A Comprehensive Literature Review on Fall Prevention in Adult In-Patients

Introduction

In this study, the focus is on conducting a literature search on the topic of preventing the risk of fall in adult in-patients. Through this study, the researcher aims at analysing various past studies that have been carried out on a similar topic. By searching such previous investigations, the researcher can showcase his/her knowledge and skills that were developed during this course. Skills of critically evaluating these past investigations are imperative because it helps in improving the learning of the researcher and also is an opportunity to present his/her thoughts more effectively. This study is a chance to showcase evidence-based practice skills.

Evidence-based practice (EBP) can be defined as any practice that uses scientific evidence for guidance and decision-making. In the context of health and social care and nursing (LoBiondo-Wood & Haber, 2017). EBP can be defined as the process of integrating the best research evidence with clinical expertise and patient values. The ultimate objective of EBP is improving the experience of the patients and resolving their health issue (Gerrish & Nolan, 2012). There are three critical elements of EBP in health and social care – individual clinical expertise; patient values & expectations and best external evidence (Melnyk & Fineout-Overholt, 2011). Integrating these three elements is known as Evidence-based practice. In EBP, the focus is on identifying and gathering the best available evidence and clinical expertise to simplify the decision-making process. In recent some years, this process gained much importance due to the widening of the research-practice gap (Gregory, Hurlburt, & Horwitz, 2011). The number of professions in health care is increasing at a fast pace and ensuring that optimal health services are provided to the patients; EBP can be crucial. It can be the differentiating factor in the way health services are delivered to the patients, and their varied needs and requirements are fulfilled (Saunders & Katri , 2016).

The risk of fall among adult in-patients is usually very high, as they face numerous health issues, due to which they are unable to walk or even stand properly (Mirelman & Rochester, 2013). It is an act of falling or collapsing, which is propelled due to a wide variety of factors and forces. World Health Organisation (WHO) defines fall as abruptly coming to rest on the ground, floor or other lower levels; but it is not done intentionally (Severo & Kuchenbecker, 2018). For adult in-patients it can be extremely dangerous and could lead to consequences like fractures, change in emotional status, worsening of clinical conditions; death is also a possible result of it (Graham, 2012).

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SEARCH

In order to conduct the current study, specific search terms were used. While carrying out any investigation, it is highly essential for the researcher to clearly define the search terms (Ferrari, 2015). Having such clarity enables the researcher to emphasise more on the whole research process and thus be able to investigate efficiently and effectively (Vom, Simons, & Niehaves, 2009). Clearly defined search terms help the researcher to conduct the literature search appropriately and therefore understand the subject matter in a better manner.

Carrying out a literature search involves searching for and compiling all the available and related materials. In any research investigation, the aspect of literature search holds vital importance. It can be the differentiating factor in the overall success and effectiveness of the study. The main reason for conducting a literature search is to provide a background about the subject matter and thereby carry out the investigation as effectively as possible (Younger, 2010). During the process of literature, search attention needs to be given on the search terms. They define parameters based on which the literature should be collected, analysed and used. In the context of the current study, specific search terms have been used (Wu & Aylward, 2012).

To conduct the literature search, three steps were followed by the researcher. The first step entailed developing a specific research question in a specific subject area (Murphy, 2009). In the current study, the researcher focused on the question – “how to present the risk of fall in adult in-patients?” In this question, the emphasis was on determining ways through which the risk of fall among adult in-patients can be reduced. By focusing on this question, the researcher was able to adopt a very different point of view that helped in understanding the factors that lead to a risk of fall and also the various regulations and standard practices put in place to control the situation as well (Finfgeld‐Connett, & Johnson, 2013).

In the second step, databases from where the relevant literature can be collected were to be listed, presented and analysed in terms of their usefulness in obtaining the information. In this regard, the researcher used CINHAL and PubMed as the main databases for collecting the data. These databases were selected because they are some of the most comprehensive sources from where plenty of information regarding the subject matter could be obtained (Amariles, 2011). By utilising these sources, the researcher was able to collect data from different past studies. Furthermore, through these databases, the researcher ensured only the literature that met the inclusion and exclusion criteria, as shown in Table 1 were collected.

