Educating hospital patients to prevent falls: protocol for a scoping review

Observational Prospective Study to Determine the Efficacy of 'Non-Slip Socks' vs. 'Adequate Footwear' Regarding the Number of Falls Observed among Admitted Patients

BACKGROUND

Fall prevention is an important indicator of the quality of patient care. Prevention includes the use of adequate footwear. Our objective is to determine the differences in the number of falls between patients with "adequate footwear" and "non slip socks", and their associated consequences, to support their use in the prevention of falls among hospitalized patients.

METHODS

This is an observational prospective study on inpatient falls. Patient characteristics, fall circumstances, and injuries were collected through Clinical Report Forms, a review of fall reports, and medical records. Admitted patients over 18 years old were recruited from Geriatric and Internal Medicine Units over a brief period of 3 months.

RESULTS

A total of 158 hospitalized patients were recruited. In total, 77 patients (48.73%) were assigned to the non-slip socks group, and 81 (51.27%) were assigned to the adequate footwear group. There were 21 falls during the study period, all of which were experienced by the adequate footwear group (p < 0.0001). The mean age of the patients who fell was 83.14 (range 60-100) years old. The most frequent reasons for admission among the patients who fell were COVID-19 infection (19%) and oncological complications (19%). Overall, 61.9% of patients had a high risk of falling. Most falls (76.1%) occurred in patient rooms, and most of these occurred while wandering around. The most frequent reason for falls was slipping (14/21). For 16 of 21 patients, falls did not have immediate consequences, while 5 had contusions and 1 suffered a wound. Nobody needed to be admitted to the ER or suffered external hemorrhages or loss of consciousness.

CONCLUSIONS

Non-slip socks represent an adequate alternative to well-fitting rubber-soled footwear. It seems that non-slip socks could prevent falls among hospitalized patients; nevertheless, further studies are necessary to clarify their role in preventing hospital falls and reducing injury rates.

Implementing Patient Falls Education in Hospitals: A Mixed-Methods Trial

Patient education is key to preventing hospital falls yet is inconsistently implemented by health professionals. A mixed methods study was conducted involving a ward-based evaluation of patients receiving education from health professionals using a scripted conversation guide with a falls prevention brochure, followed by semi-structured qualitative interviews with a purposive sample of health professionals involved in delivering the intervention. Over five weeks, 37 patients consented to surveys (intervention n = 27; control n = 10). The quantitative evaluation showed that falls prevention education was not systematically implemented in the trial ward. Seven individual interviews were conducted with health professionals to understand the reasons why implementation failed. Perceived barriers included time constraints, limited interprofessional collaboration, and a lack of staff input into designing the research project and patient interventions. Perceived enablers included support from senior staff, consistent reinforcement of falls education by health professionals, and fostering patient empowerment and engagement. Recommended strategies to enhance implementation included ensuring processes were in place supporting health professional accountability, the inclusion of stakeholder input in designing the falls intervention and implementation processes, as well as leadership engagement in falls prevention education. Although health professionals play a key role in delivering evidence-based falls prevention education in hospitals, implementation can be compromised by staff capacity, capability, and opportunities for co-design with patients and researchers. Organisational buy-in to practice change facilitates the implementation of evidence-based falls prevention activities.

Benefits and risks of non-slip socks in hospitals: a rapid review

BACKGROUND

Non-slip socks are sometimes used in an attempt to prevent falls in hospitals despite limited evidence of benefit. We critique the current literature on their risks, benefits and effects.

METHODS

A rapid review was conducted following the Cochrane Rapid Review Methods Group Guidelines. To be included, studies needed to have data on single or multifactorial interventions that used non-slip socks in hospitals or their safety, risks or effects in a laboratory setting. Six electronic databases were searched: Medline, Embase, Cinahl, Cochrane, Allied and Medical Health Database (AMED) and Proquest Central.

RESULTS

Fourteen articles met the inclusion criteria. Nine used non-slip socks as an intervention in hospitals. Three assessed their effects in laboratory settings. Two reported risks in relation to bacterial transfer. Most studies that used non-slip socks to prevent hospital falls had negative or equivocal results and were of comparatively low method quality, with a high risk of bias. Two of the laboratory tests reported traction socks to be no safer than walking barefoot and to have similar slip resistance. The laboratory studies had a low risk of bias and showed that bacteria can sometimes be acquired from socks.

CONCLUSION

Non-slip socks have the potential to carry an infection control risk that requires careful management. There was no strong or conclusive evidence that they prevent hospital falls.

Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial

Background/Objectives

We investigated the impact of ceasing routine falls risk assessment tool (FRAT) completion and instead used clinical reasoning to select fall mitigation strategies.

Design

Two‐group, multi‐site cluster‐randomized active‐control non‐inferiority trial.

Setting

Hospital wards.

Participants

Adult inpatients admitted to participating hospitals (n = 10 hospitals, 123,176 bed days).

Intervention

Hospitals were randomly assigned (1:1) to a usual care control group that continued to use a historical FRAT to assign falls risk scores and accompanying mitigation strategies, or an experimental group whereby clinicians did not assign risk scores and instead used clinical reasoning to select fall mitigation strategies using a decision support list.

