Falls In Hospitals
Research Summary and Ethical Considerations of “Factors Associated with Falls in Hospital Adults Patients”
Introduction
Falling is a crucial issue among the hospitals. Even the hospitals make all the efforts to prevent falls, falls still occur frequently and some repeatedly. According to Currie (2008), approximately 700000 to 1000000 individuals fall in the united states hospitals each year. A fall in a hospitalized patient is considered a never-event by Medicare and Medicaid services(CMS) (Cox et al., 2014) As the result, healthcare organizations are not reimbursed for these events which increase the financial burden of hospitals.
Background of study:
Falls can be categorized into accidental, unanticipated physiologic, anticipated physiologic …show more content…
or intentional (as cited in Cox et al., 2014). Furthermore, the component of causing falls in hospitals is intrinsic and extrinsic factors to the patients, as well as organizational or workforce factors (Cox et al., 2014). Fall prevention approaches are tailored to each patient’s unique intrinsic or extrinsic risks; however fall prevention strategies are universal and designed to diverse patient population (Cox et al., 2014) Moreover, the scale from all the fall risk assessment tools, such as the Hendrich I Falls Risk Assessment Scale and Morse Falls Risk Assessment Scale, do not indicate the type of fall for which a patient is at risk, making it difficult to tailor or target fall prevention approaches to complements individual's physiological or environmental risks (Cox et al., 2014). According to Cox et al. (2014), "there is a clear need to gain a broader understanding of the factors, both patients- related and environmental, that contribute to falls in hospitalized patients".
The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. The aims of Cox et al. (2014) in this study are as follows: Ascertain the number of documented patient falls attributable to one of four causes (accidental, anticipated, unanticipated and intentional) Determine the level of injury associated with each of four types of the falls Identify any associations between demographic, patient, environmental and workforce factors and the odds of fall occurrences.
Methods of study:
This was a quantitative research with descriptive, correlational, retrospective study, which was conducted in a 500-bed Magnet teaching hospital in Northeastern New Jersey. Systematic sampling was used in this study. Every third patient was selected from fallers or non-fallers. 50 adult fallers are chosen from electronic medical records with random order among fallers in medical and /or surgical unit in 2012. 110 adult non-fallers are picked from electronic medical records with order among non-fallers in the medical and surgical unit in 2012. Descriptive statistics were used to summarize and to describe the study sample( Cox et al., 2014).
Results of study:
In the study of Cox et al.
(2014), the majority of the falls were categorized as anticipated physiologic falls, 54%; more than 25% of the fall were extrinsically driven and due to environmental hazards. In consequence, with the knowledge the various stratifications of falls, nursing staff can establish personalized and timely applications of safety approaches to potentially avert a particular type of fall; the strategies to recognize the environmental hazards and orient patients to the surroundings can prevent falls from accidental falls in clinical (Cox et al., 2014).
In addition,"factors, such as age (odds ratio [OR] = 1.17; p = 0.027; 95% confidence interval [CI], 1.01-1.35), narcotic/sedative use (OR =16.64; p = 0.01; 95% CI,2.96-93), and overnight shift (OR = 3-12; p = 0.00; 95% CI, 1.69-5.75) significantly and independently predicted the probability of a fall during the hospitalization" (Cox et al., 2014). Furthermore, "patients’ diagnosis such as cardiovascular comorbidities (OR = 0.10; p = 0.001; 95% CI, 1.01-1.35) and neuro/ musculoskeletal (OR = 0.233, p = 0.000; 95% CI, 0.145-0.373, evening shift(OR = 0.011; p = 0.035; 95% CI, 0.00-0.729), implementation of fall prevention strategies (OR = 0.12; p = 0.00; 95% CI, 0.06-0.26) and a high RN to unlicensed assistive personnel staffing ratio (OR = 0.19; p = 0.001; 95% CI, 0.06-0.58) indicated a decreased probability of a fall through the hospitalization" (Cox et al., 2014). Findings from this study support the multi-etiologic nature of falls for inpatients and aid the efforts of the staff to prevent falls in future clients. From the evidence of the study, results can indicate that evidence-based fall prevention intervention can be effective modalities that can decrease fall occurrence for inpatients and the presence of RNs is indispensable to fall prevention setting (Cox et al.,
2014).