The third step required identifying different keywords and terms that the researcher can use to search for necessary articles on the subject matter (Jahan & Naveed, 2016). In the current study, several keywords were used. They were – the risk of fall in adult in-patients, fall in hospitalised adults, preventing the risk of fall among adult in-patients, accident prevention, fall accident, medical safety, elderly, consequences, and fall. In this stage, the researcher focused on searching for these keywords on the CINHAL and PubMed databases.

While searching for literature, the researcher focused on ensuring that articles and previous studies collected were conducted for ten years only, i.e. from 2009-19. This enabled the researcher to gather information from recent and latest articles, thereby enhancing the overall knowledge and understanding of the research topic. Furthermore, by using such latest articles, the researcher focused on using the studies that were conducted in the UK only. This limited the amount of search and articles that the researcher could access and use (Borah, Brown, & Capers, 2017). This was an essential part of the current study because any literature that was carried out in or was based on any other country was of no use for this study.

Apart from this, the researcher also paid attention to ensuring all literature collected and used for the current investigation were in the English language. Studies in any other language were not used by the researcher (Melnyk & Fineout-Overholt, 2011). The main reason for selecting articles of the English language was the fact that the target readers, as well as the researcher, are fluent in English as it is their native language. Therefore, the researcher could understand only those articles that were in English (Atkinson & Koenka, 2015).

Only the studies that were conducted on hospitalised adults were accessed and used. Any study that focused on adults receiving care and treatment in care homes and community health care service institutions were not used (Younger, 2010). The main reason behind this was the fact that this study emphasised on an in-patient or hospitalised adults. Since individuals admitted to care homes do not receive the same quality of care as they do in hospitals, such literature has not been considered for the current study.

Inclusion and Exclusion Criteria Inclusion and Exclusion Criteria

DISCUSSION

Article 1

What is the study about?

This was a qualitative study that focused on analysing and evaluating different risk factors for falls (Pfortmueller, Lindner, & Exadaktylos, 2014). It also discussed different possible fall prevention measures and techniques. The authors used a qualitative approach to conduct this study because it aimed at determining the risk factors and also on discussing ways through which such risk(s) can be reduced. Hill & Francis-Coad (2016) also used a qualitative approach to conducting their investigations and were successful in obtaining very reliable results.

How was it conducted?

The UK National Health Services (NHS) data was used to determine the overall prevalence of risk of fall among adult in-patients in the country. This was the primary source for collecting the relevant data. By using this database, the authors were able to acquire a considerable amount of information regarding the topic. This further helped in studying and analysing the various risk factors and prevention measures put in place by the hospitals, the NHS and the government as well.

What was found?

They found that falls in the elderly have a significant negative impact on their health and well-being. It is one of the leading causes of disabilities among them. Although falls are common among the elderly, there are certain risk factors and preventive measures that help in controlling the situations and thereby reducing the number of such cases. By using a similar approach, George & Vincent (2013) also obtained similar results.

Article 2

What is the study about?

This study aimed at evaluating the impact of a systematic training programme on falls risk assessment (FRA) on nurses in a newly built hospital. Inpatients falls were high as compared to two previous multi-bedded hospitals (Singh & Okeke, 2016). High fall rate among adult in-patients shows negligence and lack of training among the workforce. It also shows that hospital administrators are not doing their best at controlling the situation.

How was it conducted?

Plan-Do-Study-Act (PDSA) cycles were used by the authors to test the effects of the interventions employed. It enabled the authors to collect information about the overall effectiveness of the intervention techniques and the way they were implemented within the hospital. Although Demontiero, Gunawardene, & Duque (2014) obtained similar results, they did not use the PDSA cycles to measure the effects of the outcomes.

What was found?

The authors determined through this study that through the said intervention programmes of training the nurses, the incidences of risk of fall among the adult in-patients declined considerably. They further noted that because of such an intervention program, it is a lot simpler for the hospital administration to monitor the performance of the staff such as nurses and provide patients with a safe and healthy environment.

Article 3

What is the study about?

