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Randomised control trial
Adding targeted multiple interventions to standard fall prevention interventions reduces falls in an acute care setting
  1. Patricia C Dykes
  1. Brigham & Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Patricia C Dykes
    Program Director, Center for Patient Safety Research and Practice, and Program Director, Center for Nursing Excellence, Brigham & Women's Hospital, 1 Brigham Circle, Boston, MA 02120, USA; pdykes{at}partners.org

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Implications for practice and research

  • Multiple intervention strategies that are targeted to patient-specific areas of risk prevent patient falls.

Context

Patient falls are a commonly occurring adverse event in acute care hospitals. Risk factors for falls are well established. Until recently, there were no intervention protocols known to prevent falls in acute hospital settings.1

Methods

Ang et al conducted a prospective randomised control trial (RCT) on eight units in an acute care hospital to evaluate the effectiveness of targeted multiple interventions. Patients were screened for fall risk on admission using the Hendrich II Falls Risk Model (HFRM). All patients with a score of ≥5 were randomised to usual care (n=912) or to usual care and targeted interventions (n=910). The intervention was implemented by research nurses with no direct involvement with the patients. Fall rates were gathered from hospital occurrence reports and tracked over a period of 8 months.

Findings

The proportion of patients receiving the targeted multiple interventions that reported cases of falls were significantly lower than in the control group. Both the RR estimate and risk for falling favoured the intervention group. The majority of falls in both control and intervention groups occurred at the bedside or when patients were getting out of bed. The authors conclude that targeted multiple interventions were effective in reducing patient falls in acute care settings.

Commentary

The current study adds to the growing evidence base which suggests that an accurate fall risk assessment using a valid and reliable instrument and interventions that are tailored to address patient-specific determinants of risk are effective in preventing patient falls in acute care hospitals. It is difficult to conduct RCTs in acute care settings and the authors should be commended for this effort. The multiple targeted interventions were implemented by research nurses who were not affiliated with the study units. The ward-based nurses who recorded the study outcome were blinded to which patients received the intervention. However, having outside researchers to implement the intervention could have disadvantages and may not be efficacious over time in hospital settings.2 In previous studies,3 ,4 it was found that team work and communication are critical to fall prevention. Having outside researchers to implement the intervention precludes coordinated teamwork to implement multiple targeted interventions to prevent patient falls.

This study has limitations. First, the reference list is outdated. Several studies published from 2008 to 20102 ,3 ,5 were not included. Most notably, the meta-analyses referenced were published from 1998 to 2005 even though a more recent meta-analysis was published in 2008 by Coussement et al.1 Second, the multiple targeted interventions were applied solely to patients at high risk for falls (less than one-third of the patients enrolled were at high risk). It is unknown whether the multiple targeted interventions would prevent falls in patients with lower levels of risk. A previous study3 has found that 40% of patients who fell on acute care medical units were found to be at low or medium risk for falls. Given the evidence that now exists related to multiple targeted interventions, all patients, even those with a single positive area of risk should have the appropriate tailored intervention(s) applied.6 ,7 It is unknown whether the multiple targeted interventions implemented in this study are effective across varying levels of risk. In addition, the intervention set that was applied to each HFRM area of risk was not included in the manuscript. Making this information available would enable others to leverage this work and further test the interventions.

Additional work is needed to test the effectiveness of the interventions on patients with varying levels of fall risk. Moreover, testing of the intervention in the context of interdisciplinary workflows will provide a means to evaluate the degree to which it supports a coordinated team effort to prevent falls.

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Footnotes

  • Competing interests None.

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