We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial.
- Authors
Dykes, Patricia C.; Burns, Zoe; Adelman, Jason; Benneyan, James; Bogaisky, Michael; Carter, Eileen; Ergai, Awatef; Lindros, Mary Ellen; Lipsitz, Stuart R.; Scanlan, Maureen; Shaykevich, Shimon; Bates, David Westfall
- Abstract
This nonrandomized controlled trial assesses whether implementation of a nurse-led, patient-centered tool kit for fall prevention was associated with a reduction in rates of falls and fall-related injuries in 3 academic medical centers in Boston and New York City. Key Points: Question: Is a fall-prevention tool kit that engages patients and families associated with a reduction in falls? Findings: In this nonrandomized controlled trial including 37 231 patients from 14 medical units within 3 academic medical centers, an interrupted time series found that implementation of a fall-prevention tool kit was associated with a statistically significant 15% reduction in overall inpatient falls and a 34% reduction in injurious falls. Meaning: The findings suggest that tools to support patient engagement throughout hospitalization in the fall-prevention process may be associated with a reduction in falls and fall-related injuries. Importance: Falls represent a leading cause of preventable injury in hospitals and a frequently reported serious adverse event. Hospitalization is associated with an increased risk for falls and serious injuries including hip fractures, subdural hematomas, or even death. Multifactorial strategies have been shown to reduce falls in acute care hospitals, but evidence for fall-related injury prevention in hospitals is lacking. Objective: To assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. Design, Setting, and Participants: This nonrandomized controlled trial using stepped wedge design was conducted between November 1, 2015, and October 31, 2018, in 14 medical units within 3 academic medical centers in Boston and New York City. All adult inpatients hospitalized in participating units were included in the analysis. Interventions: A nurse-led fall-prevention tool kit linking evidence-based preventive interventions to patient-specific fall risk factors and designed to integrate continuous patient and family engagement in the fall-prevention process. Main Outcomes and Measures: The primary outcome was the rate of patient falls per 1000 patient-days in targeted units during the study period. The secondary outcome was the rate of falls with injury per 1000 patient-days. Results: During the interrupted time series, 37 231 patients were evaluated, including 17 948 before the intervention (mean [SD] age, 60.56 [18.30] years; 9723 [54.17%] women) and 19 283 after the intervention (mean [SD] age, 60.92 [18.10] years; 10 325 [53.54%] women). There was an overall adjusted 15% reduction in falls after implementation of the fall-prevention tool kit compared with before implementation (2.92 vs 2.49 falls per 1000 patient-days [95% CI, 2.06-3.00 falls per 1000 patient-days]; adjusted rate ratio 0.85; 95% CI, 0.75-0.96; P =.01) and an adjusted 34% reduction in injurious falls (0.73 vs 0.48 injurious falls per 1000 patient-days [95% CI, 0.34-0.70 injurious falls per 1000 patient-days]; adjusted rate ratio, 0.66; 95% CI, 0.53-0.88; P =.003). Conclusions and Relevance: In this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient–care team partnership appears to be beneficial for prevention of falls and fall-related injuries. Trial Registration: ClinicalTrials.gov Identifier: NCT02969343
- Subjects
MASSACHUSETTS; NEW York (State); PREVENTION of injury; ACADEMIC medical centers; CONFIDENCE intervals; EXPERIMENTAL design; ACCIDENTAL falls; PATIENT safety; POISSON distribution; PREVENTIVE health services; QUALITY assurance; REGRESSION analysis; RESEARCH funding; RISK assessment; TIME series analysis; SECONDARY analysis; PATIENT-centered care; DATA analysis software; MORSE Fall Scale
- Publication
JAMA Network Open, 2020, Vol 3, Issue 11, pe2025889
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.25889