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Implementing Evidence into Practice

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In hospitals and care facilities, falls are the most prevalent safety incident reported

among inpatients. Because of their compromised physical and cognitive status, older patients

are at a higher risk of falls while hospitalized (Muray et al., 2018). This presentation aims to

explore research papers to determine whether a standardized fall safety promotion plan will

decrease the number of preventable falls in older adults in a geriatric hospital unit. To critique

scholarly evidence and findings based on this research question, I will utilize the Stetler

Model of Research Utilization (Stetler, 2001).

The first paper is a systematic literature review of randomized controlled trials

investigating various interventions designed to prevent falls in geriatric patients within

hospitals and care facilities (Cameron et al., 2018). The authors screened major medical

databases for peer-reviewed articles up to August 2017. The paper included 95 trials

containing 138,165 participants with a mean age of 78 years in hospital settings and 84 years

in care facilities. The study indicated that the frequency of falls within hospital settings was

significantly reduced by implementing multifactorial interventions. These include

environmental interventions such as proper lighting and non-slip flooring, assistive

technology like bed-side rails, and enhanced patient and staff education (Cameron et al.,

2018). This study's findings imply that a multifactorial interdisciplinary fall safety promotion

plan based on individual patient risk assessment can reduce the frequency of falls in geriatric

patients. This study's primary limitation is that some of the studies were not double-blinded

and were, therefore, at a high risk of bias. The studies reporting methods were not

homogeneous across the studies, and, in some cases, adverse effects were poorly

documented.

The second paper is a retrospective study that compared the validity of three common

assessment tools used to assess geriatric patients' risk levels (Cho et al., 2020). The three

most common fall risk assessment tools utilized in a standardized fall safety promotion plan
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are the Johns Hopkins Fall Risk Assessment Tool (JHFRAT), the Hendrich II Fall Risk

Model (HFRM) the Morse Fall Scale (MFS). The study was carried out at a 2600-bed acute

care hospital.

This retrospective study's case arm comprised 447 adult inpatients who had reported

an incident of falling between June 2014 and May 2015. The study's control arm contained

1341 inpatients at the same hospital who did not report any falls incident. The three risk

assessment tools were used as measuring instruments in both the case and control groups.

The predictive accuracy of the three tools was analyzed and compared using conditional logic

regressions. The study demonstrated that the most significant factors for falls in geriatric

patients are gait impairments, mental status, vertigo, and past fall history. Out of the three

assessment tools, the study reported that the Johns Hopkins Fall Risk Assessment Tool had

the highest accuracy while the Henrich II Fall Risk Model scored the best predictive

performance.

This study's findings imply that the validity and accuracy of risk assessment tools

vary by hospital due to the differences in environment, socioeconomic factors, and diverse

patient characteristics. In light of this, it is paramount that before an institution adopts any

standardized fall safety promotion plan, the risk assessment tool's predictive accuracy should

be tested and, if necessary, customized to adapt to the institution's needs. This study's

limitation is that it was based in one setting and thus not representative of the general

population. The study was also not randomized and, therefore, prone to selection bias.

The third paper is a randomized controlled trial investigating the efficacy of

individualized education strategies in preventing falls in hospital rehabilitation centres (Hill

et al., 2015). The trial was carried out across eight publicly funded rehabilitation centres in

Australian hospitals over 50 weeks. The study was randomized using a computer-generated

sequence into a control and case group. The intervention implemented in the case group was
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a multi-media Safe Recovery education program delivered by physiotherapists to raise

awareness of personal risk of falls, how to prevent falls, and encourage them to engage in

fall-prevention strategies. The primary measure of outcome for the study was the rate of falls

per 1000 patient-days.

The total study sample size was 3606 patients; 1623 admissions during the period the

interventions were implemented, while 1982 admissions were studies in the period without

the intervention. All participants underwent a basic cognitive test using a Mini-Mental State

Examination (MMSE) to ensure they had basic cognitive functioning to comprehend and

benefit from the intervention. Data were analyzed using Stata statistical software, and the

association between variables was examined by logistics regression. The study demonstrated

a reduction in injurious falls and the rate of falling among patients during the period the

interventions were implemented. In the patient group with higher cognitive scores, fall rates

per 1000-patient days reduced from 10.68 to 4.87. The trial proved the interventions' efficacy

as injurious falls in the intervention group were 2.63 per 1000 patient-days while in the

control group, it was 4.75.

The study's main limitation was that it was carried out at rehabilitation centres with

different staff and environment as acute care settings. It was not possible to mask the research

due to the nature of the methodology. This implies that factors such as different nurse to

patient ratios might affect the study results if carried out in varying settings. The study setting

had the recommended number of healthcare and allied workers. In locations where staff are

constrained, the intervention might not be as successful. The fall-prevention interventions had

variable efficacy across the different units due to the heterogeneity of settings. However,

there was no statistically significant variation in the length of hospital stay.

The study implies that hospitals should integrate patient and staff education into fall

safety promotion plans as part of routine clinical care.

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References

Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., &

Kerse, N. (2018). Interventions for preventing falls in older people in care facilities

and hospitals. The Cochrane Database of Systematic Reviews, 2018(9).

https://doi.org/10.1002/14651858.CD005465.pub4

Cho, E. H., Woo, Y. J., Han, A., Chung, Y. C., Kim, Y. H., & Park, H.-A. (2020).

Comparison of the predictive validity of three fall risk assessment tools and analysis

of fall-risk factors at a tertiary teaching hospital. Journal of Clinical Nursing, 29(17–

18), 3482–3493. https://doi.org/10.1111/jocn.15387

Hill, A.-M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara,

M., & Haines, T. P. (2015). Fall rates in hospital rehabilitation units after

individualized patient and staff education programmes: A pragmatic, stepped-wedge,

cluster-randomized controlled trial. The Lancet, 385(9987), 2592–2599.

https://doi.org/10.1016/S0140-6736(14)61945-0

Muray, M., Bélanger, C. H., & Razmak, J. (2018). Fall prevention strategy in an emergency

department. International Journal of Health Care Quality Assurance, 31(1), 2–9.

https://doi.org/10.1108/IJHCQA-09-2016-0122

Stetler, C. B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-

based practice. Nursing Outlook, 49(6), 272–279.

https://doi.org/10.1067/mno.2001.120517