Gina Sands

Patient Falls Focusing on Human Factors rather than Clinical Conditions

Falls have consistently been the largest single category of reported incidents for acute hospital in-patients. The number of falls and risk factors have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The main response to patient falls has been to treat the physiological and psychological presenting symptoms and condition by providing nursing care (mostly through assessment and monitoring) to minimise risk with the patient as a passive care recipient. As over 70% of falls are un-witnessed (unassisted) the active role of the patient in falls has not been fully explored. The new model (DIAL-F) is proposed which reverses the traditional Human Factors / Ergonomics model by describing the system elements in terms of the level of flexibility or transience (duration of action/involvement). The patient is the most transient element of the system, represented as a series of personas (archetypal descriptions) to include physical, cognitive and behavioural changes. This allows a more stimulating, riskier environment described as the ‘horticultural model of care’.

In-patient falls: what can we learn from incident reports?

BACKGROUND a previous analysis of 12 months data from the National Reporting and Learning System offered useful insights on contributory factors for patient falls but was limited due to the small data set of free-text analysis (n = 400). A subsequent pilot study of 4,571 reports found an apparent difference in the contributory factors for patients described as having cognitive and physical impairments. OBJECTIVE to analyse 3 years national incident data (2005-08) to further explore the contributory factors of in-patient falls. METHODS a total of 20,036 reports (15% sample) were analysed by coding the free-text data field. Contributory risk factors were compared with the whole sample and explored with the Chi-squared and Fishers exact tests. RESULTS data were reported about the degree of harm (100% of reports), (un)witnessed status of fall (78%), location (47%), patient activity (27%), physical impairment/frailty (9.5%) and cognitive impairment/confusion (9.2%). Less than 0.1% of reports provided data about dizziness, illness, vision/hearing, and medicines. Overall, patients were more likely to be harmed when away from the bed space, mobilising/walking and by falling from the bed when not intending to leave the bed. CONCLUSIONS this analysis explored incident reports at a level of detail not previously achieved. It identifies significant contributory factors for fall locations and activities associated with physical and cognitive characteristics.

A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR)

Objective: To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Design: Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Setting: Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Subjects: Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. Interventions: The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. Outcomes: The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Results: Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. Conclusions: The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial.

Qualitative study investigating the commissioning process for older people's services provided by third sector organisations: SOPRANO study protocol

Introduction The commissioning of third sector services for older people may influence the quality, availability and coordination of services for older people. The SOPRANO study aims to understand the relationships between and processes of commissioning bodies and third sector organisations providing health and social care services for older people. Methods and analysis This qualitative study will be based in the East Midlands region of England. An initial scoping survey of commissioners will give an overview of services to maintain the health and well-being of older people in the community that are commissioned. Following this, semistructured interviews will be conducted with 4 sample groups: health and social care commissioners, service provider managers, service provider case workers and older service users. A sample size of 10–15 participants in each of the 4 groups is expected to be sufficient to reach data saturation, resulting in a final expected sample size of 40–60 participants. Informed consent will be gained from all participants, and those unable to provide informed consent will be excluded. The interview data will be analysed by 2 researchers using framework content analysis. Ethics and dissemination Approval for the study has been gained from the University of Nottingham School of Medicine ethical review board, and the relevant approvals have been gained from the National Health Service (NHS) research and development departments for interviewing NHS staff. Early engagement with a wide range of stakeholders will ensure that the research findings are extensively disseminated to relevant stakeholders (including commissioners and third sector providers) in an accessible format using the extensive communication networks available to the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care CLAHRCs (applied health research organisations covering all of England). The study will also be disseminated through academic routes such as conference presentations and journal papers.

An occupational therapy intervention for residents with stroke living in care homes in the United Kingdom: A content analysis of occupational therapy records from the OTCH trial

Introduction This study aimed to describe the content of occupational therapy delivered in a randomized controlled trial of United Kingdom care home residents with stroke (The Occupational Therapy in Care Homes (OTCH) trial). The trial intervention aimed to maintain or improve residents’ activity levels in relation to personal activities of daily living and mobility. Method A qualitative design was adopted using content analysis to thematically code and analyse the occupational therapy notes of residents in the intervention arm of the trial. Treatment notes comprised of an initial assessment, a goal and treatment plan and a description of activities at each visit. A purposive sample of 50 sets of therapy notes was selected reflecting the geographical locations, care home types and resident characteristics observed in the OTCH trial intervention group. Findings Occupational therapists individually assessed residents’ function and goals. Planning was sometimes client-centred, but not all residents were able to share personal goals. Carers impacted on the success of the intervention. Treatment outcomes in relation to increasing functional activity were noted in some cases, but not always fully realized in this frail population. Conclusion Increasing functional activity is challenging in care home populations; future studies should assess occupational therapy for residents in relation to leisure or social activities.