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SAFETY: falls and pressure ulcers by type of hospital unit

Development of a hospital quality improvement measure that evaluates patient falls and pressure ulcers was the focus of this study based on 2013 data from the National Database of Nursing Quality Indicators.  Table 2 has interesting unit-level data for different types of hospital patient care units based on statistics supplied by 857 hospitals.  The different types of patient care units compared included: critical care, step-down, medical, surgical, med-surg, rehab and critical access.  The group of hospitals in this study is said to under-represent small hospitals.

Highest and Lowest Rates by Type of Hospital Unit

  • 6.09 total falls / 1000 patient days in rehab units – critical care units had the lowest falls rate (1.13 per 1000)
  • 6.42 percent of patients in critical care units had hospital acquired pressure ulcers – critical access hospitals had the lowest occurrence – at 1.52 percent
  • 17.36 percent of patients in critical care units had restraints – critical access hospitals had the lowest rate at 0).

Source: Boyle, D.K., and others. (2017). A pressure ulcer and fall rate quality composite index for acute care units: A measure development study. International Journal of Nursing Studies. 63, 73-81.  Click here: http://www.journalofnursingstudies.com/article/S0020-7489(16)30146-8/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PATIENT FALLS: Baptist Health High Risk Falls Assessment

There are a number of tools that clinicians can use to figure out if patients are likely to be at high risk of falling–the Morse Falls Scale, the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), the Hendrich II Fall Risk Model, among others.  This article describes development of the Baptist Health High Risk Falls Assessment.  A copy of this one-page assessment is included in the article.  It assigns points based on the patient’s age, type of medications being taken, mobility, mental status, and other factors.

Source: Corley, D., Brockopp, D., and others.  The Baptist Health High Risk Falls Assessment: a methodological study.  JONA. The Journal of Nursing Administration;44(5):263-269, May 2014.  Click here for the publisher’s website: http://journals.lww.com/jonajournal/pages/articleviewer.aspx?year=2014&issue=05000&article=00006&type=abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Checklists to Improve Patient Safety

AHA’s Health Research and Educational Trust has just released a series of 10 evidence-based checklists for improving patient safety in these areas:

  1. Adverse drug effects
  2. Catheter-associated urinary tract infections
  3. Central line-associated blood stream infections
  4. Early elective deliveries [Cesarean]
  5. Injuries from falls and immobility
  6. Hospital-acquired pressure ulcers
  7. Preventable readmissions
  8. Surgical site infections
  9. Ventilator-associated pneumonias and events
  10. Venous thromboembolisms

For additional information, ‘change packages’ for each checklist topic are available on the AHA/HRET Hospital Engagement Network [HEN] web site at www.hret-hen.org.

Source: Checklists to improve patient safety; signature leadership series. Health Research and Educational Trust in partnership with American Hospital Association, June 2013. http://www.hpoe.org/Reports-HPOE/CkLists_PatientSafety.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

PATIENT FALL RATE: 3.56 falls / 1,000 patient days

This research, based on the National Database of Nursing Quality Indicators, presents data on over 300,000 falls in hospitals during a two-year period just prior to implementation of the new rules from the Centers for Medicare and Medicaid Services banning payment for costs associated with patient falls during hospitalization.  Comparative patient fall rates are given for medical versus surgical units, for hospitals of different sizes, magnet versus non-magnet, teaching versus non-teaching.  Here are some overall findings (quoted from the article abstract):

  • 3.56 falls / 1000 patient days (overall)
  • 0.93 injurious falls / 1000 patient days (overall)
  • Injurious falls represent 26.1 percent of all falls

Why I like this article: Data based on large number of hospitals; authoritative researchers; topical data; numbers numbers numbers!

Source: Bouldin, E.L.D., and others.  Falls among adult patients hospitalized in the United States: prevalence and trends.  Journal of Patient Safety;9(1):13-17, Mar. 2013.  Click here for the publisher’s website: http://journals.lww.com/journalpatientsafety/Abstract/2013/03000/Falls_Among_Adult_Patients_Hospitalized_in_the.3.aspx  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

How preventable are patient falls?

