scholarly journals Nursing Unit Design and Hospital Falls: Protocol for Linking Patient Falls and Environmental Factors (Preprint)

2020 ◽  
Author(s):  
Ronald Shorr ◽  
Sherry Ahrentzen ◽  
Stephen Luther ◽  
Chaady Radwan ◽  
Bridget Hahm ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Environmental Assessment ◽  
Fall Risk ◽  
Patient Falls ◽  
Medical Centers ◽  
Surgical Units ◽  
Unit Design ◽  
Fall Rates ◽  
Assessment Survey ◽  
Design Factors

BACKGROUND Patient falls are the most common adverse events reported in hospitals. Although it is well understood that the physical hospital environment contributes to nearly 40% of severe or fatal hospital falls, there are significant gaps in our knowledge about the relationship between inpatient unit design and fall rates. The few studies that have examined unit design have been conducted in a single hospital or a small number of inpatient units, limiting generalizability. Furthermore, there have been no studies focused on unit design and falls in Veteran Administration medical centers. Thus, the overarching goal of this study is to identify unit design factors contributing to inpatient falls within the Veterans Health Administration. OBJECTIVE Aim 1: Investigate front-line and management perceptions of and experiences with Veteran falls as they pertain to inpatient environmental factors. An iterative Rapid Assessment Process will be used to analyze the data. Interview findings will directly inform the development of an Environmental Assessment Survey to be conducted as part of Aim 2, as well as, contribute to interpretation of Aim 2 results. Aim 2: Quantify associations between unit design factors and fall rates by comparing spatial and environmental factors of units with higher- versus lower- than expected fall rates. METHODS Aim 1. We will conduct walk-through interviews in 12 medical/surgical units at three Veterans’ Administration medical centers in Florida unit and facility personnel to identify environment-related fall risk factors at each site. Data will be used to finalize an Environmental Assessment Survey for nurse managers and facilities management leaders. Aim 2. We will use fall data from the VA Inpatient Evaluation Center and patient data from additional data sources to identify med/surg nursing units with higher- than expected (n = 25), and lower- than expected (n = 25), fall rates. Once these units are identified, we will measure spatial factors by analyzing computer aided design files of unit floorplans, and environmental factors, based on the Environmental Assessment Survey. Statistical tests will be performed to identify those design factors that distinguish high and low outliers. RESULTS Data collection and analysis was completed for Aim 1 with a manuscript of results in progress. For Aim 2, the medical/surgical units were categorized into higher and lower than expected falls categories, the Environmental Assessment Surveys were distributed, and data to measure spatial characteristics are being compiled. CONCLUSIONS To our knowledge this study is the first to objectively identify spatial risks for falls in hospitals within in a large multi-hospital system. The proposed research design employs multiple methods to paint a complete picture of fall risk in medical/surgical units, leverages the large VA administrative databases to identify nursing units that have the highest and lowest risk-adjusted fall rates, and creatively combines spatial analyses to identify fall risk.

Creating a Safer Patient Room Environment: The Contribution of Patient Bed Height

2021 ◽  
Vol 10 (1) ◽  
pp. 180-184
Author(s):  
Dorothy Taylor ◽  
Janice Morse ◽  
Andrew Merryweather
Keyword(s):  
Elderly Patient ◽  
Fall Risk ◽  
The Elderly ◽  
Lower Leg ◽  
Patient Specific ◽  
Leg Length ◽  
Patient Room ◽  
Patient Falls ◽  
Sit To Stand ◽  
Bed Height

Elderly patient falls are expensive and may cause serious harm. Studies have identified the sit-to-stand-and-walk (STSW) task as the task where the greatest number of elderly patient falls occur. There is a great need to identify the particular movement and environmental conditions that lead to these elderly patient falls. This study begins to address this gap by evaluating the elderly patient during self-selected hospital bed egress. Using an observed fall risk episode (FRE) as a fall proxy, statistically significant parameters were identified which include bed height, pausing prior to initiating gait, level of fall risk, and Stand phase. Low bed height was identified as the least safe bed height. Patient-specific bed height (PSBH) using the patient’s lower leg length (LLL) is recommended. In addition, suggested guidelines are presented for clinical application in setting PSBH without measuring the patient’s LLL.

