Running head: FALL RISK INTERVENTION

Comparison of Fall Risk Interventions Erin White Ferris State University

FALL RISK INTERVENTIONS Abstract Patients who suffer from strokes are at greater risk for falling during their hospital stay a few factors include neurological damage, decrease cognition function, change in mental status and inability to express needs. Numerous interventions were included in each study consisting of bed alarms, identifying fall risk bracelets for the patients, anti-skid socks, and a toileting

schedule every two hours, incorporating a multidisciplinary team approach and administering the function independence measure (FMI) test. Throughout this paper it will discuss the interventions of three articles and the level of measurement used in the research conducted.

FALL RISK INTERVENTIONS Reducing Falls among Stroke Patients in Hospitals Patients who suffer from stroke are at greater risk for falls due to neurological damage, paralysis to one side of their body, muscular atrophy, confusion and cognitive impairments.

Nurses interpret research findings and use evidence-based research to support nursing decisions. The purpose of this assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice (Singleterry, 2013, p. 8). PICO Question A researcher will form a PICO question to research using evidence-based practice the acronym PICO is used to formulate a research question, it stands for patient, intervention, comparison of intervention and outcome(s) desired (Nieswiadomy, 2012, p. 282). When formulating a PICO question the researcher focuses on a certain population and compares two interventions; the outcome is determined by the comparison of the interventions. The PICO question for this research paper is does implementing fall risk assessments reduce falls compared to not implementing fall risk assessments in hospitalized stroke patients? In answering the PICO question it will determine the importance of fall prevention strategies among stroke patients and assist in reducing falls in the hospital setting. In reducing the number of falls in the hospital setting will improve quality of care for patients who have suffered from strokes and improve their rehabilitation time frame. When the nurse gives proper education to the patient and family members the quality of care may increase due to the patient and family are reassured safety measures are in place to decrease the patients risk for falls during their stay at the hospital. When a hospital has implemented a fall risk assessment it may improve the safety of the patient in preventing a longer stay in the hospital and additional injuries. The safety of the

FALL RISK INTERVENTIONS patient is associated with the severity of the stroke with a wide range of nursing interventions.

The severity of the stroke determines the rehabilitation measures and fall risk prevention that will need to be in place by the hospital during their recovery process. The nurses responsibility is to educate the patient and family member on the preventative measures that are in place to help reduce a fall during the patients recovery; such as using the call light appropriately and effectively, ensuring the patient has proper knowledge of the assistive devices therapy has offered and education on the bed alarms to ensure patient safety. Methodology Throughout researching articles on credited databases to support the PICO question, does implementing fall risk assessments reduce falls compared to not implementing fall risk assessments in hospitalized stroke patients? The databases used during the research included cinhal, pubmed and google scholar the limitations to find nursing research articles were limited due to the specificity of the PICO question. The limited articles were a factor in searching for current evidence-based practice within the last five years and ensuring the publication is nursing research specific to patients who have suffered a stroke and are a fall risk in the hospital setting. Search criteria was limited nursing research studies due to many of the article results were written by therapists and doctors to the specific subject of preventing falls among stroke patients. Throughout searching the databases for nursing research articles related to stroke patients and fall prevention interventions it was evident how important the nurse is in assisting with implementing fall prevention strategies. The nurse spends a quality of time with the patient and assesses the patients thoroughly at the beginning of their shift and throughout the day as required by policy of the facility they are employed. While searching for articles for the PICO question the search included the word nurse to ensure the nursing aspect was included in the research.

FALL RISK INTERVENTIONS Discussion of Literature In identifying nursing research articles to address the PICO question, it is important to find reliable sources and evidence-based practice research. The articles mention fall risk prevention among stroke patients in a hospital setting and include nursing research and a systematic review. Throughout the articles mentioned below the nurse is highly involved in the preventative measures to decrease falls among stroke patients in the hospital setting, including assisting with ensuring the interventions are in place during the patients recovery process. Article One The systematic review article mentions interventions for fall prevention in acute and chronic hospital setting. The objective of this research is to determine the effectiveness of fall prevention programs implemented in the hospital to improve patient safety and quality of care. The article mentioned the different interventions complied from nursing research that has been completed on the fall prevention programs which exist in hospital settings. According to Coussement, De Paepe, Schwendimann, Denhaerynck, Dejaeger & Milisen (2008), of fall

prevention in elderly people found that effective fall prevention programs exist for elderly people living at home or in residential institutions but not for elderly people in the hospital (p. 29). In the article one intervention mentioned to assist in reducing the number of falls from stroke patients in the hospital is a bracelet and bed alarms to alert faculty that specific patient is a fall risk. The second intervention researched was to determine whether carpet or vinyl in the patients room would decrease the number of falls and the final intervention was a twelve week study assessed whether altering calcium homeostasis and increasing muscle strength by giving patients vitamin D in addition to their usual calcium carbonate dietary supplement (Coussement, De Paepe, Schwendimann, Denhaerynck, Dejaeger & Milisen, 2008, p. 31). The

FALL RISK INTERVENTIONS study conducted of the four interventions determined there was no significant decrease with the fall preventions listed above. The article involving four interventions would not be recommended for future use, due to the article is a systematic review and states out of the four

interventions listed none were beneficial to decrease fall risks among stroke patients in hospitals. Article Two In the journal Falls on an Inpatient Rehabilitation Unit: Risk Assessment and Prevention it states the key intervention is for the nurse to write a nursing diagnosis for the patient at the time of the admission and administer the function independence measure (FIM) test to determine if the patient is a fall risk (Forrest, Huss, Patel, Jeffries, Myers, Barber & Koiser, 2012, p. 56). The study conducted in this article consisted of the admission diagnosis plus the FIM score, the study also inquired if the patients age and polypharmacy increased falls during hospital stays for stroke patients. In the article interventions beside the FIM test consisted of anti-skid socks, three bed rails up, toileting the patient every two hours, the patients chart next to their room for nurses to do their charting closer to the patients room and education with patient and family members on fall risk preventions. Through all of the interventions in the research conducted the function independence measure (FIM) test was proven to be the most significant intervention for prevention of falls for stroke patients in the hospital setting. According to Forrest, Huss, Patel, Jeffries, Myers, Barber & Koiser, (2012) the FIM were significantly correlated with the rate of falls (p. 58). The data collected in this study is considered ordinal data, due to the comparison of interventions provided throughout this study. This article is highly recommended since it looks at numerous interventions and has proven the FIM at the time of admission has decreased the risk of falls for stroke patients in the hospital. The nurse is highly involved in the patient care and determining

FALL RISK INTERVENTIONS the fall risk according to the nursing diagnosis given at the time of admission and the function independence measure (FMI) test. Article Three

According to Frisina, Guellnitz & Alverzo (2012), multidisciplinary meetings among the hospital staff assist in decreasing falls among stroke patients in the hospital. The team meets at the time of admission and re-evaluates after a fall has occurred, the multidisciplinary team consists of physicians, nurses, rehabilitation assistant and therapists (p. 146). A post assessment from the multidisciplinary team is conducted throughout the study after each discharge to validate the effectiveness of all members participating in the fall prevention among stroke patients. The article does not mention specific interventions implemented in the research besides the multidisciplinary teams participation. The data collected was placed in a chi-square and the p value was less than .05; the research collected is considered nominal data. According to Frisina, Guellnitz & Alverzo (2012) although the severity of injury could be analyzed at the ordinal scale of measurement, we treated this variable as a nominal variable, examining the number and percentage of cases with either no injury or with injury (p. 142). This article would not be recommended due there was not significant interventions listed to facilitate guidelines for the nurse to provide quality and safe care to the patient to prevent falls in the hospital. Significance to Nursing In researching to determine the PICO question, does implementing fall risk assessments reduce falls compared to not implementing fall risk assessments in hospitalized stroke patients? The data discovered consists of numerous interventions implemented in the hospital setting to prevent falls among stroke patients. The nurses role in implementing the interventions is

FALL RISK INTERVENTIONS extremely important considering the nurse assesses the patient and ensures the interventions are being properly used by the patient and staff members. The nurse is the educator to the patient and family members to explain the importance of the interventions provided throughout their hospital stay to eliminate falls and what interventions are in placed to keep the patient safe. When the nurse informs the patient and family of the interventions to prevent falls during the stay at the hospital it provides quality of care to the patient. The interventions may improve the quality of care given to the patients during their hospital stay starting with effective communication among the multidisciplinary team and the

nurse educating the patient and family members at the time of the admission of the interventions to improve the patients safety during their recovering process. The research thoroughly discusses the safety for the patients in the hospital to prevent falls and the nurses responsibility to ensure fall prevention interventions are in place.

FALL RISK INTERVENTIONS References

Coussement, J., De Paepe, L., Schwendimann, R., Denhaerynck, K., Dejaeger, E., & Milisen, K. (2008). Interventions for preventing falls in acute- and chronic-care hospitals: A systematic review and meta-analysis. Journal of American Geriatrics Society, 56(1), 2931. Retrieved from http://mcintranet.musc.edu/agingq3/documents/images/Copy of Coussement_Intervention for Prevention Falls.pdf Forrest, G., Huss, S., Patel, V., Jeffries, J., Myers, D., Barber, C., & Koiser, M. (2012). Falls on an inpatient rehabilitation unit: Risk assessment and prevention. Rehabilitation Nursing, 37(2), 56-61. Retrieved from http://www.rehabnurse.org/ Frisina, P. G., Guellnitz, R., & Alverzo, J. (2012). A time series analysis of falls and injury in the inpatient rehabilitation setting. Rehabilitation Nursing, 35(4), 141-166. Retrieved from http://www.rehabnurse.org/ Nieswiadomy, R. M. (2012). Foundations of nursing research (6th Ed.). Boston: Pearson. Singleterry, L. (2013). Nursing research. Retrieved from http://www.ferris.edu/HTMLS/colleges/alliedhe/docs/nursing/NURS_350_Research_in_ Nursing.pdf