Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms

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  1. Sasha J Cuttlerone,2,
  2. Jill Barr-Walker3,
  3. Lauren Cuttler4
  1. 1 Collaborative Alliance for Nursing Outcomes Coordinator, San Francisco General Hospital, San Francisco, California, USA
  2. ii Physiological Nursing, University of California San Francisco, San Francisco, California, USA
  3. 3 ZSFG Library, University of California, San Francisco, California, United states
  4. iv Department of Nursing, City College of San Francisco, San Francisco, California, USA
  1. Correspondence to Sasha J Cuttler, Collaborative Alliance for Nursing Outcomes Coordinator; sasha.cuttler{at}sfdph.org

Abstract

Groundwork Inpatient falls and subsequent injuries are amidst the most common hospital-acquired conditions with few constructive prevention methods.

Objective To evaluate the effectiveness of patient teaching videos and fall prevention visual signalling icons when added to bed get out alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates.

Design Operation improvement study with celebrated control.

Setting Four medical-surgical units in one U.s.a. public acute care hospital.

Study participants Adult medical-surgical inpatients units.

Interventions A four min video was shown to patients by trained volunteers. Icons of private patient risk factors and interventions were placed at patients' bedsides. Beds with integrated iii-mode sensitivity exit alarms were activated for confused patients at risk of falling.

Main outcome measures The chief result measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with whatsoever injury and falls with serious injury. The incident rate ratio (IRR) for each mensurate compared Jan 2009–September 2010 (baseline) with the follow-up menstruation of Jan 2015–December 2015 (intervention).

Results Falls decreased 20% from four.78 to 3.80 per grand PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per grand PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented.

Conclusion The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was accomplished. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons crave further testing. Multicentre randomised controlled trials are needed to ostend the effectiveness of icons and video interventions and exit alarms.

  • agin events, epidemiology and detection
  • patient rubber
  • nurses
  • patient education

This is an Open Access article distributed in accordance with the Artistic Eatables Attribution Not Commercial (CC BY-NC four.0) license, which permits others to distribute, remix, adjust, build upon this work non-commercially, and license their derivative works on dissimilar terms, provided the original work is properly cited and the apply is not-commercial. See: http://creativecommons.org/licenses/by-nc/iv.0/

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  • adverse events, epidemiology and detection
  • patient rubber
  • nurses
  • patient education

Introduction

Falling is a major public wellness problem with sequelae that range from small-scale bruises and abrasions to more serious consequences such as lacerations, fractures, caput injuries and even decease.1 Age-adjusted fall mortality rates have increased in recent years.1 Complications from falls while hospitalised are included on the Centers for Medicare and Medicaid Services' list of non-reimbursable events.2 More than one million patients fall in U.s. hospitals annually, accounting for 85% of all hospital-caused conditions.3

Inpatient fall and injury incidence varies according to unit of measurement characteristics,4 with medical-surgical patients at higher chance than intensive care patients. Medical-surgical units in the Usa report between 3.67 and six.26 falls per grand patient days (PDs).4 Xx per cent of medical-surgical unit of measurement falls result in some injury, while 2% result in serious injuries.4 The acute care patient may exist at increased chance of falling due to newly altered mobility, medication side effects, history of previous falls, frequent toileting and altered mental status all in an unfamiliar environment.

Every bit part of the 2010 US Patient Protection and Affordable Intendance Act, acute care hospitals were encouraged past the Partnership for Patients to examination interventions to subtract patient falls and resultant injuries by forty%.5 By the end of 2014, the Agency for Healthcare Research and Quality reported that infirmary falls were substantially unchanged from 2010 levels.6 The lack of meaning injury reduction despite years of endeavour and the finding that fall prevention efforts may not exist toll-effective7 have contributed to frustration among researchers, healthcare workers and patients at chance. To improve patient and hospital staff satisfaction and forestall needless suffering, this study examines the efforts of one hospital's medical-surgical units to brainwash patients and staff via video, icons and alarms.

