Fall-Prevention Toolkit tied to Fewer Falls & Injuries Among Hospitalized Adults,: JAMA

Falls represent a leading cause of preventable injury. Hospitalized patients are at an increased risk for falls, which may result in serious injuries, such as hip fractures, subdural hematomas, or even death.

Multifactorial strategies can reduce rates of falls in hospitals, although the evidence for reducing fall-related injuries is inconclusive owing to the limited number of clinical trials that have assessed this outcome. To date, no prior multisite evaluation in acute care hospitals has shown a significant reduction in injurious falls.

Researchers undertook the present study 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.

The study included 37,000 adults hospitalized at three academic medical centers in Boston and New York City. For the intervention, nurses used a bedside poster or electronic health record (EHR)-integrated tool to screen patients for fall risk factors. Each risk factor was automatically linked to a corresponding preventive intervention, and a personalized fall-prevention plan was thus developed. The plan was then printed out and hung (or displayed on a screen) at the bedside and was reviewed with the patient and family during each nursing shift. The primary outcome measure was the overall rate of patient falls per 1000 patient-days during the study period. The overall rate of falls with injury per 1000 patient-days was the secondary outcome.

Overall, the rate of falls declined between a 21-month pre-intervention period and a 21-month post-intervention period, from 2.9 to 2.5 falls per 1000 patient-days. The rate of injurious falls also declined, from 0.7 to 0.5 per 1000. After multivariable adjustment, the intervention was associated with a 15% reduction in risk for falls and a 34% reduction in risk for injurious falls.

On data analysis, the following interesting facts emerged.

· 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).

"In this nonrandomized controlled trial, implementation of a nurse-led, patient-centered fall-prevention tool kit was associated with reduced rates of falls and injurious falls. The fall-prevention tool kit helped link patient-specific risk factors to interventions most likely to prevent a fall. Various modalities of the tool kit allow for integration into existing clinical workflows in diverse hospital settings. This tool kit appears to addresses the gap among nursing assessment of fall risk, tailored fall-prevention interventions, and engagement of patients throughout the fall-prevention process." concluded the team.

For full article follow the link: 10.1001/jamanetworkopen.2020.25889

Primary source: JAMA Network Open