Martin Severs

Effect of bedroom size on falls in hospital: does one size fit all?

Improving patient observation is a commonly used strategy for those at risk of falls and injury. In our experience of establishing a study on flooring for fall-related injury prevention, policies to place high-risk patients in rooms with good line of sight from the nursing station appear widespread, yet there is a dearth of empirical evidence on room type for patient safety, particularly with respect to falls. Serendipitously, the double relocation of a local elderly care general rehabilitation ward provided an ideal opportunity to assess the influence of bedroom type on falls.

Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in elderly care units: study protocol

Falls are an issue disproportionately affecting older people who are at increased risk of falls and injury. This protocol describes a pilot study investigating shock-absorbing flooring for fall-related injuries in wards for older people. Objectives To inform future research by evaluating fall-related injuries on the intervention and existing flooring, assessing the sustainability of the flooring in ward environments, estimating the cost-effectiveness of the floor and assessing how the floor affects patients and other users. Design This study uses mixed methods: a pilot cluster randomised controlled trial, observation via mechanical testing and interviews. Eight participating wards (clusters) are randomised using a computer-generated list. No blinding is incorporated into the study. Each site has a baseline period of approximately 6 months. Then, four sites receive the intervention floor, while four continue using standard floors. Sites are then followed up for approximately 1 year. Participants Any person admitted to a bed in the ‘study area’ of a participating ward can be entered into the trial. Orientated patients, visitors and any hospital staff who use the floor in a study area are eligible for inclusion in an interview. Intervention An 8.3 mm thick vinyl floor covering with polyvinyl chloride foam backing (Tarkett Omnisports EXCEL). Outcomes The primary outcome is fall-related injuries. Severity of injuries, falls, cost-effectiveness, user views and mechanical performance (shock absorbency and slip resistance) are also being assessed. Trial registration ClinicalTrials.gov: NCT00817869; UKCRN ID: 5735.

Cost–utility analysis of a shock-absorbing floor intervention to prevent injuries from falls in hospital wards for older people

BACKGROUND hospital falls place a substantial burden on healthcare systems. There has been limited research into the use of hospital flooring as an intervention against fall-related injuries. OBJECTIVE to assess the cost-effectiveness of shock-absorbing flooring compared with standard hospital flooring in hospital wards for older people. DESIGN a cost-utility analysis was undertaken drawing upon data collected in a pilot cluster randomised controlled trial and the wider literature. SETTING the trial included eight hospital sites across England. Four sites installed shock-absorbing flooring in one bay, and four maintained their standard flooring. MEASUREMENTS falls and resulting injuries and treatment were reported by hospital staff. Data on destination of discharge were collected. Patients were followed up at 3 months and further resource use data were collected. Health-related quality of life was assessed, allowing quality-adjusted life years (QALYs) to be estimated. The incremental cost-effectiveness ratio of the shock-absorbing flooring was assessed compared with the standard hospital flooring. RESULTS in the base case, the shock-absorbing flooring was cost saving, but generated QALY losses due to an increase in the faller rate reported in the intervention arm. Scenario analysis showed that if the shock-absorbing flooring does not increase the faller rate it is likely to represent a dominant economic strategy-generating cost savings and QALY gains. CONCLUSION the shock-absorbing flooring intervention has the potential to be cost-effective but further research is required on whether the intervention flooring results in a higher faller rate than standard flooring.

Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery

BACKGROUND Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety. OBJECTIVE To investigate an audiovisual distraction (Bedscapes) on pain and anxiety during minor surgery for the correction of ingrown toenail. METHOD In a randomised controlled trial, patients (N=152) with ingrown toenails requiring surgical correction under local anaesthesia were allocated to receive Bedscapes+standard care or standard care alone. Pain levels due to local anaesthetic injection were assessed post-procedure, and anxiety levels were assessed pre- and post-procedure in both groups. Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group, and one-to-one interviews were held with four podiatrists. RESULTS Participants with high pre-procedure anxiety scores experienced greater pain on injection, and older patients reported lower pain than younger patients, regardless of group allocation. Bedscapes did not reduce pain or anxiety, and was apparently no more effective than interpersonal interaction between podiatry staff and the patient. CONCLUSIONS Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.

Care Home Rehabilitation Schemes: Further Findings from a National Survey

The continued expansion of the intermediate care initiative has resulted in the use of alternative care settings, such as nursing and care homes, for the delivery of rehabilitative interventions for older people. In this paper, we report on the findings from the second stage of a national survey of rehabilitation schemes that use care home settings. The survey reveals a wide range of approaches and standards, leading us to ask whether there is a gap between policy goals, good practice and actual service provision. The care home rehabilitation schemes were selected on the basis that they offered, as a minimum, rehabilitation to improve an older persons physical status.

Care Home Environments, Rehabilitation and Older Persons: A Survey of Current Service Provision in England

The emergence of the intermediate care agenda has added momentum to the debate on the use of alternative care settings for the delivery of rehabilitative interventions for older persons. This paper reports on the findings of the first stage of a research programme to investigate the extent of the use of care home environments for the rehabilitation of older people in England. Stage two of the project will explore in more depth the characteristics of the rehabilitation provision identified in stage one.

A case of mistaken identity

Abstract An Organisation with a Memory [Department of Health (2000)] indicates that there is a lot of repetition in failure within the healthcare delivery in the U.K. with detrimental effect to those involved. Can lessons be learnt and the cycle of repetition be broken (ibid) by the use of Reasons Br Med J (2000) 768 system approach ? This paper presents an example of a Radiographic incident, which demonstrates this approach and explores some of the issues behind it. Factors related to policies and protocols are discussed, as well as the ways in which health care organisational culture can affect the comprehensiveness of incident investigation and the learning potential that can result from an incident review. Suggested ways of adopting the approach are given, especially in relation to the work environment, focusing on how the environment can affect adverse incidents. In conclusion the full-scale implementation of the system approach is suggested as the way to maximise the learning potential from incidents and reduce the cycle of incident repetition.