Falls: A Retrospective Study Summary
Introduction
The purpose of this discussion is to describe the data collection method(s) utilized by Windia Wilbert (2013) entitled: The Effectiveness Of A Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study. The study was undertaken to analyze if there was a correlation between the nursing staff assessment and identification of patients at risk for falls and the nursing compliance with the hospital’s policy on fall prevention program. There were four research questions that the study sought to answer: (1) What were the hospital policy on fall prevention and the compliance of the nursing staff with the policy? (2) What were the common interventions that the nursing staff implemented to reduce patients’ falls? (3) What were the common patients’ risk factors for falling? And (4) what were some of the common medications and preventive measures identified for patients who were at risk for falling?
The study design utilized the retrospective review of the patients’ charts, e.g., patients’ electronic medical record, post fall analysis form, and incident report. As described by Vassar and Holzmann (2013) retrospective chart review is a type of research design that uses pre-recorded and patient-centered data to answer the research questions. One advantage of the …show more content…
retrospective analysis of the medical record is that it is cost-effective, e.g., large amount of information is found in one place, at one time and at little cost to the researcher (Worster & Haines, 2002).
Recruitment of Study Participants: Were the recruitment and selection of study participants or subjects clearly described and appropriate?
The recruitment and selection of the study participants were clearly described and was appropriate to address the research questions formulated for the study. The study was held on a 40-bed nursing home where 140 medical records of patients were reviewed. Out of the data extracted, a randomized sample of 70 patients older that 65 years old who fell between the period of two months (January 1, 2009 to March 31, 2009) were compared to 70 patients who did not fall during the same time period (Wilbert, 2013).
Consistency in Data Collection: Were the data collected in a consistent way?
There was consistency in the data collection with the utilization of a research tool in the abstraction of each patient’s information from the medical record. The clinical data extracted included the “patient’s age, gender, race, height, weight, blood pressure, activity, diagnosis, medications, men¬tal status, sensory deficits, mobility, footwear, patterns of elimination and, location of fall if a fall occurred” (Wilbert, 2013, p. 25). Also, the study used the patient falls data extracted from incident reports and post fall reports. To further facilitate consistency and maintain the validity of the study, the inci¬dent reports were separated by month and the fall rate was calculated quarterly (as the number of patient falls x 1000/number of patients’ days).
Control in the Study Design: Were the study controls maintained as indicated by the design? Did the design include an intervention that was consistently implemented?
The hospital’s policy on fall prevention program was built into the study to reflect the controls implemented to ensure that extraneous variables did not intervene and influenced the study findings.
As the policy indicated, the nursing staff has to initiate a plan of care to reduce falls in patients who were identified to be at risk for falling. At the same time, patients at risk for fall should be identified with visual signs, e.g., falling star on the wristband, outside patients’ door, on the front cover of patients’ medical record (Wilbert, 2013). In addition, common interventions to reduce falls were identified and to be implemented as protective
measures.
Integrity of the Study: Was the integrity of the study protected, and how were the problems resolved?
Informed consent was waived for the reason that the study utilized the retrospective review of patients’ medical record. It was also noted that no ethical issues were identified and no specific individuals were interviewed or questioned. The nursing staff and the patients were not informed about the study (Wilbert, 2013). Also, the data collected were de-identified by the investigator and the Medical Center Director granted approval and permission. In general, it should be noted that human subjects in any research study are to be protected and that it is not allowed to conduct a research study without ethics approval from an institutional review board (Gearing, Mian, Barber, & Ickowicz, 2006).
Studies Obtaining Data from Existing Databases: Did the researchers obtain data from an existing database? If so, did the data obtained address the study problem and objectives, questions, or hypotheses? Were the reliability and validity of the database addressed in the research report?
Following the retrospective design format, the study utilized existing administrative database from the following sources, e.g., patients’ electronic medical record, post fall analysis form, and incident reports. It has been observed that utilization of existing databases has the advantage of having access to a larger amount of information, at lower cost to the researcher, and less burden to the study participants (Grove, et al., 2015). Thus, the data obtained addressed the study’s objective to evaluate the compliance of the nursing staff in implementing the hospital’s fall prevention policy in assessing patients’ risk for fall and implementing interventions as measures to reduce patients’ falls and fall-related injuries (Wilbert, 2013). However, obtaining data from the patients’ medical record posed a limitation that was cited in the study. As stated, the study relied on the data provided in the Post Fall analysis form that was developed by the hospital and therefore “may lack any psychometric standardization” (Wilbert, 2013, p. 27) that would then be a threat to the reliability and validity of the study.
Conclusion
As previously noted, retrospective study using patients’ medical records is cost-effective and an efficient way to access and collect data. However, the validity of the results may be compromised due to the inconsistencies and incompleteness of the medical record (Columbia University, n.d.). For the most part, it is during the data abstraction that would affect the reliability and validity of the findings. Thus, it is important that data abstractors understand the type of data needed and how to address missing or incomplete records (Gearing et al., 2006).
