Joke Coussement

Interventions for preventing falls in acute and chronic care hospitals: a systematic review and meta-analysis.

OBJECTIVES: To determine the characteristics and the effectiveness of hospital fall prevention programs.

Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

To determine characteristics and effectiveness of prevention programs on fall‐related outcomes in a defined setting.

Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: An observational study

BACKGROUND Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patient care in the hospital. A number of instruments are used to measure this patient safety climate or culture. The Safety Attitudes Questionnaire is a validated, widely used instrument to investigate multiple dimensions of safety climate at the clinical level in a variety of inpatient and outpatient settings. OBJECTIVES The purpose of this study is to explore the face- and content validity and the internal consistency of the Safety Attitudes Questionnaire in a large Belgian academic medical center. METHOD The translation into Dutch was done by three researchers. A panel of fifteen Dutch speaking experts evaluated the translation and its content validity. Content validity was quantified by the content validity index (CVI) and a modified kappa index. Face validity was evaluated by two nurses and two physicians who assessed the Dutch version of the SAQ. A cross-sectional design was used to test internal consistency of the SAQ items by calculating Cronbachs alpha and corrected item-total correlations. RESULTS Twenty-three of the 33 SAQ items showed excellent and seven items showed good content validity. One item had a fair kappa value (item 20) and two items had a low content validity index (items 15 and 16). The average CVI of the total scale was 0.83 and ranged from 0.55 to 0.97 for the six subscales. The face-validity was good with no fundamental remarks given. The SAQs overall Cronbachs alpha was 0.9 and changed minimally when removing items. The item-total correlations ranged from 0.10 to 0.63, no single items were strongly correlated with the sum of the other items. CONCLUSION We conclude that in this study the Dutch version of the Safety Attitudes Questionnaire showed acceptable to good psychometric properties. In line with previous evidence, this instrument seems to be an acceptable to adequate tool to evaluate the safety climate.

Feasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study

BACKGROUND About 40% of all adverse events in hospital are falls, but only about one in three Belgian hospitals have a fall prevention policy in place. The implementation of a national practice guideline is urgently needed. OBJECTIVE AND DESIGN This multicentre study aimed to determine the feasibility of a previously developed guideline. SETTING, PARTICIPANTS AND METHOD: Seventeen geriatric wards, selected at random out of 40 Belgian hospitals who agreed to take part in the study, evaluated the fall prevention guideline. After the one-month test period, 49 healthcare workers completed a questionnaire on the feasibility of the guideline. RESULTS At the end of the study, 512 geriatric patients had been assessed using the practice guideline. The average time spent per patient on case finding, multifactorial assessment and initiating a treatment plan was 5.1, 76.1 and 30.6 min, respectively. For most risk assessments and risk modifications, several disciplines considered themselves as being responsible and capable. The majority (more than 69%) of the respondents judged the practice guideline as useful, but only a small majority (62.3%) believed that the guideline could be successfully integrated into their daily practice over a longer period of time. Barriers for implementation included a large time investment (81.1%), lack of communication between the different disciplines (35.8%), lack of motivation of the patient (34.0%), lack of multidisciplinary teamwork (28.3%), and lack of interest from the hospital management (15.4%). CONCLUSION Overall, the guideline was found useful, and for each risk factor (except for visual impairment), at least one discipline felt responsible and capable. Towards future implementation of the guideline, following steps should be considered: division of the risk-factor assessment duties and interventions among different healthcare workers; patient education; appointment of a fall prevention coordinator; development of a fall prevention policy with support from the management of the hospital.

Translating Fall Incidence Data into Fall-Preventive Measures in Geriatric Wards – A Survey in Belgian Hospitals

Background: Fall incidents and their negative outcomes represent a considerable problem in hospitals, especially in geriatric wards, and require implementation of strategies to prevent these undesirable events. For this reason, the College of Geriatrics, a body funded by the Belgian Government to set up quality improvement initiatives in geriatric wards, selected ‘Fall prevention in Belgian hospitals’ as a quality project for the year 2006. Objectives: Before developing and implementing a practice guideline specifically adapted to the clinical context in Belgian geriatric wards, this study was set up to gain insight into fall prevention measures currently implemented in geriatric wards of Belgian hospitals. Methods: In this study, we used a cross-sectional survey design. The study involved 113 hospitals with a geriatric department. Participants were geriatricians, head nurses, medical directors, care coordinators and occupational therapists. Measurements were carried out using a survey questionnaire (response rate: 56.6%). Results: Less than one third (32.8%) of Belgian geriatric wards had a formal fall prevention policy. However, more than 90.0% systematically registered falls, but less than a quarter used these data to improve preventive measures. Although the majority used screening (78.1%), comprehensive assessment (92.2%), and preventive strategies (98.4%) when patients are admitted, only about 10% used a standard plan to direct these efforts. Furthermore, 93.8% acknowledged using physical restraints as a fall prevention strategy. Conclusion: Given the high rates and complexity of falls in geriatric wards, hospitals need to further implement evidence-based assessment and standard intervention care plans to maintain uniformity and quality of care.