Background

An urban public prophylactic net hospital with a linguistically various patient population found that patient autumn and injury rates were trending upwards. From 2009 through September 2010, fall prevention measures varied widely throughout the hospital. A 'meteor' magnet was placed on the door to the patient's room. This was meant to communicate to staff that the patient is at risk of falling. Unfortunately, staff plant the star neither obvious nor indicative of particular interventions.8

Bed exit alarms could be ordered simply this required extra steps. Failure of the patient to activate the call low-cal was the nigh unremarkably cited caption of the autumn. Communication between nursing shifts and other units did not routinely include the patient'due south autumn take a chance. Competing priorities for performance comeback such as concrete restraint and pressure injury reduction were also being prioritised during this fourth dimension.

In late 2010, VersaCare beds with congenital-in, three-sensitivity bed exit alarms were introduced. Staff were alerted when patients moved virtually in bed (most sensitive), are seated on the edge of bed (intermediate sensitivity) or are getting out of bed (least sensitive). This allowed nursing staff to come to the bedside earlier the patient had exited. The new beds also have a green indicator calorie-free that confirms that the bed is in its lowest position with the alarm fix. Nurses were responsible for training their peers in the apply of the new bed alarms; this grooming was anecdotally associated with a reduction in falls and injuries. The nurse managers reported that the early on warning provided by the exit alarm immune nurse assistants to exist freed from close observation for only one patient at a time. Assay of reported hospital falls by fourth dimension of day found that injury was more frequent amongst the patients who barbarous during the dark shift. Subsequent improvement piece of work focused on encouraging nursing staff to consider using the go out alarm for confused patients at adventure of falls, especially during the night.

In addition to connected use of the shooting star and the iii-fashion bed leave alarm, in the time span of 2011 through 2014, the falls prevention team developed other interventions. Improvements included documentation and analysis of fall occurrences such as a 'post-fall huddle', collaboration with inpatient pharmacy to identify common medications that are take chances factors for falls and development of a x min falls prevention video shown to all new clinical non-doctor employees during orientation. It was besides common for nursing staff to asking a nurse banana to perform shut observation for individuals at risk of falls. All the same, the new measures fell short of expectations. Despite twice-daily screening of all medical-surgical inpatients with the Schmid screening tool,9 it was discovered that communication of falls risk amid staff was inconsistent and patients were often unaware of their ain risk. Xanthous wrist bands indicating high fall run a risk were applied to patients in the emergency room but not used afterwards access to a medical-surgical unit of measurement equally changes in patients' conditions would require placing and cutting off the wrist band ofttimes. Finally, in 2014, infirmary staff decided to implement a patient safety didactics programme with volunteer-delivered multiple language videos and take a chance factor-specific fall icons.

The hospital also selected pressure ulcer injury prevention for team-based functioning improvement during the same period. This provided an opportunity to retrospectively evaluate if at that place were any changes in the mobility of all medical-surgical patients. Physical restraints that prevent a patient from getting out of bed are too occasionally used on medical-surgical units. If falls were reduced by patients being bars to bed, then there could have been an increase in pressure ulcer injuries and/or the use of restraints.

Primary aim

Tin medical-surgical inpatient falls and autumn injuries exist reduced by volunteer-administered video education and icons in addition to bed go out alarms?

Literature review

There are few published randomised controlled trials of autumn prevention programmes in the astute care setting, and a recent meta-analysis of falls prevention found simply a small reduction in falls.x 11 Evidence of injury reduction is even more elusive, with few studies demonstrating significant improvement in fall injuries.12 thirteen

Prevention programmes that have been widely implemented in acute intendance hospitals include screening patients with standardised risk assessments and addressing the risk with interventions including patient education,10 xiv–17 falls risk alarm signs (icons)xiv and exit alarms18–21 that indicate when a patient is getting up without assistance.

A search was conducted in PubMed, Embase and the Cumulative Index to Nursing and Allied Wellness Literature using a multifariousness of controlled vocabulary and keyword searches involving falls prevention, acute intendance and injuries. This comprehensive search revealed a gap: few studies of fall rates examined the event of interventions on injury and injury severity. U.s. hospitals appear to differ from other countries in standards for information collection and have dissimilar patient intendance environments (eg, open wards vs 1 or 2 patient beds per room), staffing characteristics, and much higher or lower baseline rates than Australia,22 the UK,23 24 Ireland25 and Singapore.26 Six US recent studies of falls injury prevention on acute inpatient medical-surgical units are summarised in table 1.

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Table one

U.s. medical-surgical autumn and injury studies, 2009–2016

Ii studies used exit alarms,20 21 iii included patient education14 20 27 and 2 used icons or signs for visual signalling of fall risk.fourteen 20 2 studies reported a statistically meaning subtract in falls,13 fourteen but only i reported a statistically meaning decrease in falls with any injury.13 One of the few randomised controlled trials to demonstrate a statistically significant decrease in fall rates adult risk factor-specific icons that were printed automatically when the nurse performed the screening.14 The researchers designed icons based on each of the private risk factors from the screening tool; these were tested in an iterative process.28 The object was to facilitate rapid identification of patients at risk and provide intuitively articulate guidance on prospective interventions: for example, an icon showed a nurse assisting a patient to ambulate. In another written report, volunteers in an Australian written report provided companionship but non educational activity and had no effect on fall rates.29 Patient education as a unmarried intervention was found to be effective in reducing falls and injuries in an Australian randomised controlled trial, but this was in a rehabilitation setting with an average patient stay of x–xi days.xxx DuPree et al21 in their multicentre report reported a 62% decrease in injury, but no evidence is presented to propose that the improvement was statistically significant, the criteria for unit option are not included, and the follow-up period is not specified. Ii recent randomised controlled trials of patient autumn reduction programmes failed to demonstrate a reduction in injuries,14 23 and several quality improvement falls prevention studies neglect to report injury rates17 27 or demonstrate no change.25 31 Weinberg et al12 reported a 64% decrease in serious injury falls over a 12-month catamenia; however, injury outcome data were missing and the patient care units were heterogeneous. Quigleyet al27 reported a 55% reduction in serious falls simply stated 'no significant trends in whatever management', and a recent multicentre evaluation by the same author reported no changes in injuries.32 DuPree et al's21 multicentre study does not describe fall injury severity except to state 'there were no patient deaths as a result of a fall throughout the course of the projection' (p100). Interventions in Lohse et al13 included assisted toileting and instructions to patients to remain in bed after surgery. Although they reported their report as the commencement to reduce acute inpatient falls and falls with injury, serious injuries do not appear to have decreased: at that place were no fractures or dislocations during the preintervention catamenia and ii such injuries postintervention.

Methods

Setting

This performance comeback written report was implemented in a United states urban public condom net teaching hospital. Four medical-surgical units were selected. Two of the units had more surgical patients, and two others were designated acute care for elders units. Most of the patient rooms were shared past two patients; ii of the units as well had one room each with four patient beds to allow nursing staff to closely notice more than vulnerable patients.

Interventions

Hospital staff were encouraged to submit images respective to each of the fall risk factors used to screen admitted patients every 12 hours. The images were evaluated by the falls task forcefulness and a patient advisor group. An illustrator developed icons to nowadays to infirmary staff, who agreed that the icons provided more than information to the staff about individual patient risk than the shooting star magnet. The icons were printed and mounted with a spiral bounden to allow each to be flipped to the advisable gamble factor. They were mounted over the head of the bed, and staff were asked to adjust the icons to applicable run a risk status or to neutral position, based on screening results.

A iv min video was produced with infirmary staff and filmed in a patient room suggesting how a patient at adventure of falls could mitigate their risk. Brochures were not used because of depression literacy and numerous non-English language languages spoken by the patients. The 4 min video featured hospital physicians, nurses, nurse administration, pharmacists, social workers, and physical and occupational therapists, many of them bilingual. Information technology was produced in English language, Spanish, Tagalog and Cantonese versions. Nursing students and other community volunteers were trained to bear witness the video on tablet devices to patients because there were no airtight excursion televisions. Prospective volunteers were trained with the staff education video alongside new clinical staff. Later completing an online volunteer training, the volunteers were trained on the unit of measurement one-on-one by written report author or research banana. The training included how to activate the call lights if patients were getting out of bed. The tablet device was placed in a disposable transparent sleeve and sanitised between patients. Patients who screened equally at risk of falling (using the Schmid9 screening tool) were identified on a estimator-generated list and the volunteers were encouraged to inquire nursing staff for individual patients to educate (eg, nowadays on the unit and awake) or avoid (eg, on isolation or a history of violence). Bilingual volunteers would often select patients whose language they spoke. The video described some of the risk factors, such as an unfamiliar surroundings especially at nighttime, new medications, and temporary weakness and dizziness. The video demonstrated a patient and nurse placing holding in achieve, using the call light and waiting, letting the nurse know when visitors leave, requesting a bedside commode, and accepting staff presence while toileting. The volunteers did not provide hands-on assistance or perform assessments. Although there was no formal knowledge assessment, volunteers were encouraged to ask patients to place falls prevention measures that applied to them. The video was offered to patients and their families at any betoken during their hospitalisation. Volunteers were encouraged to offer multiple viewings and to enlist visitors' support and were instructed to share their observations with the nursing staff assigned to the patient'southward care. Because confusion is one of the chance factors for falling, the video was likewise shown to patients with cognitive damage. Volunteers were instructed to reinforce the information as just equally possible, particularly for confused patients. Seventeen patient educational activity points are demonstrated in the video.

From late 2010 through 2015, nurses were encouraged to continue to use the integrated 3-mode bed go out alarms, especially at night-time and for dislocated autumn take a chance patients who could not reliably use the phone call light.

Both the icons and the videos were developed and piloted on the acute treat elders unit of measurement with behavioural patients because this unit had the most patients at adventure of falls and injury every bit well as the most frequent falls. Piloting began during the last quarter of 2014 and spread to all medical-surgical units in January 2015. Figure 1 depicts the icons used in this report, forth with nursing interventions and video teaching points associated with each.

Data collection

Patient falls were defined equally an unintentional descent to a lower elevation with or without a infirmary staff observing or physically profitable the patient downward. When a patient brutal, hospital staff provided help or first aid and notified the medico. Clinical follow-upward was variable and depending on the circumstances of the autumn, such every bit apparent injury, height of fall, whether at that place was loss of consciousness or if the patient's caput struck the flooring. A narrative description of the fall incident was reported electronically to the hospital's unusual occurrence database. The unit of measurement's clinical nurse specialist or nurse manager investigated the fall by speaking to witnesses and consulting the medical record. The investigator determined if the autumn was observed or assisted by hospital staff, if the patient was restrained at the time of the fall and the severity of injury if whatever. Injuries were defined as either small (bruise, abrasion or hurting 24 hours after the event), moderate (laceration that required peel glue, Steri-Strips or suturing) or major (fracture, subdural haematoma, blood products required or decease). Data were not collected regarding whatever increased length of stay or transfer to a higher level of care. The patient's historic period and gender were also collected and the de-identified data were submitted quarterly to the Collaborative Alliance for Nursing Outcomes (CALNOC), a voluntary nursing measures unit-based information repository.36 The number of patient bed days per month was also reported to CALNOC. To protect patient privacy, falls were counted rather than private fallers as is standard in US unit of measurement-based databases. All measures were in alignment with the CALNOC codebook. At that place were no significant changes in data definitions, collection or methods over the course of the study. The period January 2009–September 2010 (seven quarters) was selected as the baseline considering this preceded the introduction of VersaCare infirmary beds with integrated three-fashion bed exit alarms. The follow-upwards menstruation of Jan–Dec 2015 (iv quarters) was selected because the video and icons were in use in all of the medical-surgical units. Frequencies of viewings of the video and comments were maintained on the tablet devices.

To evaluate if at that place was a change in medical-surgical patient mobility or morbidity, the point prevalence was calculated for pressure injuries,33 physical restraints34 and the use of close observation by nurse assistants.35 Data on each of these indicators were collected quarterly by the hospital staff. The denominator for the quarterly survey is the number of patients on each medical-surgical unit. As a marking of patient morbidity, the quarterly pct of medical-surgical patients at risk of pressure ulcers (Braden score eighteen and under) was also calculated. The quarterly survey data were besides collected and reported using CALNOC standardised methodology.36

Information analysis

The rate for all falls (with or without injury), falls with any injury (minor, moderate or major) and falls with serious injury (moderate and major injury only) were all calculated as 1000 × the number of events divided by the number of PDs. The proportion of falls resulting in injury was calculated by dividing the number of falls with whatever injury by all the falls. Descriptive statistics of frequency, mean and SD were calculated. Bivariate statistics were calculated by Student'southward t-test for continuous measures and χii for categorical measures. The incident rate ratio (IRR) compared the intervention period rates with the baseline catamenia. The 95% ii-sided CI was calculated and statistical significance was established as p<0.05. Statistics were calculated using the OpenEpi software.37

Results

During the 7-yr period of January 2009 through December 2015, 1215 patient falls were recorded on medical-surgical units. Of the 1215 patient falls, 239 (20%) resulted in any injury. All three effect measures declined after the baseline period during the final quarter of 2010 after the introduction of the new hospital beds with three-mode bed exit alarms (figure two). The average historic period of fallers was 56 years erstwhile, 21% were 65 and older, and 32% were women. The baseline period from January 2009 through September 2010 included 75 293 PDs or about 10 756 days per quarter. The intervention menses of Jan 2015 through December 2015 included 42 580 PDs or about 10 645 days per quarter. The hateful deviation in days per quarter was not statistically significant. The average daily census of 30 patients on each unit was also stable.

Patients and family members were approached approximately 1200 times by trained volunteer educators who showed the video and informally discussed risk reduction. Patients and family unit members most oftentimes cited the importance of using the telephone call light. The icons were posted over 10 beds, only were infrequently adjusted and therefore not spread to all beds.

Table 2 presents the fall and injury rates at baseline and during the intervention.

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Table 2

Medical-surgical falls, falls with any injury and falls with serious injury frequency and rates

The falls charge per unit during 2015 showed a statistically significant decrease from baseline. The IRR of 0.lxxx (p=0.01, 95% CI 0.66 to 0.96) represents a 20% reduction in all falls during the intervention period. The percentage of falls with injury decreased from 21% during the baseline period to sixteen% in 2015. For falls resulting in injury, the IRR of 0.60 (p=0.02, 95% CI 0.38 to 0.94) represents a 40% reduction during the intervention menses.

Serious injuries (moderate or major) remained exceptional later the baseline period. During the baseline period there were 12 falls that resulted in lacerations, fractures, dislocations or subdural haematoma. During the four quarters of 2015, there was merely one moderate injury autumn, which resulted in a laceration requiring suturing. For falls resulting in serious injury, the IRR of 0.15 (p=0.03, 95% CI 0.01 to 0.85) indicates an 85% reduction during the intervention period. There were no deaths as a effect of a patient fall from 2009 through 2015.

The proportion of falls that were observed by a staff member more than doubled from 13.27% (SD viii.32) during the baseline menstruation to 28.03% (SD 4.94) in 2015, and this was statistically meaning (p=0.01, 95% CI 4.31 to 25.21). Falls that were physically assisted past staff as the patient fell increased from 2.78% (SD 2.10) to fifteen.09% (SD 8.54), only this was not statistically significant (p=0.07, 95% CI −1.51 to 26.xiii).

Infirmary-acquired pressure ulcer injuries (all categories) decreased during the aforementioned period from iii.24% (SD 1.23) in 2009–Q3 2010 to 0.21% (SD 0.42) in 2015, and this was statistically pregnant (p<0.00, 95% CI 1.56 to 4.50). The percentage of patients at risk of pare injury (Braden 18 and lower) at admission to the hospital was unchanged from 48.87% (SD vii.95) in 2009–Q3 2010 to fifty.81% (SD 3.83) (p=0.66). Restraint prevalence was too stable with the apparent decrease from 2.14% (SD 1.79) in the baseline catamenia to 0.88% (SD 0.77), not statistically significant (p=0.22). The proportion of patients under close observation by a nurse banana decreased significantly from the baseline 17.87% (SD i.88) to 11.83% (SD 2.84) (p<0.00, 95% CI 2.86 to 9.22).

Discussion

In 2015, all 3 falls effect measures were significantly reduced for the commencement time in 6 years. When volunteer-delivered instruction videos and three-mode bed exit alarms were used, a significant decrease was observed in patient falls (xx%), falls with any injury (forty%) and falls with serious injury (85%). Injury reduction met and serious injury reduction exceeded the Partnership for Patients goal of a 40% reduction.

In dissimilarity to previous studies, this written report constitute positive results from the use of bed go out alarms. This is the first known report to examine the furnishings of an exit alarm that is integrated into the bed. The comeback sustained in the current study may be attributable to targeting patients who stood to benefit: nursing staff were instructed to select patients who were both at risk of falls and subsequent injury and unable or unwilling to reliably use the call bong. Such run a risk stratification may assist avoid alarm fatigue. Nursing staff believed that utilize of the exit alert helps past freeing upward staff from continuous ascertainment because it functions equally an actress 'call low-cal'. Quarterly survey data on medical-surgical units showed a modest decrease in the percentage of patients with close ascertainment past nurse assistants from eighteen% during the baseline menstruum to 12% in 2015. Nonetheless, staff were twice as likely to witness a patient fall in 2015 every bit they were during the baseline period. Although the increase in falls physically assisted by a staff number was not statistically significant, the opportunity to reach the patient merely before falling appears to have increased in the follow-up menses. It is also possible that the audio stimulus delays or stops the patient's bed exit. The finding that injuries and especially serious injuries were reduced supports the theory that the three-style bed exit alarm alerts staff before the patient is fully standing and ambulating and at risk of striking the floor at a higher velocity.

The falls icons were never fully implemented considering adherence was challenging. Unlike the Dykes et al14 written report, the icons were not printed automatically when the nurse screened the patient. When icons were placed above the head of the patient'southward bed, it was physically difficult to conform them. Considering falls screening is washed every 12-hour shift by the registered nurse, it was necessary to adjust the icons twice a day per patient. Training was inadequate and at that place was business about excessive visual signalling as the icons were added to the meteor magnet on the patient'due south room doorway. Future work being considered includes placement of falls prevention icons on erasable board (white board) visible to all who enter the room, too as the patients and their family. In order to decrease the number of icons, it may be useful to focus on a single visual reminder to mobilise with help. Any changes and tests of icons should include front-line staff as well as patients.

The falls prevention video was more widely accepted by patients, their family and hospital staff. The volunteers reported that patients were engaged and ofttimes surprised to learn that they had been screened as at take chances of falling. The medical-surgical patients in the electric current report had a shorter length of stay, which may decrease the amount of time at take chances of falling just also reduces the amount of time available for patient education. The video available in four languages and the bilingual patient education volunteers may accept been more helpful than a brochure in a depression literacy environs and may have improved communication betwixt patients and their caregivers.38 The novelty of receiving a visit from a volunteer with a video on a tablet device may have increased the retention of information by the patients. Anecdotally, patients were more engaged past the videos because they featured hospital staff addressing the patients in their environs.

It was gratifying to note that falls and injury reduction was not achieved at the price of patient autonomy (restraint prevalence unchanged) or mobility (infirmary-acquired pressure ulcer injury prevalence decreased from 3% to less than ane%). There was no alter noted in patient vulnerability, with approximately one-half of all medical-surgical patients at take a chance of injury throughout both the baseline and follow-upwardly periods.

Falls and injury prevention programmes are challenging to evaluate for price-effectiveness.7 In the current study, the iii-way bed leave warning was already integrated into the bed for each inpatient, and then it was not possible to evaluate this price. Boosted costs were incurred for tablet devices to testify video to patients and for printing icons.

This performance improvement written report has several limitations. The lack of randomisation or contemporaneous comparison group inherent to the written report blueprint makes it difficult to infer that the interventions were associated with the improvement observed. The principal investigator and hospital staff were non blinded to the interventions. Multiple interventions for patient safety were implemented during this time, all of which may accept contributed to fewer falls and injuries. The lack of an attending control ways that specific elements of the icons and patient video may accept been less important than the novelty of each method and/or the presence of a friendly volunteer. The nursing unit level of data measurement prevents evaluation of the outcome on individual patients. Measuring falls rather than unique fallers makes it difficult to evaluate the effectiveness of interventions to prevent multiple falls by individual patients. If risk factors for falling more than once can be identified, and so educational interventions could exist targeted appropriately. To protect private patient privacy, it is unknown which of the fallers received the video educational activity or had the icons posted over the caput of their beds. At that place may accept been changes in potential effect modifiers such as patient morbidity or length of hospitalisation. Characteristics of the patient room such equally proximity to the nursing station and the presence or absence of roommates were not nerveless. Roommates may likewise benefit from the proximity of staff attention to patients. The environment of care should be considered as there is some evidence that isolating patients in individual rooms may lead to increased risk because staff cannot visualise more than ane patient at a time.39

Conclusion

Brief video education of medical-surgical inpatients on fall risk in conjunction with the employ of three-style bed go out alarms was shown to exist both feasible and effective The employ of standardised reporting methods increases confidence that the observed comeback was due to the interventions. That there was no significant alter in the historic period, gender and morbidity of the fallers suggests that the results were not afflicted past those known confounders. The efforts to risk-stratify with the use of the existing screening tool and the availability of an electronically generated listing of patients at take a chance may have helped to identify prospective interventions for individual patient hazard factors. It is unknown if at that place is an ideal time to provide the instruction to patients during their stay in hospital. Patients are more likely to exist mobile past the cease of their hospitalisation than when they make it. Although they are less debilitated, in that location are more than opportunities for an convalescent patient to autumn.

Future prospective trials should evaluate the effectiveness of fall and injury prevention programmes that control for known risk modifiers such every bit patient age, gender, length of stay and admitting diagnosis, also as nurse staffing. Fall prevention trials should report on injuries too as fall rates. The reduction of patient injury should be the primary goal of a fall prevention programme. As stated past the acute intendance for elders clinical nurse specialist at the end of the patient didactics video: "We don't want anyone to go hurt while they are in the infirmary."

Acknowledgments

In addition to thanking the volunteers and the medical-surgical bed-side nurses and certified nurse assistants and each of the hospital staff who appear in the video who implement safety measures continuously and tirelessly , the authors wish to acknowledge the work of interdisciplinary falls prevention team members: Dana Freiser RN BSN, Annelie C. Nilsson RN MSN CNS,Janet Kosewic RN MSN CNL, Purificacion Quevedo-Maghinang RN MA, Thomas Holton RN MS CPPS, Amy Murphy RN CNL, Chad Belicena RN MSN, Bonnie Seaman PT, Margarita Sotelo Medico, Linda Lee RN BSN, Kathy Ballou RN MSN, David Rubin RN, Jeanette Cavano PharmD, Irina Gruzman RN, Patrick Nagle RN BSN, Michelle Reyes PT DPT, and Rachel Limon Perry RN MS CNS; Clinical Nurse Educators: Monique DeRouen Lowerre RN BSN, Elizabeth Adviento RN BSN, Jennifer Berke RN MSN MPA, and Anita Roberts RN MSN; Customs counselor coordinators: Rachael Kagan and Arla Escontrias; Video production: Ben Briones MS, Video translators: Mari Mo and Liliana Diaz MSW; Icon design: Ferdinand Mabaet RN andJulie Ho BFA ; Comeback coaching: America's Essential Hospitals Infirmary Date Network; CALNOC and Testify-Based Practice Fellowship Programme: Mary Foley RN PhD; Inquiry administration: Sarah Lougher Bertero RN BSN PHN, Monica Jensen Certified Nursing Assistant, and Emerson Sosa BS; Literature Review:Librarians Stephen Kiyoi MLIS, and Charlotte Kuo RN NP; Joanna Briggs Found UCSF Centre: Michelle Lieggi MLS AHIP and Daphne Stannard RN PhD; Nursing administration: Leslie Holpit RN MSN; Education and Volunteer Coordination: Kala Garner MA , Akilah Cadet MPH DHSc , Joseph Griffin MPH, and Harold Santos BS; Information consultants and editorial services: Nancy Gordon MS and Alice Webber PhD; Critical review: Liz Charalambous RN BSc (hons) MSc, Sarah Goldberg RN PhD, Joanne Cooper RN PhD, and Judy Kleppel MD MPH Encouragement to publish: Joseph Clement RN MN CCNS, Cynthia Johnson RN NP, Cheryl Kalson MHA, Jessica Morton MA and Suk Chung RN NP; Professional Organization: Service Employees International Union Nurse Alliance.

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