Sahota, Drummond, & Kendrick (2013) realised that falls among patients in hospital settings is a very dangerous situation. This is supported by the findings of McMillan & Hubbard (2012) as well, who stated that falls among the patients tend to show the inefficiency of the hospital administration in providing a safe environment to the patients. It puts a substantial burden on the UK healthcare system. This study evaluated the effectiveness of pressure sensors used on beds and chairs for detecting falls in acute hospital care. It also determined whether these methods are clinically effective and cost-effective or not.

How was it conducted?

The authors conducted a pragmatic, parallel-arm and individual randomised controlled trial of pressure sensors used on beds and bedsides using radio-pagers (intervention group). They were compared with standard care (control group). The study was conducted in a large teaching hospital in the UK, and the outcome was measured through the number of in-patient bedside falls per 1000 bed days. This was a quantitative study.

What was found?

Contrasting to the results of Vieira & Berean (2013) and Teh & Mahajan (2015), this study found that there were 85 bedside falls in the intervention group and 83 bedside falls in the control group. The fall rate was 9 per 1000 bedside days. It was further observed that there were no significant differences between the two groups in terms of time to first bedside fall.

Article 4

What is the study about?

This was a qualitative, observational study that focused on identifying changes in the local policies in UK hospitals since the publication of the National Patient Safety Agency (NPSA)’s ‘Slip trips and falls in hospitals’ and ‘Using bedrails safely and effectively’ (Healey & Treml, 2012). Through this study, the authors, thus aimed at analysing steps taken by local hospitals in the regions of England and Wales since the publication of these papers.

How was it conducted?

The authors accessed policies put in place during 2006 and 2009 from 50 hospitals in the two regions. Hospitals were selected through random sampling technique. The authors ensured that the selected hospitals were acute hospital trusts, and their policies were categorised by a single reviewer who used especially defined criteria.

What was found?

Authors were able to gain responses from 37 hospitals and trusts in the two regions. The number of fall risks reduced from 50% to 19% through unreferenced numerical falls risk assessment tool. Hospitals that had a bedrails policy in place saw an improvement in safety for the patients from 49% to 89%.

Article 5

What is the study about?

In this quantitative study, the authors aimed at exploring the impact of medications on fall risks among adult and elderly in-patients (Costa-Dias, Oliveira, & Martins, 2014). The number of falls as a result of medication has increased significantly over the last few years. Authors thought that since this phenomenon is increasing at such a rapid pace, there is a need to conduct such an investigation. The objective of this study was to test and explore the association between medication and falls and recurrent falls among adult inpatients.

How was it conducted?

This study included a sample of 214 episodes of fall events, which had occurred in 193 patients. Face to face consensus technique was used to conduct this study. Student’s t-test, ANOVA and Odds Ratio were used to analyse the data along with Kruskal-Wallis test for parametric statistics. Morse Fall Risk Scale and Medication Fall Risk Score were used to measure the fall risk and fall due to medication risks.

What was found?

They observed that the patients who had received drugs from the therapy group of the Central Nervous System were at least ten times more exposed to fall risk. There was a significant association between falls and their reoccurrences among the patients. 34% of the patients scored six or higher in the medication fall risk score.

Article 6

What is the study about?

In this study, the authors paid emphasis on using a specific implementation strategy in order to deliver a nursing-staff led intentional rounding intervention to reduce the incidences of inpatient fall (Morgan & Flynn, 2017).

How was it conducted?

Customised Intentional Rounding was used and was evaluated as a part of staff-led quality improvement interventions in order to reduce the number of cases of falls among adult inpatients. Process and outcome measures were pre-recorded.

What was found?

They found a 50% reduction in the number of falls among adult inpatients on the active ward as compared with the minimal increase across the rest of the hospital.

CONCLUSION

In this study, the focus is on conducting a literature search on the topic of preventing the risk of fall in adult in-patients. Through this study, the researcher aims at analysing various past studies that have been carried out on a similar topic. Evidence-based practice (EBP) can be defined as any practice that uses scientific evidence for guidance and decision-making. EBP can be defined as the process of integrating the best research pieces of evidence with clinical expertise and patient values. The ultimate objective of EBP is improving the experience of the patients and resolving their health issue. World Health Organisation (WHO) defines fall as abruptly coming to rest on the ground, floor or other lower levels; but it is not done intentionally. For adult in-patients, it can be extremely dangerous and could lead to consequences like fractures, change in emotional status, worsening of clinical conditions; death is also a possible result of it. In order to conduct the current study, specific search terms were used.

