Informatics Research Seminar: Fall Prevention in Hospitals: Results of a Randomized Trial

January 12 @ 4:00 – 5:00 pm

 

Speaker: Patricia Dykes, DNSc, RN
Presented from Duke University

 

Abstract:

  • Context

Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls.

  • Objective

To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals.

  • Design, Setting, and Patients

Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).

  • Intervention

The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients’ specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.

  • Main Outcome Measures

The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.

  • Results

During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries.

  • Conclusion

The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.

Complete the sign-in sheet to receive CEU credit for attending this presentation.

Biosketch:

Center for Nursing Excellence at Brigham and Women’s Hospital, Boston , Mass.

Patricia Dykes, DNSc, RN, FAAN is Sr. Nurse Scientist and Research Program Director in the Center for Nursing Excellence at Brigham and Women’s Hospital in Boston, MA where she is building a program of informatics and patient safety research. Dykes was formally Corporate Manager Nursing Informatics & Research with the Clinical Informatics Research & Development group at Partners HealthCare, Inc., (2004-2010) where she conducted informatics and patient safety research and served as informatics consultant for electronic acute care documentation. With the support of the Robert Wood Johnson Foundation, Dykes and her team developed the Fall TIPS Toolkit (Tailoring Interventions for Patient Safety) a decision-support and communication intervention for use by care team members (including patients and family members) that integrates communication and workflow patterns into an HIT application. Dykes is first author on a paper published in JAMA in November 2010 describing the effectiveness of the Fall TIPS Toolkit for decreasing falls in hospitalized patients.

In addition, Dykes is conducting research on the bedside data needs and preferences of hospitalized patients, and evaluating the adequacy of standardized nursing terminologies to support measurement of nursing workload as a byproduct of electronic clinical documentation. Dykes has widely presented and published her work on electronic clinical documentation, informatics and patient safety and is the recipient of the 2007 Health Information Management Systems Society Nursing Informatics Leadership Award and the 2009 American Medical Informatics Association Harriet Werley Award for her paper presentation at the annual symposium that was judged to make the greatest contribution to advancing the field of nursing informatics. (http://connects.catalyst.harvard.edu/profiles/profile/person/31402