention strategies for this high-risk group.

scholarly journals Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

2021 ◽  
Author(s):  
◽  
Manjusha Maprel
Keyword(s):  
Acute Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
The Elderly ◽  
Fall Rate ◽  
Prevention Strategies ◽  
Severe Injuries ◽  
Meaningful Improvement ◽  
Telemetry Unit ◽  
Practice Problem

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

scholarly journals Fall Prevention: Who's at Risk?

EDIS ◽  
2019 ◽  
Vol 2005 (5) ◽  
Author(s):  
Sergio Romero
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Fall Prevention ◽  
Cooperative Extension Service ◽  
Extension Service ◽  
Publication Date ◽  
Risk Of Falling ◽  
University Of Florida ◽  
Factors Associated ◽  
Poor Lighting

There are many risk factors associated with falls. Some risks are environmental, like poor lighting. Others relate to diseases people have or medications they take. It’s important to know if you are at high risk of falling. Take this quiz in this document to see if you are at risk. This document is FCS2227, one in a series of the Department of Family, Youth and Community Sciences, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611. Publication date: April 2005. FCS2227/FY733: Fall Prevention: Who's at Risk? (ufl.edu)

scholarly journals Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

2021 ◽  
Author(s):  
◽  
Manjusha Maprel
Keyword(s):  
Acute Care ◽  
Fall Prevention ◽  
Fall Risk ◽  
The Elderly ◽  
Fall Rate ◽  
Prevention Strategies ◽  
Severe Injuries ◽  
Meaningful Improvement ◽  
Telemetry Unit ◽  
Practice Problem

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

Risk factors for ED visits and admissions during outpatient chemotherapy in head and neck cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 223-223
Author(s):  
Navika Shukla ◽  
Anirudh Saraswathula ◽  
Saad A. Khan ◽  
Vasu Divi
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Acute Care ◽  
Neck Cancer ◽  
Care Utilization ◽  
Factors Associated ◽  
Outpatient Chemotherapy ◽  
Acute Care Utilization ◽  
Ed Visits

223 Background: Despite the recent introduction of the CMS metric, OP-35, which tracks 30-day inpatient admissions and ED visits after outpatient chemotherapy administration, the risk factors driving acute care utilization (ACU) in the head and neck cancer treatment setting are not yet well understood. Further characterization of these risk factors could allow for improved care quality and reduce preventable inpatient and ED admissions. Methods: This was a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked cancer registry-claims database. The study cohort consisted of patients aged 66 years or older diagnosed with head and neck cancer between 2004-2015 who received outpatient chemotherapy within the first two years after diagnosis. Multivariable logistic regression modeling was utilized to characterize the risk factors associated with an inpatient or ED admission within 30 days after receiving chemotherapy. Results: Of the 2,236 eligible patients, 735 (32.9%) had at least one inpatient or ED admission within 30 days of receiving outpatient chemotherapy. On multivariable analysis, cancer of the oral cavity [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.04-1.96] and oropharynx/hypopharynx [OR 1.34; 95% CI 1.06-1.70] were associated with an increased odds of ACU. Other factors associated with ACU included NCI comorbidity index [OR 1.10; 95% CI 1.03-1.18], prior ACU [OR 1.06; 95% CI 1.02-1.09], second cycle of chemotherapy relative to the first cycle [OR 0.38, 95% CI 0.29-0.50], and third or greater cycle of chemotherapy [OR 0.17; 95% CI 0.13-0.21]. Certain chemotherapeutic agents also modified risk: use of an angiogenesis inhibitor [OR 0.18; 95% CI 0.06-0.45], alkylating agent [OR 1.24; 95% 1.01-1.53], plant alkaloid [OR 1.63; 95% CI 1.25-2.10], or antimetabolite [OR 2.69; 95% CI 1.78-4.09]. The most common admission diagnosis was pain (n = 243; 33.1%) followed by dehydration (n = 167; 22.7%). Conclusions: Multiple clinical variables modify risk of acute care utilization after outpatient chemotherapy in the head and neck cancer setting, providing several potential avenues of intervention for providers.

scholarly journals 42 Fall Brain: Cognitive and Biological Perspectives

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv9-iv12
Author(s):  
Joe Verghese
Keyword(s):  
Risk Factors ◽  
Fall Prevention ◽  
Neural Mechanisms ◽  
Prevention Strategies ◽  
Clinical Predictors ◽  
Risk Of Falls ◽  
Falls In Older Adults ◽  
Reduce Risk ◽  
Risk Factors For Falls ◽  
The Relationship

Abstract While many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls. Hence, there is a knowledge gap regarding the underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which in turn are major risk factors for falls in older adults. A growing understanding of the relationship between cognitive and mobility processes in aging opens up the possibility of novel interventions to improve mobility and reduce risk of falls.

Predicting Use of Outdoor Fall Prevention Strategies: Considerations for Prevention Practices

2018 ◽  
Vol 38 (6) ◽  
pp. 775-790 ◽  
Author(s):  
Tracy Chippendale
Keyword(s):  
Fall Prevention ◽  
Stepwise Regression ◽  
Strategy Use ◽  
Community Dwelling ◽  
Behavioral Strategies ◽  
Prevention Strategies ◽  
Factors Associated ◽  
Different Types ◽  
Education Levels ◽  
Urban Versus

Purpose: Outdoor falls are just as common as indoor falls, but have received less attention in research and practice. Behavioral strategies play an important role in outdoor fall prevention. The purpose of this study was to examine predictors of strategy use. Method: Backward stepwise regression was used to study factors associated with use of outdoor fall prevention strategies among a random sample ( N = 120) of community-dwelling seniors. Results: Significant negative predictors of strategy use included higher education levels ( p < .01) and living in an urban versus a suburban environment ( p < .01). Concern about falls and number of identified risks were positive predictors ( ps < .05). Differences were found between outdoor fallers and nonfallers in the use of three different types of strategies ( ps < .05). Conclusion: There are some differences in the profiles of people who use and do not use outdoor fall prevention strategies. Further study of additional factors is warranted.

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