Measurements

The primary measure was between‐group difference in mean fall rates (falls/1000 bed days). Falls were identified from incident reports supplemented by hand searches of medical records over three consecutive months at each hospital. The incidence rate ratio (IRR) of monthly falls rates in control versus experimental hospitals was also estimated.

Results

The experimental clinical reasoning approach was non‐inferior to the usual care FRAT that assigned fall risk ratings when compared to a‐priori stakeholder derived and sensitivity non‐inferiority margins. The mean fall rates were 3.84 falls/1000 bed days for the FRAT continuing sites and 3.11 falls/1000 bed days for experimental sites. After adjusting for historical fall rates at each hospital, the IRR (95%CI) was 0.78 (0.64, 0.95), where IRR < 1.00 indicated fewer falls among the experimental group. There were 4 and 3 serious events in the control and experimental groups, respectively.

Conclusion

Replacing a FRAT scoring system with clinical reasoning did not lead to inferior fall outcomes in the short term and may even reduce fall incidence.

Improving hospital falls screening and mitigation using a health professional education framework

OBJECTIVE

Although health professional education has the potential to mitigate hospital falls risk, the best methods to develop, deliver and evaluate health professional education remain unclear. This study applied evidence-based approaches to education design to improve falls risk mitigation.

DESIGN

Mixed methods using questionnaires to evaluate health professionals knowledge of evidence-based falls risk assessment and mitigation, followed by semi-structured interviews with individual health professionals.

SETTING

Five large Australian hospitals.

PARTICIPANTS

For each hospital, 10 clinical leaders from nursing and allied health professions were invited to participate in falls workshops.

METHODS

46 participants received a three-hour education program on the latest evidence in hospital falls risk assessment and how to implement evidence-based falls screening and management. This was based on the "4P" education model (Presage, Planning, Process and Product). They were taught practical skills to enable them to educate other health professionals.

RESULTS

The education workshop significantly changed participants' views about best practice guidelines for falls screening and prevention. Participants felt more confident in assessing falls risk and judging and implementing the best mitigation strategies. They were prepared and motivated to educate others about falls prevention and satisfied with the skills gained.

CONCLUSIONS

A high-quality education program grounded in a rigorous quality framework improved health professionals knowledge regarding evidence-based falls prevention. Use of evidence-based rationales for behaviour change promotes effective learning.

Hospital bed height influences biomechanics during bed egress: A comparative controlled study of patients with Parkinson disease

Although a significant proportion of patient falls occur during egress from the hospital bed, the biomechanical adaptations during egress from different bed heights are still largely unknown. The purpose of this study was to evaluate the effect of hospital bed height on natural transition during egress in patients with Parkinson disease (PD). Twelve patients with PD and fourteen healthy elderly adults (HEA) were recruited and the natural transition during egress from three different bed heights (low, medium and high) were recorded for each participant using a motion capture system and force plates. The bed egress time, joint kinematics, ground reaction force and center of mass (CoM) were compared using a two-factor repeated ANOVA to determine the effects of three bed heights and two groups. The results showed that patients with PD had a significantly increased bed egress time, decreased peak of pelvis anterior tilt, hip flexion, and anteroposterior distance between pelvis center and CoM compared to HEA. Additionally, both PD and HEA groups increased the peak of trunk, hip and knee flexions to generate forward CoM momentum and joint torque to rise from a low bed height. These findings indicated that patients with PD invoked a more conservative movement pattern than HEA during egress to improve postural stability. The low bed height increased demands of balance and postural control during egress which exacerbates the risk of falls for patients with PD.

Hospital falls prevention with patient education: a scoping review

Background

Hospital falls remain a frequent and debilitating problem worldwide. Most hospital falls prevention strategies have targeted clinician education, environmental modifications, assistive devices, hospital systems and medication reviews. The role that patients can play in preventing falls whilst in hospital has received less attention. This critical review scopes patient falls education interventions for hospitals. The quality of the educational designs under-pinning patient falls education programmes was also evaluated. The outcomes of patient-centred falls prevention programs were considered for a range of hospital settings and diagnoses.

Methods

The Arksey and O’Malley (2005) framework for scoping reviews was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Eight databases, including grey literature, were searched from January 2008 until February 2020. Two reviewers independently screened the articles and data were extracted and summarised thematically. The quality of falls prevention education programs for patients was also appraised using a modified quality metric tool.

Results

Forty-three articles were included in the final analysis. The interventions included: (i) direct face-to-face patient education about falls risks and mitigation; (ii) educational tools; (iii) patient-focussed consumer materials such as pamphlets, brochures and handouts; and (iv) hospital systems, policies and procedures to assist patients to prevent falls. The included studies assessed falls or education related outcomes before and after patient falls prevention education. Few studies reported incorporating education design principles or educational theories. When reported, most educational programs were of low to moderate quality from an educational design perspective.

Conclusions

There is emerging evidence that hospital falls prevention interventions that incorporate patient education can reduce falls and associated injuries such as bruising, lacerations or fractures. The design, mode of delivery and quality of educational design influence outcomes. Well-designed education programs can improve knowledge and self-perception of risk, empowering patients to reduce their risk of falling whilst in hospital.