Introducing an Evidence-Based Protocol to Reduce and Prevent Fall Events among Elderly Hospice Patients

Document Type : Research Paper

Author

Nursing Department, All Seasons Healthcare Organization, Lancaster, California

Abstract

Introduction:
To examine the effectiveness of a multifactorial intervention to reduce falls for elderly hospice patients who live at home and in skilled nursing facilities.
Materials and Methods:
This pre--post intervention study was conducted in a local agency of a healthcare organization for hospice patients in California. The study included 51 hospice patients who did not object to the intervention at the local agency. The multifactorial intervention consisted of four components: (1) fall risk assessment, (2) post-fall huddle session, (3) universal fall precautions education, and (4) the 5 Ps to reduce falls for elderly hospice patients. The primary outcome was the fall rates (falls per 1,000 occupied bed days). Other outcomes included patient fall risk scores, post-fall huddle compliance, and compliance of universal fall precautions and the 5 Ps.
Results:
The multifactorial intervention reduced the fall rates for hospice patients from 6.9 in 2017 (baseline period) to 1.7 in 2019 (implementation period) per 1,000 occupied bed days. There was 100% compliance with fall risk assessment, post-fall huddle administration, universal fall prevention documentation, 5 Ps education, and care plan initiation and modification.
Conclusion:
The finding of this study indicated a significantly positive effect of a nurse-led multifactorial intervention on fall prevention of hospice patients cared for at home or at skilled nursing facilities. The intervention was easy to implement, cost effective, and took a very short time to complete, which would allow nursing leadership to initiate such interventions to prioritize fall prevention in every hospice healthcare organization.

Keywords


  1. Hain D. Overview and summary: Delivering nursing care: Current factors to consider. OJIN 2013; 18(2).
  2. American Nurses Association (ANA). Code of ethics for nurses with interpretive statements. Silver Spring, Maryland: Nursesbooks.org; 2015.
  3. Goodridge D, Marr H. Factors associated with falls in an inpatient palliative care unit: An exploratory study. Int. J. Palliat. Nurs. 2002; 8(11): 548–56.
  4. Oregon Hospice Association. What if I fall. https://oregonhospice.org/media/PPE20133DowneyTitus.pdf. Published 2013. Accessed January 6, 2019.
  5. Cangany M, Back D, Hamilton-Kelly T, Altman M, Lacey S. Bedside nurses leading the way for falls prevention: An evidence-based approach. Crit Care Nurse. 2015;35(2):82-84.
  6. Haddad YK, Bergen G, Florence CS. Estimating the economic burden related to older adult falls by state. J Public Health Manag Pract. 2019; 25(2): E17–E24.
  7. Florence CS, Bergen G, Atherly A et al. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693-698.
  8. The Joint Commission (TJC). The Joint Commission sounds the alert on fall prevention. Aging Today. 2015;16. https:// jointcommission. new-media- release. com/ 2015_sea_falls/. Accessed April 4, 2019.
  9. Centers for Medicare Services (CMS). Accountable care organization 2017 quality measure narrative specifications. https:// www. cms. gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2017-Reporting-Year-Narrative-Specifications.pdf. Published 2017. Accessed April 4, 2019.
  10. Burton E, Lewin G, O’Connell H, Hill K. Falls prevention in community care: 10 years on. Clin Interv Aging, 2018;(13):261–269.
  11. Elliott S, Leland NE. Occupational therapy fall prevention interventions for community-dwelling older adults: A systematic review. Am J Occup Ther. 2018;72(4):1–10.
  12. Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319(16):1705–1716.
  13. Granbom M, Clemson L, Roberts L et al. Preventing falls among older fallers: Study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program. Trials. 2019; 20(1):2.
  14. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157.
  15. Gray-Micelli D, Quigley PA. Fall prevention: Assessment, diagnosis, and intervention strategies. In M. Boltz, E. Capezuti, T. Fulmer, & D. Zwicker (Eds.), Evidence-based geriatric nursing protocols for best practice (4th ed.) (pp. 268–297). New York, NY: Springer Publishing Company; 2012.
  16. Grossman DC, Curry SJ, Owens DK et al. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA. 2018; 319(16):1696-1704.
  17. France D, Slayton J, Moore S et al. A multicomponent fall prevention strategy reduces falls at an academic medical center. Jt Comm J Qual Patient Saf. 2017;43(9):460–470.
  18. Peer K, Rakich J. Accreditation and continuous quality improvement in athletic training education. J Athl Train. 2000;35(2):188–193.
  19. Gillam S, Siriwardena AN. Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit. Qual Prim Care. 2013; 21(2):123-130.
  20. Calys M, Gagnon K, Jernigan S. A validation study of the Missouri Alliance for Home Care Fall Risk Assessment Tool. HHCMP.2013;25(2):39–44.
  21. Reiter-Palmon R, Kennel V, Allen JA, Jones KJ, Skinner AM. Naturalistic decision making in after-action review meetings: The implementation of and learning from post-fall huddles. J Occup Organ Psychol. 2015;88(2):322–340.
  22. Tannenbaum S, Cerasoli CP. Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors.2013;55(1):231–245.
  23. University of Nebraska Medical Center. Post-fall huddle tools [Internet]. CAPTURE Falls Resources. Available from: https:// www.unmc. edu/patient-safety/_documents/capture-huddle-guide-5-1.pdf
  24. Cameron ID, Dyer SM, Panagoda CE et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018(9).
  25. MacPhail LH, Edmondson AC. Learning domains: The importance of work context in organizational learning from error. In D. A. Hofmann & M. Frese (Eds.), Errors in organizations (pp. 177–198). New York: Routledge; 2011.
  26. World Health Organization (WHO). Falls. https://www.who.int/news-room/fact-sheets/detail/falls. Published 2018. Accessed August 23, 2019.
  27. Giles LC, Bolch D, Rouvray R et al. Can volunteer companions prevent falls among inpatients? A feasibility study using a pre-post comparative design. BMC Geriatr. 2006;6(1):11.
  28. Godlock G, Christiansen M, Feider L. Implementation of an evidence-based patient safety team to prevent falls in inpatient medical units. Medsurg Nurs. 2016;25(1):17–23.
  29. Uymaz PE, Nahcivan NO. Evaluation of a nurse-led fall prevention education program in Turkish nursing home residents. Educ. Gerontol. 2016; 42(5): 299-309.
  30. While AE. Falls and older people: preventative interventions. Br. J. Community Nurs. 2020; 25(6): 288-292.