Research Activities, August 2013
Implementation factors important in promoting successful interventions to reduce hospital falls
Patient Safety and Quality
Falls in acute care hospitals are reported to range from 1.3 to 8.9 per 1,000 bed days. Hospitals have used multicomponent interventions to reduce fall risk by as much as 30 percent, according to four previous meta-analyses including 19 studies. An updated review supports that conclusion.
Evidence from 11 studies examined the implementation of multicomponent interventions, such as risk assessment, patient and staff education, bedside risk sign, an alert wristband, footwear, and medication review. The evidence suggests the importance of several implementation factors in successful fall reduction. These include leadership support, engagement of front-line clinical staff in the design of the intervention, guidance by multidisciplinary committee, pilot-testing the intervention, use of information technology, staff education and training, and changing nihilistic attitudes about falls.
Multicomponent interventions have been effective in hospitals that vary in size, location, and teaching status. However, the effects of context have not been well-studied. Also, the researchers caution that harms of multicomponent interventions are unclear, because they have not been studied systematically. Harms may include the potential for increased use of restraints and sedating drugs and decreased efforts to mobilize patients. This study was supported by AHRQ (Contract No. 290-07-10062).
For more details, see "Inpatient fall prevention programs as a patient safety strategy. A systematic review," by Isomi M. Miake-Lye, B.A., Susanne Hempel, Ph.D., David A Ganz, M.D., Ph.D., and Paul G. Shekelle, M.D., Ph.D., in the March 5, 2013, Annals of Internal Medicine 158(5) Part 2, pp. 390-396.