A failed fall prevention study in an acute care setting: lessons from the swamp

Designing and implementing fall intervention studies in acute care settings presents researchers with a number of challenges. To date, there are no fall prevention interventions that have unequivocal empirical support in these settings. Based on the best available evidence a multistrategy fall prevention program was implemented using a pretest–post-test design over a 12-month period. The results indicated no reduction in the fall rate. Contrary to the expected result, the fall rate increased post the implementation of the multistrategy fall prevention program. To assist other researchers understand the contextual and methodological barriers to conducting fall prevention research in acute care settings, this paper discusses the difficulties experienced in this study.

Fall risk factors and the nature of falls in inpatient oncology and palliative care settings

Using a prospective design, this study examined falls risk factors and the nature of patient falls in oncology and palliative care settings. Two hundred and twenty seven patients admitted to the oncology and palliative care units at a private hospital participated in this study. Of these, 34 patients had a fall and 193 patients did not have a fall. Twenty-four nurses who attended to patients who fell were interviewed. Findings revealed that, when compared to patients who did not fall, fallers had a significantly higher mean age; were assessed as more physically dependent using the Eastern Cooperative Oncology Group scale; were less alert and more confused; were more likely to have responded incorrectly to orientation to person, time and place; were weaker pre-fall in arm muscle strength; and were more fatigued. These factors are worthy of further exploration to determine whether they are more sensitive than the currently used falls risk factors used in oncology and palliative care settings.

Best buys in fall injury prevention

More than 4,400 Victorian children are admitted to hospital for fall related injuries annually. Of these, 1,967 are known to have fallen from playground equipment. These 1,967 children consume 5,620 bed days. Another 3,934 children are treated in Emergency Departments for falls from playground equipment. In total, the direct cost borne by government is estimated at more than 4.7 million dollars. The cost in bed days and Emergency services is also considerable.

The rise and fall of management: undergraduate engineering management education in Australia

The modern disciplines of engineering and management are inextricably linked. Frederick Taylor, Henry Gantt and Henri Fayol are engineers whose names are also part of the history of the theory and practice of management. As far back as 1968 it was identified that, “In all phases of practice in the profession the technical work is coupled, to a greater or lesser extent, with engineering management.” For more than 20 years the call had been increasing for an improvement in the preparation of engineering graduates in the area of management skills. In 1989 the IEAust created the task force on management engineering with the goal of formulating a policy for management education in engineering undergraduate courses. In 1990, the Council of the IEAust approved the Policy on Management Studies in Engineering Undergraduate Courses that said, “From January 1991 the Institution will require at least 5% management content in all professional engineering undergraduate courses and that the total of all management and management related components rises to the vicinity of 10% by 1995.” A 1999 analysis of engineering programs showed that the Policy had been applied with enthusiasm by about one-third of the engineering schools, fairly well in another third, remaining responses were ineffectual. Around the same time, revisions to the IEAust accreditation requirements de-emphasised the importance of management studies, mentioning it only as a subset of ‘professional practice’. By 2004 the IEAust stage 1 competency standards for professional engineers mentioned ‘management’ in only three of 79 indicators of competency. In 2002, the IEAust established the Centre for Engineering Leadership and Management. In December 2005 CELM established a working group, “…for improving the business and management content of undergraduate courses. It appears that it’s back (about 20 years) to the future for Australian undergraduate engineering management education.

The rise and fall of the internal reserve

The 'internal reserve' distinguished world's best practice for the early garden suburb movement. These 'hidden' spaces were designed for a variety of reasons: to encourage the formation of community, promote safe play for children, offer sites for small-scale agricultural pursuits, address  topographic and drainage constraints, and facilitate conservation of natural features. They were a feature of progressive plans for British icon developments such as Hampstead Garden Suburb. As these plans travelled globally, however, the purpose of the internal reserve was less clear than their spatial form, and most languished as undistinguished, left-over spaces. The historical origins, development and demise of the internal reserve are surveyed, with a focus on the Australian experience against an Anglo-American backdrop.