Ethical Considerations
According to Cox et al. (2014), the study was approved by two Institutional Review Board, Rutgers University, and Magnet teaching hospital, as well as patient privacy, was protected due to all data abstracted were de-identified to confidentially protect subjects.
This research was a retrospective study, hence no treatment which may harm or danger to anyone, involved. The principal investigator and co-investigators trained the recruited staff nurses (RN) to assist with data abstraction; in addition, in order to avoid the lack of ascertaining compliance and adherence to the data collection process, co-investigators simultaneously audited 20% of data abstracted by data collectors.
Conclusion
Patient falls cannot be completely avoided and will continue to occur in hospitalized patients; however, in order to successfully prevent a fall, risk factors must be accurately assessed, and prevention strategies must be effectively implemented (Cox et. al., 2014). In this study, assessment and prevention are the foundations of a comprehensive fall reduction program. After assessing with a validated tool, patients ,who have high fall risk scores, can be significantly predicted a fall during hospitalization Cox et al., 2014). Furthermore, the study also found the initiation of fall prevention strategies following a prescribed fall prevention protocol can decrease the likelihood of fall Cox et al., 2014).
According to the Cox et al. (2014), the nurses play a crucial role in both risk determination and prevention; hence, exploring the types of falls can guide to prevention interventions that can be specifically tailored to meet the fall risk identified for every single patient and are beneficial to RNs. Besides, "qualitative research is needed to explore and disentangle the specific and likely implicit strategies used by RNs to prevent falls in hospitalized patients in the future" (Cox et al., 2014).
In this study, evening shift hours also found to significantly reduce the likelihood of a fall so Cox et al. (2014) also stated, “ further research at the time of fall is warranted to understand the diurnal impact on fall occurrence”.
Introduction
Falling is a crucial issue among the hospitals. Even the hospitals make all the efforts to prevent falls, falls still occur frequently and some repeatedly. According to Currie (2008), approximately 700000 to 1000000 individuals fall in the united states hospitals each year. A fall in a hospitalized patient is considered a never-event by Medicare and Medicaid services(CMS) (Cox et al., 2014) As the result, healthcare organizations are not reimbursed for these events which increase the financial burden of hospitals.
Background of study:
Falls can be categorized into accidental, unanticipated physiologic, anticipated physiologic …show more content…
or intentional (as cited in Cox et al., 2014). Furthermore, the component of causing falls in hospitals is intrinsic and extrinsic factors to the patients, as well as organizational or workforce factors (Cox et al., 2014). Fall prevention approaches are tailored to each patient’s unique intrinsic or extrinsic risks; however fall prevention strategies are universal and designed to diverse patient population (Cox et al., 2014) Moreover, the scale from all the fall risk assessment tools, such as the Hendrich I Falls Risk Assessment Scale and Morse Falls Risk Assessment Scale, do not indicate the type of fall for which a patient is at risk, making it difficult to tailor or target fall prevention approaches to complements individual's physiological or environmental risks (Cox et al., 2014). According to Cox et al. (2014), "there is a clear need to gain a broader understanding of the factors, both patients- related and environmental, that contribute to falls in hospitalized patients".
The purpose of this study was to examine intrinsic, extrinsic, and workforce factors that contribute to falls among hospitalized adult patients. The aims of Cox et al. (2014) in this study are as follows: Ascertain the number of documented patient falls attributable to one of four causes (accidental, anticipated, unanticipated and intentional) Determine the level of injury associated with each of four types of the falls Identify any associations between demographic, patient, environmental and workforce factors and the odds of fall occurrences.
