Leen De Paepe

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.

Fall Prediction in Inpatients by Bedside Nurses Using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) Instrument: A Multicenter Study

OBJECTIVES: To assess the predictive value of the St. Thomass Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument, a simple fall‐risk assessment tool, when administered at a patients hospital bedside by nurses.

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.

Staffing levels and the use of physical restraints in nursing homes: a multicenter study.

There is an unclear relation between staffing levels and the use of physical restraints in nursing homes (NHs). A survey design was used in 570 older adults (median age = 86; 77.2% women), living on 23 wards within seven NHs. Restraint use was high (50% of residents, of which 80% were restrained on a daily basis). Multivariate analysis was conducted at the level of the individual wards. Neither staff intensity nor staff mix was a determinant of restraint use. Bathing dependency, transfer difficulties, risk for falls, frequent restlessness/agitation, and depression were independent predictors of restraint use. Patient characteristics have significant greater impact on physical restraint use than staffing levels. Therefore, improving knowledge and skills of NH staff to better deal with restlessness/agitation, mobility problems, and risk for falls is encouraged to decrease the use of physical restraints in NH residents.

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.

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: