Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness

Abstract

Objectives To systematically document the implementation, components, comparators, adherence, and effectiveness of published fall prevention approaches in U . S . acute care hospitals. Design Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through A ugust 2011. Setting U.S. acute care hospitals. Participants Studies reporting in‐hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies). Intervention Fall prevention interventions. Measurements Incidence rate ratios ( IRR , ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. Results Fifty‐nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed‐exit alarms, and postfall evaluations). Fifty‐four percent did not report on fall prevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio ( IRR ) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I 2 : 94%). Meta‐regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR . Conclusion Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 28

1. 1.

   Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med. 2007;357:1573-1575.

   Not in our library10.1056/nejmp078184

2. 2.

   Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148-157.

   Not in our library10.1111/j.1532-5415.2010.03234.x

3. 3.

   Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med. 2010;26:645-692.

   Not in our library10.1016/j.cger.2010.06.005

4. 4.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library

5. 5.

   Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev. 2012;12:CD005465.

   Not in our library10.1002/14651858.cd005465.pub3

6. 6.

   Coussement J, De Paepe L, Schwendimann R, et al. Interventions for preventing falls in acute- and chronic-care hospitals: A systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:29-36.

   Not in our library10.1111/j.1532-5415.2007.01508.x

7. 7.

   Evans D, Hodgkinson B, Lambert L, et al.

   Not in our library10.1046/j.1440-172x.2001.00269.x

8. 8.

   Oliver D, Connelly JB, Victor CR, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses. BMJ. 2007;334:82.

   Not in our library10.1136/bmj.39049.706493.55

9. 9.

   Stern C, Jayasekara R. Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: A systematic review. Int J Evid Based Healthc. 2009;7:243-249.

   Not in our library10.1111/j.1744-1609.2009.00143.x

10. 10.

    Hempel S, Newberry S, Wang Z, et al. Review of the Evidence on Falls Prevention in Hospitals: Task 4 Final Report. Santa Monica. 2012.

    Not in our library

11. 11.

    Cozart HCT. Environmental Effects on Incidence of Falls in the Hospitalized Elderly. 2009.

    Not in our library

12. 12.

    Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: A randomized trial. JAMA. 2010;304:1912-1918.

    Not in our library10.1001/jama.2010.1567

13. 13.

    Krauss MJ, Tutlam N, Costantinou E, et al. Intervention to prevent falls on the medical service in a teaching hospital. Infect Control Hosp Epidemiol. 2008;29:539-545.

    Not in our library10.1086/588222

14. 14.

    Barker SM, O'Brien CN, Carey D, et al. Quality improvement in action: A falls prevention and management program. Mt Sinai J Med. 1993;60:387-390.

    Not in our library

15. 15.

    Dacenko-Grawe L, Holm K. Evidence-based practice: A falls prevention program that continues to work. Medsurg Nurs. 2008;17:223-227.

    Not in our library

16. 16.

    Weinberg J, Proske D, Szerszen A, et al. An inpatient fall prevention initiative in a tertiary care hospital. Jt Comm J Qual Patient Saf. 2011;37:317-325.

    Not in our library10.1016/s1553-7250(11)37040-7

17. 17.

    Rainville NG. Effect of an implemented fall prevention program on the frequency of patient falls. QRB Qual Rev Bull. 1984;10:287-291.

    Not in our library

18. 18.

    Peterson JF, Kuperman GJ, Shek C, et al. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med. 2005;165:802-807.

    Not in our library10.1001/archinte.165.7.802

19. 19.

    Geffre S.

    Not in our library

20. 20.

    Hunderfund AN, Sweeney CM, Mandrekar JN, et al. Effect of a multidisciplinary fall risk assessment on falls among neurology inpatients. Mayo Clin Proc. 2011;86:19-24.

    Not in our library10.4065/mcp.2010.0441

21. 21.

    Lane AJ. Evaluation of the fall prevention program in an acute care setting. Orthop Nurs. 1999;18:37-43.

    Not in our library

22. 22.

    Oliver D, Papaioannou A, Giangregorio L, et al. A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: How well does it work? Age Ageing. 2008;37:621-627.

    Not in our library10.1093/ageing/afn203

23. 23.

    Oliver D, Hopper A, Seed P. Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc. 2000;48:1679-1689.

    Not in our library10.1111/j.1532-5415.2000.tb03883.x

24. 24.

    Taylor SL, Dy S, Foy R, et al. What context features might be important determinants of the effectiveness of patient safety practice interventions? BMJ Qual Saf. 2011;20:611-617.

    Not in our library10.1136/bmjqs.2010.049379

25. 25.

    Shekelle PG, Pronovost PJ, Wachter RM, et al. Advancing the science of patient safety. Ann Intern Med. 2011;154:693-696.

    Not in our library10.7326/0003-4819-154-10-201105170-00011

26. 26.

    Innes EM. Maintaining fall prevention. QRB Qual Rev Bull. 1985;11:217-221.

    Not in our library

27. 27.

    Innes E, Turman W. Evaluation of patient falls. QRB Qual Rev Bull. 1983;9:30-35.

    Not in our library

28. 28.
    Publication guidelines for quality improvement in health care: evolution of the SQUIRE project · 2008

    No notice

Cited by papers we hold 3

• Fall determinants in hospitalised older patients: a nested case control design - incidence, extrinsic and intrinsic risk in Malaysia · 2022
  Not checked
• Patient Perspectives on Hospital Falls Prevention Education · 2021
  Not checked
• Factors influencing fall prevention for patients with spinal cord injury from the perspectives of administrators in Canadian rehabilitation hospitals · 2019
  Not checked

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.