Original ArticleThe effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre–post implementation study in the U.S.
Introduction
Falls are the most common reported patient safety incident in hospitals (Anonymous, 2011, Oliver, 2008a, Rubenstein, 2006), and are a major public health problem internationally (Caldevilla et al., 2013, Higaonna, 2015, Quigley and White, 2013, Shmueli et al., 2014). Up to 30% of falls result in injury including fractures, soft tissue trauma and death (Oliver, 2008a, Rubenstein, 2006). Additional consequences include prolonged hospital stay, discharge to long term care facilities, increased hospital costs, patient anxiety, and loss of confidence in mobility and activities of daily living (Boltz et al., 2014, Caldevilla et al., 2013, Oliver et al., 2004, Rubenstein, 2006, Tinetti and Kumar, 2010).
Hospitals have instituted fall risk assessment scales to identify patients at risk for falls followed by implementation of general fall prevention interventions (e.g., putting signs on the door for those at risk) (Caldevilla et al., 2013, Oliver, 2008b). Although fall prevention interventions should be customized to the individual’s identified risk factors (Anonymous, 2011, Cameron et al., 2012), hospitals have not yet promoted use of fall prevention interventions targeted to patient-specific risks (e.g., ambulation or refer to physical therapy for unsteady gait) (Coussement et al., 2008, Hempel et al., 2013, Oliver et al., 2010). Because falls are complex and risks for falls are multifactorial, beneficial effects of fall reduction interventions may increase when interventions target patient-specific fall risk factors (Anonymous, 2011, Cameron et al., 2012, Coussement et al., 2008, Tinetti, 2003). Few studies however have examined the effect of implementing evidence-based fall prevention interventions to mitigate patient-specific fall risk factors in hospitalized adults (Dykes et al., 2010).
The purpose of this 18 month study was to implement evidence-based fall prevention interventions targeted to patient-specific fall risk factors (Targeted Risk Factor Fall Prevention Bundle) and evaluate the impact on reducing falls and fall related injuries. A multifaceted Translating Research Into Practice intervention was used to promote uptake and use of the Targeted Risk Factor Fall Prevention Bundle in 13 adult medical surgical units in three community hospitals in the U.S. Specific aims of the study were to (1) compare fall rates, fall injury rates, and types of fall injuries prior to and following implementation of the evidence-based Targeted Risk Factor Fall Prevention Bundle, and (2) evaluate adoption of the evidence-based Targeted Risk Factor Fall Prevention Bundle.
Section snippets
Fall Prevention Conceptual Framework
The conceptual framework used in this study was informed by a taxonomy that classifies types of fall prevention interventions (Cameron et al., 2012, Hook and Winchel, 2006, McCarter-Bayer et al., 2005). Interventions are conceptualized as Universal Fall Precautions (e.g., reducing environmental risks for falls such as patient room and hall free of clutter), General Fall Prevention Interventions (e.g., bedside table, call light and other personnel items within reach) and Targeted Individual
Methods
A prospective, pre–post cohort implementation design using a participatory partnership research approach was used for this study. We chose a participatory partnership approach to foster engagement, ownership of the study, as well as use of findings to improve quality of care (Cornwall and Jewkes, 1995, Gold and Taylor, 2007, Green et al., 2001).
Results
Demographics of the nurses and study units did not differ significantly between pre- and post-implementation. Patients on the study units were 65 years of age or older ( = 65.6; SD = 2.8), and the majority (68%) were in the moderate or major severity of illness category. The average RN skill mix was 75% and the mean RN hours per patient days was 6.8 (SD = 0.81). The majority of nurses were white (> 90%), female (> 90%), between 30 and 40 years of age, and with an average of over eight years work
Discussion
The Translating Research Into Practice intervention used in this study was effective in promoting use of fall prevention interventions that target patient-specific fall risk factors. Increased use included fall prevention interventions for history of previous falls, mobility, elimination, cognition/mental status, and risk for injury from a fall. Targeted risk factor fall prevention interventions were designed to mitigate patient-specific risks factors for falls, which goes beyond general fall
Limitations
The study findings are not generalizable to other types of healthcare settings, such as ambulatory and long-term care agencies. Given the pre–post design of the study, it is difficult to rule out effects from other factors in the environment occurring simultaneously with this study. Lastly, although medical records are used by regulatory agencies to measure care delivery, some of the fall prevention interventions may have been implemented, but not documented.
Conclusions
The Translating Research Into Practice intervention improved use of fall prevention interventions targeted to patient-specific fall risk factors. The study also demonstrated improvement in reduction of fall rates and types of fall injuries. To make significant gains in reducing falls in hospitals, clinicians must do more than arriving at a fall risk score with subsequent implementation of general fall reduction interventions; they need to know each patient’s risk factors for falls and implement
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