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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

FUTURE TRENDS: What is the hospital changing into?

Two traditionally hospital-focused provider organizations that are experimenting with new nontraditional models are profiled in this brief article.  The first is Montefiore Medical Center (Bronx, NY), which has a wholly owned subsidiary named CMO-The Care Management Company.  CMO was established in the late ’90s and was a principal reason that Montefiore was chosen to as a Pioneer Accountable Care Organization by the Centers for Medicare & Medicaid Services.  It provides Montefiore with a platform to assume financial risk for patients and put population health into practice.  The second organization is Texas Health Resources, which has entered into a contract with Healthways, for disease management services. 

Why do I like this article?  It’s topical!  It’s free full text!  Two nice brief case studies.

Source: Betbeze, P.  Embracing nontraditional models.  Health Leaders;16(1):30, 32, 34, 36, Jan./Feb. 2013.  Click here for full text: http://www.healthleadersmedia.com/print/MAG-289193/Embracing-Nontraditional-Models  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

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