Environmental Assessment, Cognition, and Action: Research Applications

1992 ◽  
Author(s):  
Ervin H. Zube
Keyword(s):  
Decision Making ◽  
Environmental Factors ◽  
Environmental Assessment ◽  
Environmental Planning ◽  
Assessment Process ◽  
Management Decision ◽  
Assessment Activity ◽  
Management Decision Making ◽  
Research Findings ◽  
Physical Environmental Factors

Environmental assessment has been defined as “a general conceptual and methodological framework for describing and predicting how attributes of places relate to a wide range of cognitive, affective, and behavioral responses” (Craik & Feimer, 1987). A primary purpose for assessing environments is to provide valid and reliable information that has utility in environmental planning, design, and management decision making. Implicit in the assessment activity is the assumption of identifiable relationships of physical environmental factors with descriptive and evaluative assessments, and with predictions of responses to places conceptualized in plans and designs, but not yet built. This chapter addresses the utility of research findings. Three primary questions are posed. Why are some environmental assessment and cognition research findings used successfully in decision making while others are not? What factors contribute to these outcomes? And how important are physical environmental factors in planning, design, and management decision making? The preceding chapters by Rachel Kaplan, Reginald Golledge, and Harry Timmermans provide the background for the following discussion. The first section of this chapter presents a brief review of similarities and differences among the three preceding chapters, with specific attention directed to interpretations or definitions of the concepts of assessment and preference, the use of physical environmental variables in the assessment process, and the roles of laypersons and experts in assessment. Potential uses for and applications of environmental assessment research are described in the second section. This is followed by a discussion of the differences between instrumental and conceptual applications and of factors that have been identified as influencing applications, factors such as communications between researchers and users, responsibilities for problem definition, and the context within which the research is conducted. This chapter concludes with a discussion of the opportunities for and probable limitations on applications of the preceding chapters by R. Kaplan, Golledge, and Timmermans. Four concepts and elements that are addressed in the three chapters have been selected for purposes of structuring a comparison among them. These concepts and elements—assessment, preference, roles of laypersons and experts, and physical environmental factors—are particularly salient to the issue of research applications.

scholarly journals FALLS AND NUTRITIONAL RISK AMONG RURAL STATE RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S471-S471
Author(s):  
Mariana Wingood ◽  
Nancy M Gell ◽  
Emily Tarleton
Keyword(s):  
Food Insecurity ◽  
Fall Risk ◽  
Screening Tool ◽  
Metropolitan Areas ◽  
Community Dwelling ◽  
Nutritional Risk ◽  
Rural Residents ◽  
Fall Risk Factor ◽  
Fall Rates ◽  
Nutritional Data

Abstract Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community-dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls.

scholarly journals Falling and fall risk in adult patients with severe haemophilia

2017 ◽  
Vol 37 (02) ◽  
pp. 97-103 ◽  
Author(s):  
Hanna Rehm ◽  
Jan Schmolders ◽  
Sebastian Koob ◽  
Rahel Bornemann ◽  
Georg Goldmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fall Risk ◽  
Standardized Test ◽  
Daily Practice ◽  
Adult Patients ◽  
Severe Haemophilia ◽  
Artificial Joints ◽  
Fall Risk Factors ◽  
Fall Rates ◽  
Fall Risk Screening

SummaryThe objective of this study was to define fall rates and to identify possible fall risk factors in adult patients with severe haemophilia. Patients, material, methods: 147 patients with severe haemophilia A and B were evaluated using a standardized test battery consisting of demographic, medical and clinical variables and fall evaluation. Results: 41 (27.9 %) patients reported a fall in the past 12 months, 22 (53.7 %) of them more than once. Young age, subjective gait insecurity and a higher number of artificial joints seem to be risk factors for falling. Conclusion: Falls seem to be a common phenomenon in patients with severe haemophilia. Fall risk screening and fall prevention should be implemented into daily practice.

scholarly journals Improving falls in nursing homes: a post-fall huddle quality improvement project

2019 ◽  
Vol 8 (2) ◽  
pp. 33
Author(s):  
Tekekee Buckner ◽  
Daisy Sherry
Keyword(s):  
Nursing Homes ◽  
Fall Prevention ◽  
Fall Risk ◽  
Risk Of Falling ◽  
Improvement Project ◽  
Patient Falls ◽  
Root Cause ◽  
Assessment Program ◽  
Increased Risk ◽  
Pertinent Data

