1. Potera, Carol


Nurse-led study shows a tool kit may be useful, particularly in older patients.


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Advanced age and hospitalization increase the risk of falling, which not only increases hospital costs and lengths of stay but also triggers fear in patients that can lead to reduced mobility, loss of function, and additional falls. Recently, a fall-prevention tool kit, designed by nurses at Brigham and Women's Hospital and Harvard Medical School (both in Boston), was shown to significantly reduce fall rates in hospitalized patients, particularly those older than 65 years.

Figure. Nurse Vicki ... - Click to enlarge in new windowFigure. Nurse Vicki Boehmer, a palliative care specialist, assists Hazel Lueders, 74, in getting out of bed before her discharge from Missouri Baptist Medical Center in St. Louis, where she was treated for pneumonia. Photo by Michael Reigner / AP Photo.

The tool kit, which tailors fall-prevention interventions to the patient, integrates health information technology with routine assessments of a patient's risk of falling. The three major components of the tool kit are patient- and family-friendly educational handouts, a plan of care for health care professionals, and an over-the-bed poster containing icons and brief descriptors that lay out the patient's fall risk and "actionable interventions" to mitigate that risk. The icons largely communicate patients' toileting needs (such as how often toileting is needed and the type of assistance needed to get to the toilet) because falls related to toileting account for up to half of all falls in hospitals.


"Nurses routinely assess patients' risk of falls on admission, but the degree to which they communicate the results of the assessment to care team members, including patients and family members, is highly variable," says Patricia C. Dykes, senior nurse scientist at Brigham and Women's Hospital and leader of the study that assessed the tool kit. The educational handouts tell the patient and the family how to work with the team to prevent falls.


The six-month study, believed to be the first clinical study to look at fall risk during short-term hospitalization, followed 10,264 patients spending three to four days (generally) at four hospitals in the Boston area. The patients were about equally split between the intervention group using the tool kit and the control group receiving standard care. Among patients in the intervention group, 67 experienced falls, compared with 87 among the controls. The rate of falls per 1,000 patient-days (the primary outcome) was also lower in the intervention group (3.15) than in the control group (4.18). The tool kit was especially effective in preventing falls in patients 65 years old and older (2.08 per 1,000 patient-days). For comparison, the mean fall rate for all Massachusetts hospitals is 3.99 per 1,000 patient-days.


The researchers calculated that the use of the tool kit could prevent one fall every four days, 7.5 falls per month, and about 90 falls yearly on the units involved in the study. The study wasn't large enough to determine whether the intervention could prevent repeated falls and related injuries; only one patient in the intervention group and two in the control group experienced a repeated fall. "Further study is needed to determine if a similar program evaluated over a longer period of time can significantly reduce repeat falls. Moreover, work is needed to develop a set of interventions that will prevent fall-related injuries," the authors write.-Carol Potera


Dykes PC, et al. JAMA 2010;304(17):1912-8.