Huey-Ming Tzeng

Frequently observed risk factors for fall-related injuries and effective preventive interventions: a multihospital survey of nurses' perceptions.

There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice. Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions. The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards.

Link between patients' perceptions of their acute care hospital experience and institutions' injurious fall rates.

This exploratory study used 4 publicly available large data sets to determine whether significant correlations exist between patients’ perceptions of their acute care hospital experience and hospital-acquired injurious fall rates at their hospitals in the states of California, Florida, and New York in 2007. The results showed that the higher the inpatient satisfaction levels with the responsiveness of hospital staff and cleanliness and quietness of the hospital environment, the lower were the injurious fall rates.

Most frequently observed risk factors for adult inpatient injurious falls in hospitals.

Purpose: This exploratory, multihospital, cross-sectional nurse survey identified the adult population group with the most frequently observed risk factors for injurious falls in acute hospital settings. Methodology: The survey was conducted at 5 nonprofit health systems in the United States. A subset of the survey data from the main study was used in this analysis. The main study was conducted in 2011–2012 and included 560 registered nurses (RNs) from 68 units; it was published in the Journal of Nursing Care Quality in 2013. All the subjects from the main study were included in the present study. Factor analysis was conducted on 81 risk factor frequency items. We identified the group based on the ranking of the mean values for the frequency groups. The risk factor effective preventability items were also analyzed. Results: We identified 24 most frequently observed risk factors and 3 most effectively preventable risk factors, which were all integral to each individual patient. Five of the most frequently observed risk factors were identified as physical-motor factors, 8 were identified as cognition factors, and 4 were demographic characteristics. None of the most frequently observed risk factors were related to medication. The 3 most preventable risk factors were demographic characteristics. For exploratory purposes, 1-way analysis of variance tests were used and show that statistically significant differences were present in the mean scores on some of the frequency scales and effective preventability scales across study health systems, acuity levels of the units, and unit types. Conclusion/Application of the Study: Perceptions of RNs about the most frequently observed and the most effectively preventable risk factors were mostly inconsistent. Clinical nurse specialists and nursing administrators need to identify frequently observed risk factors on a regular basis. These findings need to be communicated with RN staff in a systematic way to prioritize interventions to prevent injurious falls.

Inpatient falls: the impact of family and personal caregivers.

The impact of family and personal caregivers on inpatients with fall-related injuries in a Taiwanese medical center is investigated in this study. Taiwan has a prevalent custom for families to accompany their hospitalized loved ones during hospital stays. During the 95-day data collection period, 228 falls occurred. Results showed that if no family members were present when a patient fell, the fall-related injury was less serious. Nurses in Taiwan tend to depend on family members to help provide patient care. Regardless of whether an inpatient has a family member present, frequent bedside nursing visits are important to prevent falls.

i Engaging as an innovative approach to engage patients in their own fall prevention care

Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fall prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients’ needs, we developed “i Engaging”, a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.

Is There a Link Between the Hospital-Acquired Injurious Fall Rates in US Acute Care Hospitals and These Institutions' Implementation Levels of Computerized Systems?

Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study’s findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes.

Keeping patient beds in a low position: An exploratory descriptive study to continuously monitor the height of patient beds in an adult acute surgical inpatient care setting

This descriptive study was intended to measure the percentage of the time that patient beds were kept in high position in an adult acute inpatient surgical unit with medical overflow in a community hospital in Michigan, United States. The percentage of the time was calculated for morning, evening, and night shifts. The results showed that overall, occupied beds were in a high position 5.6% of the time: 5.40% in the day shift, 6.88% in the evening shift, and 4.38% in the night shift. It is recognized that this study was unable to differentiate whether those times patient beds being kept in a high position were appropriate for an elevated bed height (e.g., staff were working with the patient). Further research is warranted. Falls committees may conduct high-bed prevalence surveys in a regular basis as a proxy to monitor staff members’ behaviors in keeping beds in a high position.

What are the highly important and desirable patient engagement actions for self-care as perceived by individuals living in the southern United States?

Aim This exploratory survey study aimed to identify patient engagement actions that are the most frequently named as being highly important (top 30 by importance) or ones that they want to do (top 30 by desire) for community-dwelling adult patients living in the southern United States. Items not making the list of the top 30 by ability were also identified. Background Patient engagement is still an ambiguous term among population health and health care professionals in the United States as we lack a clear understanding of what it entails. Methods This 2015–2016 study used convenience sampling to recruit subjects in a university’s student health service department and in eight senior centers. Two hundred and fifty adult patients older than 18 years in the Upper Cumberland region of Tennessee participated in the study (82% response rate). A 57-item inventory, “The Patient Action Inventory for Self-Care,” was developed and used to ascertain patients’ self-designated preferences and capabilities in order to understand their needs for education and support. Results Respondents included 159 (63.6%) women, 62 (24.8%) men, and 29 (11.6%) who did not indicate their gender. Combining the list of the top 30 importance items and the list of the top 30 desired items yielded a list of 35 items; noteworthy is the fact that the list of the top 30 ability actions contained nine items that were not found in a previously mentioned list of 35 high-ranking importance and desired items. This study validated the necessity of analyzing patient engagement actions by importance, desirability, and ability to accomplish it. These three levels are distinct from each other. Conclusion Nurses may use future versions of the inventory to assist patients in identifying self-care actions to engage in. Use of the inventory will demonstrate respect for patients’ preferences and may thus improve engagement.

i Engaging user testing: lessons learned from inpatients and health care providers.

This user-testing study assessed the feasibility of the functional prototype of an innovative fall prevention intervention, i Engaging, to engage patients in their own fall prevention care during hospital stays. The i Engaging application as well as its approaches to engage patients in fall prevention care during hospital stays was perceived as being easy to use, effective, and practical. The user-testing study consisted of adults 65 years of age or older and health care providers.

Relationship between inpatient pressure ulcer prevalence and patient satisfaction levels based on US Medicare's Hospital Compare data

Keywords: consumer satisfaction; hospitals; patient harm; patient safety; patient satisfaction; patients; pressure ulcer