Falls are one of the most common preventable health problems in adults 65 years and older (AHRQ, 2013). A fall in this population can have a devastating effect often leading to a significant change in morbidity or death. Adults in assisting living, nursing homes, and skilled facilities (SNF) have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion. This makes individualizing a plan of care to prevent a secondary fall and identifying the root cause of falls within a facility imperative.In our agency, the fall rate is nearly triple that of the national benchmark. To address this problem, a Post-Fall Huddle project was implemented. The literature recommends and supports the practice of a post-fall assessment program in fall reduction to identify intrinsic and extrinsic fall risk etiologies. There was found to be a reduction in the absolute values of recurrent patient falls per quarterly reporting after the implementation of the post-fall huddle. The results also provided pertinent data that can be used for recommendations in future fall prevention for the SNF 

Good Catch! Using Interdisciplinary Teams and Team Reflexivity to Improve Patient Safety

2018 ◽  
Vol 43 (3) ◽  
pp. 414-439 ◽  
Author(s):  
Roni Reiter-Palmon ◽  
Victoria Kennel ◽  
Joseph Allen ◽  
Katherine J. Jones
Keyword(s):  
Patient Safety ◽  
Fall Risk ◽  
Improve Patient Safety ◽  
Interdisciplinary Teams ◽  
Innovation Implementation ◽  
Practical Applications ◽  
Team Innovation ◽  
Safety Outcome ◽  
Injurious Falls ◽  
Fall Rates

Interdisciplinary teams play an important role implementing innovations that facilitate the quality and safety of patient care. This article examined the role of reflexivity in team innovation implementation and its association with an objective patient safety outcome, inpatient fall rates (a fall is an unintended downward displacement of a patient’s body to the ground or other object). In this study, we implemented, supported, and evaluated interdisciplinary teams intended to decrease fall risk in 16 small rural hospitals. These hospitals were part of a collaborative that sought to increase knowledge and facilitate reflexivity about fall event reporting and fall risk reduction structures and processes. We assessed team reflexivity at the start and at the end of the 2-year intervention and innovation implementation at the end of the intervention. The 16 hospitals reported objective fall event data and patient days throughout the project, which we used to calculate comparative rates for assisted, unassisted, and injurious falls. The results suggest that teams benefited from the intervention, increasing reflexivity from the start of the project to the end, which was related to innovation implementation and decreases in fall rates. Theoretical and practical applications of the results are discussed.

The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care

2015 ◽  
Vol 38 (11) ◽  
pp. 1041-1052 ◽  
Author(s):  
Theresa Dever Fitzgerald ◽  
Thomas Hadjistavropoulos ◽  
Jaime Williams ◽  
Lisa Lix ◽  
Sharmeen Zahir ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Functional Ability ◽  
Fall Risk ◽  
Long Term Care ◽  
Term Care ◽  
Fall Risk Assessment ◽  
Patient Falls ◽  
The Impact

scholarly journals Spatial Association of Respiratory Health with Social and Environmental Factors: Case Study of Cook County, IL

2021 ◽  
Author(s):  
Aynaz Lotfata ◽  
Alexander Hohl
Keyword(s):  
At Risk ◽  
Air Quality ◽  
Environmental Factors ◽  
Respiratory Diseases ◽  
Respiratory Health ◽  
Cook County ◽  
Tree Canopy ◽  
Asthma Prevalence ◽  
Medical Centers ◽  
Canopy Access