Earth bound: the rise and fall of a ground-breaking venture

Earth Sanctuaries Ltd (ESL) intends to offer its entire asset base for sale. ESL's primary objective is to conserve Australia's biodiversity, by breeding and preserving fauna profitably by running sanctuaries, environmental consultancies and related tourist facilities. This "ailing company" is also undergoing a management restructuring and attempting cost reduction. ESL was was one of the first firms to adopt AASB 1037. The implications for the accounting profession are discussed.

Older persons' perception of risk of falling : implications for fall-prevention campaigns

Objectives. We examined older people's attitudes about falls and implications for the design of fall-prevention awareness campaigns.

Methods. We assessed data from (1) computer-assisted telephone surveys conducted in 2002 with Australians 60 years and older in Northern Rivers, New South Wales (site of a previous fall-prevention program; n=1601), and Wide Bay, Queensland (comparison community; n=1601), and (2) 8 focus groups (n=73).

Results. Participants from the previous intervention site were less likely than were comparison participants to agree that falls are not preventable (odds ratio [OR]=0.76; 95% confidence interval [Cl]=0.65, 0.90) and more likely to rate the prevention of falls a high priority (OR=1.31; 95% CI=1.09, 1.57). There was no difference between the groups for self-perceived risk of falls; more than 60% rated their risk as low. Those with a low perceived risk were more likely to be men, younger, partnered, and privately insured, and to report better health and no history of falls. Focus group data indicated that older people preferred messages that emphasized health and independence rather than falls.

Conclusions. Although older people accepted traditional fall-prevention messages, most viewed them as not personally relevant. Messages that promote health and independence may be more effective.

Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis.

Introduction: Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals. Design-related bias in evaluations of tool predictive accuracy could lead to overoptimistic results, which would then contribute to program failure in practice.

Methods: A systematic review was undertaken. Two blind reviewers assessed the methodology of relevant publications into a four-point classification system adapted from multiple sources. The association between study design classification and reported results was examined using linear regression with clustering based on screening tool and robust variance estimates with point estimates of Youden Index (= sensitivity + specificity - 1) as the dependent variable. Meta-analysis was then performed pooling data from prospective studies.

Results: Thirty-five publications met inclusion criteria, containing 51 evaluations of fall risk screening tools. Twenty evaluations were classified as retrospective validation evaluations, 11 as prospective (temporal) validation evaluations, and 20 as prospective (external) validation evaluations. Retrospective evaluations had significantly higher Youden Indices (point estimate [95% confidence interval]: 0.22 [0.11, 0.33]). Pooled Youden Indices from prospective evaluations demonstrated the STRATIFY, Morse Falls Scale, and nursing staff clinical judgment to have comparable accuracy.

Discussion: Practitioners should exercise caution in comparing validity of fall risk assessment tools where the evaluation has been limited to retrospective classifications of methodology. Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular settings, but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment.

Fall incidence and fall prevention practices at acute care hospitals in Singapore : a retrospective audit

Objective To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore.

Design A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005.

Study participants Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals.

Outcome measures Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented.

Results The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records.

Conclusion This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.
Methods

Nurses were surveyed to identify their perceptions regarding barriers to implementation of clinical practice guidelines in their practice setting. The validated questionnaire, 'Barriers and facilitators assessment instrument', was administered to nurses (n = 1830) working in the medical, surgical, geriatric units, at five acute care hospitals in Singapore.
Results

An 80.2% response rate was achieved. The greatest barriers to implementation of clinical practice guidelines reported included: knowledge and motivation, availability of support staff, access to facilities, health status of patients, and, education of staff and patients.
Conclusion

Numerous barriers to the use of the Fall Prevention Clinical Practice Guideline have been identified. This study has laid the foundation for further research into implementation of clinical practice guidelines in Singapore by identifying barriers to change in acute care settings.