Patient Falls: A National Health Service Overview - Research Paper

Introduction

Patient falls are described as unplanned descent to the floor that results in different levels of injuries or even death. It is reported by National Health Service that the most recorded safety incidents involve falls among the inpatients (Morris and O'Riordan, 2017). It is outlined that 30% to 50% of falls culminate in a certain level of injuries, while 1% to 3% culminate in fractures (Morris and O'Riordan, 2017). It, therefore, means that the risk of falls for adult in-patients and its implications cannot be understated, hence the choice of the topic. The topic "How can the risk of fall be reduced for an adult in- patients? " is appropriate for the application of an evidence-based practice model. The desired outcome, which is the reduction of risk of falls for adult inpatients, can be achieved through examination of data concerning risk factors to falls and the most feasible prevention procedures. The research topic was selected due to its importance in the United Kingdom health care industry. The paper seeks to evaluate evidence on prevention interventions appropriate for reducing adult in-patient falls in the United Kingdom.

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The paper has different sections, namely literature search, discussion, conclusion, and implication for the nursing practice. The search process details how evidence-based data is collected using appropriate keywords from different databases such as Cochrane Reviews. Also there is provision of the inclusion and exclusion criteria to determine the highest quality sources. The discussion section provides a comprehensive overview of the fundamental articles utilized. The conclusion summarises the literature search process and reiterating the key findings confirming that the research question has been adequately answered. Lastly, there is an implication for practice section, which outlines the existing gaps in the evidence and implication for the nursing practice.

Evidence-based practice (EBP) is described as an approach whose objective is the enhancement of the process for collecting scientific research evidence that is high quality transformable to most appropriate practical choices to enhance health. The systematic collection of data is the impetus to quality research findings that are used as evidence critical in supporting practice. Some of the evidence-based models applicable include Iowa Model and Johns Hopkins Nursing Model. Iowa Model facilitates practice on evidence finding and guides clinical decisions and evidence-based practice. Johns Hopkins Nursing Model facilitates development and details concerning the intergration of evidenced-based practice content into nursing practice.

Literature Search

Literature Searching Process

To enable the development of hospital falls prevention approaches, there was a systematic review of the existing evidence base. The search determined different publications on fall prevention interventions for adult in-patients. It included intervention policies and multifactorial interventions which entailed fall risk assessment, and education and training for the health care staff. The search also identified different tools for reducing falls in hospitals, and most of these ere fall risk assessment tools such as the Multifactorial Fall Risk assessment tool (FRA) to develop intervention programs. Table 1 illustrates the keywords used in the evidence search process. These keywords are essential in searching evidence-based information relating the topic which is "how can the risk of fall be reduced for the adult in-patients?" This helped to inform the research process by providing the exact search terms to promote an accurate and effective literature search process.

Table 1: Search Term Used

Search Term Used

Keywords Falls, prevention, patient safety, adult in-patients, multifactorial fall risk assessments, fall prevention, systematic review, evidence-based practice

Evaluation of Interventions

The development of risk of falls reduction intervention necessitated the systematic assessment of the existing evidence base for the prevention of falls for adult inpatients. There is a substantial resource relevant to the risk of fall reduction for adult in-patients. To evaluate the available resources, there was a selection of a list of online networks and search for policy guides. The sources include government documents and internet searches such as Google search and NCBI journals. The resources from the database search are outlined in the table indicated in the Appendix. The list on the table (Appendix) is not exhaustive but indicates various policies and clinical studies concerning the prevention of fall risk available. The resources used are information published by governmental agencies in the United Kingdom, health agencies, and published research articles such as journals. These resources are listed in the reference list and Appendix. The policy commissioned by government agencies is developed to guide health care practitioners in the implementation of intervention programs for the risk of falls for adult in-patients. The summative review will indicate different interventions and procedures to deal with the problem of adult inpatient falls in the United Kingdom settings. The information is essential to hospitals in the implementation of appropriate interventions to prevent the cases of adult inpatient falls.

The summative evaluation has the objective of systematically collecting analysis concerning interventions on hospital fall prevention. The evaluation of the evidence will analyze hospital fall reduction approaches to ensure the identification of appropriate evidence-based interventions. The inclusions in this evaluation include interventions that were tested in hospital settings, and those outside this scope were excluded. The Cochrane Database, National Centre for Biotechnology, and Google searches had relevant hospital fall interventions. The search approach was broad and not confined to a set of interventions to ensure the identification of diverse interventions. Some of the interventions include assessment scales, bed alarms, emphasis on environmental safety, and multi-faceted approaches, among others. The objective of the interventions is the reduction of falls and injuries emanating from falls. The search was confined to hospital settings in the United Kingdom to ensure the applicability of the interventions to inpatient facilities.