A study published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons examines the effectiveness of fall prevention programs to actually reduce the number of patient falls. Fall prevention is a significant challenge for hospitals, not only in terms of patient well-being but also with regard to costs. The Centers for Medicare and Medicaid Services no longer reimburses hospitals for injuries related to falls that occur inside the hospital that could have been prevented by following evidence-based guidelines.  The authors of the article found no conclusive medical evidence that evidence-based guidelines are effective in fall prevention.

Source: Clyburn, T. A., and Heydemann, J. A. Fall prevention in the elderly: analysis and comprehensive review of methods used in the hospital and in the home. Journal of the American Academy of Orthopaedic Surgeons. 19(7):402-409, July 2011. http://www.jaaos.org/cgi/content/abstract/19/7/402

Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org

Sequential compression devices NOT significant fall risk

Sequential compression devices (SCDs) are helpful in preventing deep vein thrombosis, but there is concern that inpatients wearing the devices are at a greater risk of falling because they may trip over the device or the tubing when they get out of bed to walk around.  This study of nearly 5 years of data from Johns Hopkins Hospital (Baltimore) found that SCDs were rarely cited as the cause of patient falls.  There were about 3 SCD-related falls per year, or well less than 1 percent of all falls.  Viewed another way, there were about 0.06 SCD-related falls per 1000 SCD patient days.  In cases where SCDs were found to be the cause of a fall, the fall did not result in significant harm.    The data for this study were from the Patient Safety Net database maintained by University HealthSystem Consortium.

Why I like this article:  1. There has been a great deal of interest in a blog post about patient bedside mats — thought readers might find this interesting as well.  2.  It’s out of Johns Hopkins.  3.  I did not know about the Patient Safety Net database.

Source: Boelig, M.M., and others.  Are sequential compression devices commonly associated with in-hospital falls?  A myth-busters review using the Patient Safety Net DatabaseJournal of Patient Safety;7(2):77-79, June 2011.

FALLS: Bedside floor mats risky for patient falls?

INTRODUCTION: Floor mats are sometimes placed by the patient’s bed to cushion the patient in the event of a fall. This blog post has proved popular, so I’ve added additional information.

While the mats have been studied to evaluate their ability to reduce the force of impact in a patient fall, (Doig & Morse, 2010) focused on how the mat affected the patient’s ability to move around near the bed.  The bevel edge of the mat proved to be a potential hazard.  The authors conclude that the mats should be used only with patients who are not able to get out of bed and in situations, such as in the imaging department, when patients must stand unaided.

The US Department of Veterans Affairs has published an overview of considerations in selecting bedside floor mats (Applegarth, 2008?).

(Crane et al., 2016) compared the characteristics of six different types of floorpads: woodfoam, exercise pad, rubber, gel, gym pad, and airex.  Of particular interest was the trade off between energy absorption (as a patient falls to the ground) versus footing instability and balance (in increased tippiness as a patient gets out of bed and moves around the room).  Also of interest was determining whether each material got in the way of caregivers.

Sources:

  1. Doig, A.K., and Morse, J.M. (2010, June). The hazards of using floor mats as a fall protection device at the bedside.  Journal of Patient Safety.  6(2):68-75.  Click here for publisher’s website: http://journals.lww.com/journalpatientsafety/Abstract/2010/06000/The_Hazards_of_Using_Floor_Mats_as_a_Fall.2.aspx
  2. Applegarth, S.P. (No date, 2008?)  Tips and Tricks for Selecting a Bedside Floor Mat.  Tampa, FL: VISN 8 Patient Safety Center of Inquiry.
  3. Crane, B., and others. (2016, Sept.). Multidisciplinary testing of floor pads on stability, energy absorption, and ease of hospital use for enhanced patient safety. Journal of Patient Safety, 12(3), 132-139.  Click here for publisher’s website: http://journals.lww.com/journalpatientsafety/Abstract/2016/09000/Multidisciplinary_Testing_of_Floor_Pads_on.3.aspx