The purpose of this discussion is to describe the data collection method(s) utilized by Windia Wilbert (2013) entitled: The Effectiveness Of A Fall Prevention/Management Program In Reducing Patient Falls: A Retrospective Study. The study was undertaken to analyze if there was a correlation between the nursing staff assessment and identification of patients at risk for falls and the nursing compliance with the hospital’s policy on fall prevention program. There were four research questions that the study sought to answer: (1) What were the hospital policy on fall prevention and the compliance of the nursing staff with the policy? (2) What were the common interventions that the nursing staff implemented to reduce patients’ falls? (3) What were the common patients’ risk factors for falling? And (4) what were some of the common medications and preventive measures identified for patients who were at risk for falling?
The study design utilized the retrospective review of the patients’ charts, e.g., patients’ electronic medical record, post fall analysis form, and incident report. As described by Vassar and Holzmann (2013) retrospective chart review is a type of research design that uses pre-recorded and patient-centered data to answer the research questions. One advantage of the …show more content…
retrospective analysis of the medical record is that it is cost-effective, e.g., large amount of information is found in one place, at one time and at little cost to the researcher (Worster & Haines, 2002).
Recruitment of Study Participants: Were the recruitment and selection of study participants or subjects clearly described and appropriate?
The recruitment and selection of the study participants were clearly described and was appropriate to address the research questions formulated for the study. The study was held on a 40-bed nursing home where 140 medical records of patients were reviewed. Out of the data extracted, a randomized sample of 70 patients older that 65 years old who fell between the period of two months (January 1, 2009 to March 31, 2009) were compared to 70 patients who did not fall during the same time period (Wilbert, 2013).
Consistency in Data Collection: Were the data collected in a consistent way?
There was consistency in the data collection with the utilization of a research tool in the abstraction of each patient’s information from the medical record. The clinical data extracted included the “patient’s age, gender, race, height, weight, blood pressure, activity, diagnosis, medications, men¬tal status, sensory deficits, mobility, footwear, patterns of elimination and, location of fall if a fall occurred” (Wilbert, 2013, p. 25). Also, the study used the patient falls data extracted from incident reports and post fall reports. To further facilitate consistency and maintain the validity of the study, the inci¬dent reports were separated by month and the fall rate was calculated quarterly (as the number of patient falls x 1000/number of patients’ days).
Control in the Study Design: Were the study controls maintained as indicated by the design? Did the design include an intervention that was consistently implemented?
The hospital’s policy on fall prevention program was built into the study to reflect the controls implemented to ensure that extraneous variables did not intervene and influenced the study findings.
As the policy indicated, the nursing staff has to initiate a plan of care to reduce falls in patients who were identified to be at risk for falling. At the same time, patients at risk for fall should be identified with visual signs, e.g., falling star on the wristband, outside patients’ door, on the front cover of patients’ medical record (Wilbert, 2013). In addition, common interventions to reduce falls were identified and to be implemented as protective
measures.
Integrity of the Study: Was the integrity of the study protected, and how were the problems resolved?
Informed consent was waived for the reason that the study utilized the retrospective review of patients’ medical record. It was also noted that no ethical issues were identified and no specific individuals were interviewed or questioned. The nursing staff and the patients were not informed about the study (Wilbert, 2013). Also, the data collected were de-identified by the investigator and the Medical Center Director granted approval and permission. In general, it should be noted that human subjects in any research study are to be protected and that it is not allowed to conduct a research study without ethics approval from an institutional review board (Gearing, Mian, Barber, & Ickowicz, 2006).
Studies Obtaining Data from Existing Databases: Did the researchers obtain data from an existing database? If so, did the data obtained address the study problem and objectives, questions, or hypotheses? Were the reliability and validity of the database addressed in the research report?
Following the retrospective design format, the study utilized existing administrative database from the following sources, e.g., patients’ electronic medical record, post fall analysis form, and incident reports. It has been observed that utilization of existing databases has the advantage of having access to a larger amount of information, at lower cost to the researcher, and less burden to the study participants (Grove, et al., 2015). Thus, the data obtained addressed the study’s objective to evaluate the compliance of the nursing staff in implementing the hospital’s fall prevention policy in assessing patients’ risk for fall and implementing interventions as measures to reduce patients’ falls and fall-related injuries (Wilbert, 2013). However, obtaining data from the patients’ medical record posed a limitation that was cited in the study. As stated, the study relied on the data provided in the Post Fall analysis form that was developed by the hospital and therefore “may lack any psychometric standardization” (Wilbert, 2013, p. 27) that would then be a threat to the reliability and validity of the study.
Conclusion
As previously noted, retrospective study using patients’ medical records is cost-effective and an efficient way to access and collect data. However, the validity of the results may be compromised due to the inconsistencies and incompleteness of the medical record (Columbia University, n.d.). For the most part, it is during the data abstraction that would affect the reliability and validity of the findings. Thus, it is important that data abstractors understand the type of data needed and how to address missing or incomplete records (Gearing et al., 2006).