AbstractBackgroundPeople who live with respiratory diseases like asthma are more likely at risk of serious illness. Spatial analytic techniques allow for discovering areas of concern and finding correlates of asthma prevalence.ObjectiveThere is growing interest in disentangling the impacts of socioeconomic and environmental factors on respiratory health, their spatial correlation, and the demographic profile of people at risk of respiratory diseases. It is important to know how people with asthma are geographically distributed and what social and environmental factors correlate with asthma. Thereby, the purpose of the study is to describe socioeconomic factors associated with asthma prevalence in Cook County, IL and to identify the significant risks and the protective factors to control asthma.Data and MethodsData obtained from CDC 2018 SVI, ACS, the City of Chicago Data Portal, HealthData.gov, and ESRI. In this paper, we illustrate the usefulness of geospatial regression analysis in the analysis and presentation of spatially distributed asthma prevalence among the population with disabilities, minorities with the language barrier, nonwhite population, age 17 and younger, and age 65 and older in the census tracts of Cook County, IL where Chicago Metropolitan Area located. In addition, we map the spatial variation of asthma prevalence with variation in the tree canopy, access to medical centers, air quality, and household quality. Lastly, we used bivariate mapping to illustrate the spatial distributions of residential land use and tree covers.ResultsOur findings show a good correlation between asthma and socioeconomic and physical factors including age 17 and younger, age 65 and older, population with disabilities, a minority with the language barrier, tree canopy, access to medical centers, air quality, and household quality. The aged 65 and older, 17 and younger, and people with disabilities are found to have a higher asthma prevalence in areas around the industrial corridors in southeast and west sides of Cook County, IL. Results may guide further decisions in planning for asthma research and intervention, especially for identifying vulnerable areas and people.

scholarly journals FALL RISK BEHAVIORS AND INTRINSIC RISK FACTORS FOR FALLS IN INDIGENOUS AND NON-INDIGENOUS RURAL OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S471-S472
Author(s):  
Andre G Bouweraerts ◽  
Justus Ortega
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Rural Communities ◽  
Risk Behaviors ◽  
Rural Areas ◽  
Fall Risk ◽  
Future Studies ◽  
Fall Risk Factors ◽  
Fall Rates ◽  
Risk Factors For Falls

Abstract Within California, older adults living in rural counties have reported higher rates of falls than urban dwelling older adults. Although many Indigenous people live in rural areas, it is unclear whether the rate of falls among Indigenous older adults is similar to that of non-indigenous older adults living in rural areas. Thus, the purpose of this study was to examine fall risk behaviors and intrinsic risk factors for falls in rural dwelling Indigenous (N = 89), and non-Indigenous (N = 68) older adults 60-95 years of age living in California. Results showed that both Indigenous and non-Indigenous older adults share similarly high fall rates, but there are a much greater number of Indigenous older adults falling multiple times a year. Moreover, fall risk behaviors and intrinsic fall risk factors were significantly different between Indigenous and non-Indigenous rural-dwelling older adults. Future studies should investigate falls and fall risk factors in different tribes/locations of Indigenous older adults to better understand whether these risk factors differ among tribes. Moreover, it would be beneficial for future studies to assess the effectiveness of fall prevention exercises on fall risk in these communities. Information gained from this study helps to inform clinicians and researchers alike about the prevalence of falls and factors contributing to falls among Indigenous older adults living in rural communities; and helps to influence decisions in the future of programs for reducing fall risk in this often neglected population.

Learning Collaboratives in Medical Education: Exploring the Impact of Collaboratives’ Structure and Resources and Teams’ Experience

2019 ◽  
Vol 35 (4) ◽  
pp. 297-305
Author(s):  
Robert Dressler ◽  
Hania Janek ◽  
Lauren Sager ◽  
David S. Kountz ◽  
Judi Gravdal
Keyword(s):  
Academic Medical Centers ◽  
Learning Collaborative ◽  
Self Assessment ◽  
Medical Centers ◽  
Academic Medical ◽  
Learning Collaboratives ◽  
National Initiative ◽  
Assessment Survey ◽  
The Impact ◽  
Post Assessment

The Alliance of Independent Academic Medical Centers (AIAMC) organized and coordinated a multicenter learning collaborative, National Initiative V (NI V), focused on community health and health inequity. A pre–post descriptive study was designed to examine the outcomes of the AIAMC NI V. Data were collected from pre- and post-assessment surveys as well as a project milestone self-assessment survey. Twenty-nine institutions participated. By the conclusion of the NI, the majority of institutions had completed at least 1 of the milestones in each of the pre-work/background (65.52%), measurement (62.07%), methods (62.07%), and implement/sustain (20.69%) domains. Institutions reported a significant association between their readiness assessments prior to the start of the NI compared with their status of activities on completion. Milestone achievement is significantly associated with 3 of the assessment items. Learning collaboratives with thoughtfully integrated structure and support can be impactful on topic readiness for the participating organizations.

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