Recidiverend vallen, osteoporose en sarcopenie, drie belangrijke problemen, een geïntegreerde benadering.

SamenvattingValincidenten treden frequent op en hebben vaak heel wat nadelige effecten, zo is er niet alleen de kans op een verwonding maar vaak zijn er ook psychologische - en financiële gevolgen die aanzienlijk kunnen zijn. Als men deze problematiek grondig wil aanpakken, zal men zowel aandacht dienen te besteden aan een reductie van het valrisico als van het fractuurrisico. De afdeling Gerontologie en Geriatrie van de Katholieke Universiteit Leuven is op beide domeinen actief betrokken en dit zowel onderzoeksmatig als op het maatschappelijke vlak.In deze bijdrage wordt deze betrokkenheid nader toegelicht. Eerst wordt de oprichting van het “Expertisecentrum Valpreventie Vlaanderen” en de opdrachten ervan beschreven, nadien worden enkele onderzoeksprojecten in verband met valpreventie kort aangehaald en in het laatste deel wordt er uitgebreider ingegaan op de onderzoekslijn ‘ouderdomsgebonden osteoporose en sarcopenie’.Recurrent falling, osteoporosis and sarcopenia, three major problems, an integrated approachFalling incidents occur frequently and have many harmful side-effects. Not only is there a risk of injuries, the psychological -and financial consequences can also be considerable. If these issues are to be addressed thoroughly attention will have to be paid to a reduction of the risk of falling as well as to that of fractures. The department of Gerontology and Geriatrics of the University of Louvain is actively involved in both areas. This involvement is clarified in this contribution. Firstly there is a description of the establishment of the ‘Expert Centre Prevention of Falling Flanders’ and its tasks. Then some research projects related to prevention of falling will be dealt with briefly, whilst the final part discusses in greater detail the research programme ‘Old age related osteoporosis and sarcopenia’.

Preventie van valincidenten bij thuiswonende ouderen: een kostenbesparende interventie?

SamenvattingNationale en internationale cijfers tonen aan dat 1 op 3 thuiswonende 65-plussers en nagenoeg de helft van de 80-plussers minstens eenmaal per jaar valt. Bij ongeveer 40% van hen resulteert dit in een letsel.1-4 Ongeveer 10% van de valpartijen bij ouderen leidt tot ernstige letsels, waaronder heupfracturen (1-2%), andere fracturen (3-5%) en letsels van de weke delen en hoofdtrauma (5%).1,3-5Nationale en internationale cijfers tonen aan dat 1 op 3 thuiswonende 65-plussers en nagenoeg de helft van de 80-plussers minstens eenmaal per jaar valt. Bij ongeveer 40% van hen resulteert dit in een letsel.1-4 Ongeveer 10% van de valpartijen bij ouderen leidt tot ernstige letsels, waaronder heupfracturen (1-2%), andere fracturen (3-5%) en letsels van de weke delen en hoofdtrauma (5%).1,3-5

RESPONSE LETTER TO DR. OLIVER: PREVENTING FALLS IN HOSPITALS—INTERPRETING THE EVIDENCE

Second, it stated that that it ‘‘failed to consider the quality of studies.’’ (Actually, the Downs and Black quality score was explicitly employed and used to order the studies in forest plots.) Third, it stated that it failed to make clear ‘‘what constituted the samples.’’ (The characteristics of study populations are clearly set out in the ‘‘Web extra’’ tables.) A more valid potential criticism would be of the deliberate decision to include and pool studies that were not RCTs. To exclude such studies might have led to the rejection of useful sources of evidence for practice in a field in which ‘‘criterion standard’’ RCTs are hard to perform. I have no such criticisms of the JAGS study, which also incorporated two studies reported after the census date of the original study, but readers should be cautious in taking home to their own institutions the message that fall prevention programs in hospital do not work after all, because: