Patient Safety Against Injurious Falls Description

A White-Paper Testimony on Current Risks

With more than a thousand preventable deaths a day, the need to pay greater attention to improving current patient safety conditions and standards is unquestionable (Gandhi, 2014). This was the gist of a testimony to the U.S. Senate Committee on Health, Labor, Education and Pensions Subcommittee on Primary Health and Aging. The white paper discussed the current safety risks faced by ambulatory patients in the hospital setting. This has been the direction of the patient safety movement since 15 years with emphasis on ambulatory safety problems. Recent studies identified the major safety issues confronting hospital settings. These include medication safety, missed or delayed diagnoses, transitions of care, patients' non-adherence to medication (Gandhi) and poor clinician communication with patients (Schnall et al., 2012). The last issue was the finding of a recent survey of 162 registered nurses attending an APN education program. This issue accounted for 42.4% or almost of 489 encounters they had and relating to diagnosis or management or treatment of patients (Schnall et al.). But one more major current nursing practice, which cries out for prompt change, involves the management of injurious falls among patients.

Insufficiency and Ineffectiveness of Current Programs

(add Malik and Patterson, 2012)

Why the Need for Change

One out of three of hospitalized patients aged 65 and older suffer from falls (Malik, 2012). The rate is highest among psychiatric or behavioral health facilities where it rises to a range of 4.5 to 25 incidents per 1,000 days (Malik). The aging population continues to swell not only nationally but also globally. With a third of them hospitalized and suffering from falls, often injurious, the need to change current preventive management measures to reduce the incidence and prevalence. (Add info from filler)

B. Key Stakeholders -- Older adults are the main key stakeholders, the one most affected as they are the victims of injurious falls and most in need of effective or improved prevention measures (Lach, 2011).

Other Key Stakeholders and Their Roles

They need the support of other key stakeholders, who are the informal caregivers, healthcare providers, and community groups (Lach, 2011). The informal caregivers are their families and those directly caring for them at home or in the hospital. The healthcare providers are the nurses, physicians, and hospital staff. And community groups extend material, emotional, spiritual and other forms of outside support to these older adults and other stakeholders (Lach).

C. Evidence Critique Table

1. Authors and Focus of Intervention -- R. Schnall et al. patient safety issues

Study Design or Method -- online survey project

Intervention Settings and Populations -- 162 registered nurse enrolled at an APN education program

Outcomes/Measures -- Most common were clinician communication problems with patients at 42.4% of 489 encounters

Findings and Conclusions -- Improving or reducing these identified patient safety issues in APN practice setting may be accomplished through information technology.

Evidence Strength -- Level 6

2. Authors and Focus of Intervention -- Sue Child et al. factors influencing the implementation of fall prevention programs

Study Design or Method -- systematic qualitative review of 19 literature from 1998-2012 synthesized through meta-etnography

Intervention Settings and Populations -- community-dwelling older people and healthcare professionals

Outcomes and Measures -- Limited data on barriers to implementation revealed practical considerations, adapting for community and psychological reasons. Implementation was also complex and influenced by several factors.

Findings and Conclusions -- This review of various interventions showed substantial methodological issues, which deter the implementation of practice. This systematic review recommended that those involved modify existing behavior, thoughts and practice and to fully consider and address the issues identified.

Evidence Strength -- Level 5

3. Authors and Focus of Intervention -- Angela Malik and Norma Patterson

Preventing Falls in Acute Mental Health Settings

Study Design or Method -- research article

Intervention Settings and Populations -- older patients in an inpatient acute mental health setting

Outcomes and Measures -- The article lists the factors, which lead to falls, and discusses how to prevent them in older adults I this health setting

Findings and Conclusions -- Factors that contribute to falls in mental health settings can be intrinsic, extrinsic, situational or any two of these. Prevention of falls and patient safety committees should combine their resources to reduce incidence. Fall prevention toolkits and evidence-based practices yield the causes of falls and how to prevent them, specifically in older adults in this setting.

Strength of Evidence -- Level 5

4. Authors and Focus of Intervention - Lach, H.M. et al.

Best Practice in Fall Prevention and the Roles of Stakeholders

But the support of other stakeholders, like informal caregivers, healthcare providers and community groups is a basic requirement to prevention.
Findings and Conclusion -- The roles played by additional stakeholders provide and make up the best practices in fall prevention. They can help older adults help themselves avoid falls according to their individual preferences, available local resources, programs and healthcare services.

Strength of Evidence -- Level 7

5. Authors and Focus of Intervention -- Wilson, D. et al.

Differences in Perceptions between Charge and Non-charge Nurses on Patient Safety

Study Design or Method -- a descriptive correlational and cross-sectional study

Intervention Settings or Populations -- 710 registered nurses at the 12 adult medical units of a large medical center in the Midwest

Outcomes or Measures -- The differences between the perceptions of these two groups emanate from the broader view by charge nurses of both potential and real safety errors and greater familiarity with error reporting or errors in the unit than non-charge nurses.

Findings and Conclusion -- The differences in perceptions are quite important to patient safety, particularly in the assessment aspect, and in improving nurse effectiveness. The association between safety guidelines and nurse perceptions should be the subject of future study.

Strength of Evidence -- Level 4

D. Summary of Evidence from Findings

Malik and Patterson (2012) list the four types of factors, which can lead to falls in mental health settings, and explain each of them. These are intrinsic, extrinsic, situational and a combination of any two. They suggest interventions in the form of engineering concepts and a system approach, identifying barriers, tracking and a review of all falls on a yearly basis. They recommend the assimilation of resources by fall prevention and patient safety committees and the use of tool kits and evidence-based practices specifically for older adults in hospital settings. The strength of evidence is B. As the evidence is of limited quality and drawn only from patient-oriented sources.

Child and her team (2012) used a systematic qualitative review of 19 literature sources from 1998 to 2012 in identifying the factors, which influence the successful implementation of fall prevention programs. These were records of community-dwelling older people and healthcare professionals. Their review yielded limited information, which included barriers to implementation and its complexities in methodology. They recommended a change in existing behavior, thinking and practice and a full address of the issues found.

Schnall and team (2012) conducted an online survey project on patient safety issues with 162 registered nurses at an APN education program. The survey revealed that the most common patient safety issue among the volunteer nurses was poor communication between clinicians and patients at 42.4% out of 489 encounters between them. The survey concluded that closing the communication gap between the two groups through the use of information technology would improve the situation (Schnall).

Lach and her team (2011) pooled in and published their collective expert opinions in this peer-reviewed journal. They identify the key stakeholders in the prevention of falls, with older adults as the main or key ones. But older adults stand in complete need of, and dependence on, the support of the rest of the identified key stakeholders. These are informal caregivers, like family members, relatives, friends, neighbors and other unrelated individuals; healthcare providers; and community groups. They describe the roles of these individuals and groups assisting older adults increase their own ability to prevent falls. This assistance depends on target older adults' preferences, available resources, and outside programs and healthcare services (Lach et al.)

Older adults are the key stakeholders in fall prevention programs as the very target recipient (Lach et al., 2011). Other key stakeholders are informal caregivers, such as family members, relatives, friends, neighbors and other helpful individuals; healthcare providers, like physicians, nurses, and other members of the healthcare team and paramedical staff; and community groups with programs and resources available for older adults. The effective pool of efforts and resources of these support givers would constitute best practice (Lach et al.).

Wilson and her team (2012) explore the differences in the perceptions of charge and non-charge nurses as essential in the implementation of patient safety policies and programs. Staff or charge nurses are employed to function as champions of change. They have more positive perceptions of safety than non-charge nurses. The authors further observed that the perceptions of charge nurses themselves are not uniform. The length of experience in years, their view of team work within units, perception of safety, safety conditions of their work area, and the number of reported events…