Inclusion and Exclusion Criteria

The aim of the criteria was the determination of falls prevention interventions that are appropriate for inpatient hospital settings. Factors for the inclusion and exclusion criteria include:

Participants: Research and studies that involved strategies to prevent falls for adult inpatients were considered for inclusion. Research and studies involving fall prevention for medical staff, child inpatients, and outcomes were excluded.

Design: Studies that included data concerning the results of fall intervention were considered for inclusion. This included randomized controlled trials, cohort studies, and controlled clinical trials. Also, government fall prevention guidelines were included. Simple discussions of interventions not supported by credible data were excluded.

Interventions: Interventions that focused on the reduction of adult in-patients falls were included in the summative review. Another inclusion was single and multi-faceted approaches. Research on the reduction of restraints and those focusing on the reduction of risk of injuries were excluded since that was not the primary aim of the review.

Setting: The summative review confined appropriate studies to hospital settings. The health care settings excluded are non-hospital care facilities, nursing homes, and residential care facilities.

Outcomes: Those interventions that recoded accidentals falls for adult inpatients were included. Additionally, these studies were required to have numerical data on fall intervention to be considered. Some of the outcomes included rates of falls and the number of falls. Research concerning outcomes such as falls after the patient is discharged was excluded.

Discussion

A Culture of Vigilant Safety Consciousness

Adult in-patient falls have been reported to be among the most reported safety cases with England and Wales recoding approximately 250,000 fall yearly. The recent audit data indicate a mean of 6.63 falls for every 1000 occupied bed day (Morris and O'Riordan, 2017). This translates to approximately 1700 falls annually in an 800-bed inpatient hospital setting. Different risk factors have been used to developed appropriate fall prevention efforts. In hospitals, evidence on effective fall reductions has been confined to simplified 'before and after' designs or cluster randomization methodologies. Fall prevention has not been successful through single interventions such as bed signage, routine provision of vitamin D, and high-risk wristbands, among others. The interventions that have shown promising outcomes in fall prevention have integrated complex multi-faceted elements of risk. This has have incorporated in the assessment process and, ultimately, the appropriate interventions. According to reviews, multifactorial assessments translate to interventions that prevent falls in hospitals by an estimated 2% to 30% (Morris and O'Riordan, 2017). It is a challenge to implement complex, multifactorial interventions in hospital settings. However, the integration of fundamental quality improvement might play a critical role. One such improvement includes developing a safety-conscious culture within hospital settings that can lead to the prevention of falls. For instance, hospitals can have short multidisciplinary team briefings that expound on the present states of different patients and seek to determine opportunities to enhance patient care.

Multifaceted Podiatry Intervention

The authors described the Reducing Falls with Orthoses, and a Multifaceted (REFORM) podiatry approach in the prevention of patient falls. Falls have been evidenced to be a cost burden to the health care system, and it has been evidenced to setback the United Kingdom National Health Service (NHS) an estimated 2 billion euros annually (Carbacho et al. 2018). The frequency of falls is even higher concerning older adults. The use of podiatry health care has been reported to be essential in the prevention of falls. The multifactorial podiatry intervention integrates foot and ankle exercise and other foot care to aid in the reduction of falls. The REFORM study examined the effectiveness of a multifactorial podiatric intervention in terms of cost and reductions of risk of falling and took one year. It was established that the podiatric intervention program cost 252.17 euros more per patient in comparison to normal care (Carbacho et al. 2018). However, it registered and in improvement in quality-adjusted life years, which translated to reduced falls. The analysis present in this study is indicative of a potential of podiatry intervention in the reduction of falls as implemented by National Health Service, and especially in hospital settings. It shows that such multifactorial fall intervention is more cost-effective in minimizing falls in hospitals.

Systematic Nurse Training Program

It evident that in-patient falls are the most prevalent safety cases, and this has been the situation in a newly constructed hospital in Wales, UK. The study sought to prevent the cases of in-patient falls. It meant addressing the hospital setting with 100% single rooms (Signh and Okeke, 2016). The fundamental strategy for enhancing fall prevention was educating and training medical staff on different fall risk factors...