While carrying out any investigation, the researcher needs to define the search terms clearly. Having such clarity enables the researcher to emphasise more on the whole research process and thus be able to investigate efficiently and effectively. Carrying out a literature search involves searching for and compiling all the available and related materials. In any research investigation, the aspect of literature search holds vital importance. It can be the differentiating factor in the overall success and effectiveness of the study.

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The main reason for conducting a literature search is to provide a background about the subject matter and thereby carry out the investigation as effectively as possible. During the process of literature, search attention needs to be given on the search terms. They define parameters based on which the literature should be collected, analysed and used. In the context of the current study, specific search terms have been used.

IMPLICATIONS

By conducting this study, I have understood that there is a need for me to follow the concept of evidence-based practice. It can be an effective way for me to learn more about my performance and also determine ways through which I can improve it. EBP provides the significant ability to the concerned individual in analysing own practices and also in comparing it with that of others’. Such information can be of vital importance for an individual, who is trying to improve their performance and also ensure that the available resources are used efficiently and effectively.

Furthermore, as a nurse, conducting this investigation about the risk of fall among adult inpatients and ways to prevent it, have enhanced my understanding about its overall importance and also ways in which I can try to help control this situation. Through this study, I have come to an understanding that there are several aspects that I still have to learn and improve on so that I can perform my tasks and duties as a nurse more efficiently and effectively.

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Costa-Dias, M. J., Oliveira, A. S., & Martins, T. (2014). Medication fall risk in old hospitalized patients: a retrospective study. Nurse Education Today, 171-176.

Demontiero, O., Gunawardene, P., & Duque, G. (2014). Postoperative prevention of falls in older adults with fragility fractures. Clinics in geriatric medicine, 333-347.

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George, J., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. Journal of the Royal Society of Medicine, 355-361.

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Graham, B. (2012). Examining evidence-based interventions to prevent inpatient falls. Medsurg Nursing , 21-25.

Gregory, A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 4-23.

Healey, F., & Treml, J. (2012). Changes in falls prevention policies in hospital in England and Wales. Age and ageing, 106-109.

Hill, A.-M., & Francis-Coad, J. (2016). My independent streak may get in the way’: how older adults respond to falls prevention education in hospital." BMJ open 6, no. 7 (2016): e012363. BMJ open , e012363.

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McMillan, G., & Hubbard, R. (2012). Frailty in older inpatients: what physicians need to know. QJM: An International Journal of Medicine, 1059-1065.

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Mirelman, A., & Rochester, L. (2013). V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial. BMC neurology, 15.

Morgan, L., & Flynn, L. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of clinical nursing, 115-124.

Murphy, S. (2009). Review of physical activity measurement using accelerometers in older adults: considerations for research design and conduct. Preventive medicine , 108-114.

Pfortmueller, C., Lindner, G., & Exadaktylos, A. (2014). Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review. Minerva Med , 275-81.

Sahota, O., Drummond, A., & Kendrick, D. (2013). REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial. Age and ageing, 247-253.

Saunders, H., & Katri , V.-J. (2016). The state of readiness for evidence-based practice among nurses: An integrative review. International Journal of Nursing Studies, 128-140.

Severo, I. M., & Kuchenbecker, R. S. (2018). Risk factors for fall occurrence in hospitalized adult patients: a case-control study. Revista latino-americana de enfermagem, 26.

Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a 100% single room elderly care environment: evaluation of the impact of a systematic nurse training programme on falls risk assessment (FRA). BMJ Open Quality, u210921-w4741.

Teh, R. C.-A., & Mahajan, N. (2015). Clinical effectiveness of and attitudes and beliefs of health professionals towards the use of health technology in falls prevention among older adults. International journal of evidence-based healthcare, 213-223.

Vieira, E. R., & Berean, C. (2013). Reducing falls among geriatric rehabilitation patients: a controlled clinical trial. Clinical rehabilitation, 325-335.

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