Methods of study:
This was a quantitative research with descriptive, correlational, retrospective study, which was conducted in a 500-bed Magnet teaching hospital in Northeastern New Jersey. Systematic sampling was used in this study. Every third patient was selected from fallers or non-fallers. 50 adult fallers are chosen from electronic medical records with random order among fallers in medical and /or surgical unit in 2012. 110 adult non-fallers are picked from electronic medical records with order among non-fallers in the medical and surgical unit in 2012. Descriptive statistics were used to summarize and to describe the study sample( Cox et al., 2014).
Results of study:
In the study of Cox et al.
(2014), the majority of the falls were categorized as anticipated physiologic falls, 54%; more than 25% of the fall were extrinsically driven and due to environmental hazards. In consequence, with the knowledge the various stratifications of falls, nursing staff can establish personalized and timely applications of safety approaches to potentially avert a particular type of fall; the strategies to recognize the environmental hazards and orient patients to the surroundings can prevent falls from accidental falls in clinical (Cox et al., 2014).
In addition,"factors, such as age (odds ratio [OR] = 1.17; p = 0.027; 95% confidence interval [CI], 1.01-1.35), narcotic/sedative use (OR =16.64; p = 0.01; 95% CI,2.96-93), and overnight shift (OR = 3-12; p = 0.00; 95% CI, 1.69-5.75) significantly and independently predicted the probability of a fall during the hospitalization" (Cox et al., 2014). Furthermore, "patients’ diagnosis such as cardiovascular comorbidities (OR = 0.10; p = 0.001; 95% CI, 1.01-1.35) and neuro/ musculoskeletal (OR = 0.233, p = 0.000; 95% CI, 0.145-0.373, evening shift(OR = 0.011; p = 0.035; 95% CI, 0.00-0.729), implementation of fall prevention strategies (OR = 0.12; p = 0.00; 95% CI, 0.06-0.26) and a high RN to unlicensed assistive personnel staffing ratio (OR = 0.19; p = 0.001; 95% CI, 0.06-0.58) indicated a decreased probability of a fall through the hospitalization" (Cox et al., 2014). Findings from this study support the multi-etiologic nature of falls for inpatients and aid the efforts of the staff to prevent falls in future clients. From the evidence of the study, results can indicate that evidence-based fall prevention intervention can be effective modalities that can decrease fall occurrence for inpatients and the presence of RNs is indispensable to fall prevention setting (Cox et al.,
2014).
Ethical Considerations
According to Cox et al. (2014), the study was approved by two Institutional Review Board, Rutgers University, and Magnet teaching hospital, as well as patient privacy, was protected due to all data abstracted were de-identified to confidentially protect subjects.
This research was a retrospective study, hence no treatment which may harm or danger to anyone, involved. The principal investigator and co-investigators trained the recruited staff nurses (RN) to assist with data abstraction; in addition, in order to avoid the lack of ascertaining compliance and adherence to the data collection process, co-investigators simultaneously audited 20% of data abstracted by data collectors.
Conclusion
Patient falls cannot be completely avoided and will continue to occur in hospitalized patients; however, in order to successfully prevent a fall, risk factors must be accurately assessed, and prevention strategies must be effectively implemented (Cox et. al., 2014). In this study, assessment and prevention are the foundations of a comprehensive fall reduction program. After assessing with a validated tool, patients ,who have high fall risk scores, can be significantly predicted a fall during hospitalization Cox et al., 2014). Furthermore, the study also found the initiation of fall prevention strategies following a prescribed fall prevention protocol can decrease the likelihood of fall Cox et al., 2014).
According to the Cox et al. (2014), the nurses play a crucial role in both risk determination and prevention; hence, exploring the types of falls can guide to prevention interventions that can be specifically tailored to meet the fall risk identified for every single patient and are beneficial to RNs. Besides, "qualitative research is needed to explore and disentangle the specific and likely implicit strategies used by RNs to prevent falls in hospitalized patients in the future" (Cox et al., 2014).
In this study, evening shift hours also found to significantly reduce the likelihood of a fall so Cox et al. (2014) also stated, “ further research at the time of fall is warranted to understand the diurnal impact on fall occurrence”.