Do Fall Risk Screening Tools Lead to Reduction in Falls in Acute Hospital Stays - Article Example

Falls cause injuries in hospitals and have thus complicated hospital stays, prolonging the period of hospitalization. Thus, putting in place effective fall risk assessment tools would be helpful in reducing fall risks. With a focus on acute hospital setting, this paper seeks to evaluate whether fall risk screening tools lead to a reduction in falls. In part 1, the paper presents the procedure followed in searching the PubMed database for relevant literature. It elaborates the process used to narrow down the search and the limitations applied to achieve the objective, with frustrations and successes of the processes shared. In part 2, a review of literature identified from the database search on fall screening tools and their influence on falls during acute hospitalization would be presented, articulating factors that informed the choice of the topic, barriers to resolving underlying problems and the best practices to adopt so as to make fall screening tools effective. Do Fall Risk Screening Tools Lead to Reduction in Falls in Acute Hospital Stays? Part 1: Database Searching for Relevant Literature There has been an increase in conducting research in nursing due to the need for evidence-based professional practice. This has seen the emergence of evidence-based practice, EBP which, according to Polit and Beck (2012), entails the use of best clinical evidence to make patient care decisions. Such evidence would be informed through conducting research from a repertoire of information and knowledge which vary in validity and reliability. Nonetheless, disciplined research provides the most sophisticated approach to acquiring knowledge developed by humans over time. Cumulative findings from systematically and rigorously appraised research provide the basis for a majority of evidence hierarchies. Following this development, in seeking to evaluate whether fall risk screening tools reduce fall risks in acute hospital stays, I used a relevant database to search for reliable articles to provide relevant literature review. The Searching Process Indeed, healthcare literature on fall risk assessment, even when specifically limited to acute care hospital settings, exist in their abundance. Thus, the knowledge on importance for most appropriate literature for the study topic would be critical. I used PubMed (pubmed.gov), a free search engine that primarily accesses the Medical Literature Analysis and Retrieval System Online, MEDLINE database, for this search because of its comprehensive resourcefulness in online references for students (Polit & Beck, 2013). To begin with, I identified key words as guided by the topic of study. Thus, I came up with fall risk, assessment tool and acute hospital as the keywords to be used for the search. I input the key words in the search field with the PubMed Advanced Search Builder used to limit the search to most relevant sources. Initially, with all filter options open, the search yielded 343 hits, this being a robust number of sources to effectively get the relevant articles. As such, I used the Boolean operator AND as defined by Polit and Beck (2013) to limit the search to records that had the key word only. The character $ instructed the engine to consider all words beginning with “assess” in the search, thus including assessment and assessing. This yielded a hit of 28 journal articles. These were further limited to 6 hits by filtering only for free full text journals. To come up with a useful literature review, understanding the whole research would be relevant, thus the need to access full text journals. When the search was finally limited to a publication period of within the last five years, only 3 hits were achieved. Search restriction Hits Fall risk assessment tools 343 Fall risk AND assess$ tools AND acute hospital 28 Limit to journal article 28 Limit to free full text 6 Limit to publication dates within 5 years 3 The result of 3 articles was lesser than the required 4 articles. Moreover, one of the articles was not relevant to the topic. As such, there were only two articles found to be relevant with regards to the topic. “Fall prevention in acute care hospitals” by Dykes et al. (2010) sought to investigate whether fall risk assessment tool that leverage on health information technology would decrease patient falls in acute hospital setting. Providing relevant background information to justify this study, this journal article passed as relevant as it not only informed on the effectiveness of the current fall risk assessment tools but also provided solutions on how to make them effective in an acute hospital setting. This makes it relevant in responding to the research problem and providing solutions. The journal article, “local adaptation and evaluation of a falls risk prevention approach in acute hospitals” by Walsh, Hill, Bennell, Vu, and Haines (2011) sought to determine whether making a fall risk assessment tool adapt locally would make it effective in preventing hospital falls. Thus, this also provided relevant data and information to answer the research question. With only two articles, the filters had to be altered to provide more relevant search results. Thus, I edited the field of article type to include books and documents, clinical trial, journal article, meta-analysis and review, with the other fields remaining constant. This yielded 48 hits. From the sources found, I selected two resources for their relevance. “Instruments for assessing the risk of falls in acute hospitalized patients: A systematic review and meta-analysis” by Aranda-Gollardo et al. (2013) was a product of inclusion of meta-analysis among the search items. The article sought to determine the accuracy obtained from fall risk detection and prediction instruments thus relevant to the objectives of this literature review. The article, “hospital-based fall program measurement and improvement in high reliability organizations” by Quigley and White (2013) also provided useful insights to the discussion on relevant solutions to the problem of fall risk assessment identified, having sought to identify components of safety for patients in acute hospitalization. Thus, all the four required articles, relevant to the determination of the effectiveness of fall risk assessment tools in preventing fall risks in acute hospital settings, were identified. Frustrations Retrieval of evidence-based nursing literature for this paper was marred by difficulties. The first frustration related to the choice of an appropriate search engine. Appreciating the argument by Polit and Beck (2013) of Cumulative Index to Nursing and Allied Health Literature, CINAHL being a resourceful database because of its over 1 million records, I selected the search engine for use in this search. However, the search engine was not appropriate because it required membership to access the available sources or even conduct a search and also charged for access to its database. This was a frustrating start to the assignment. However, the second search engine, PubMed, met my need, this being a free to access database. Even so, PubMed, the search engine perceived as appropriate, also contributed to the frustration associated with searching for relevant literature sources. With the database endowed with resources, a general search yields massive results that make the identification of the relevant source a difficult task. Take for instance the first search that I made. The resultant 343 hits provided many sources that it made it difficult to make the most appropriate choice of article. This therefore called for limiting the search so as to narrow down to more relevant results. However, with further limiting, the hits shrunk below the required limits. Thus, the filters had to be adjusted to delimit the search again, thus ending up with reasonable pool of results from which to select the relevant sources. This inability to come up with relevant pool of results first time proved frustrating. Successes However, there were successes from the search. Specifically, PubMed being a free search engine provided an easy access to relevant sources. Unlike other search engines such CINAHL that would require membership and a fee to access the database, PubMed provided an opportunity for free access to its database. This proved useful in meeting the goals of this task. Additionally, this exercise was time-saving. Within a few minutes of inputting the relevant search criteria, meaningful results were displayed. In fact, the results appeared almost instantaneously on commanding for search. This saved time that would have otherwise been spent searching through physical libraries for relevant articles. Most importantly, this search yielded relevant sources that critically informed the topic under study. With the search limitations, it was possible to retrieve sources that precisely relate to the topic under study. This would have been difficult had a physical database been used instead. Therefore, the online database search was not just efficient, but also effective in retrieving the most relevant literature to answer the research problem. Part 2: Literature Review Factors that Influence the Topic Falls have been noted to be the leading cause of injuries acquired in hospitals, thus complicating and frequently prolonging hospital stays. Hospitalization increases the risk of falls because of the unfamiliar environment, treatments and illness all combined together (Dykes et al., 2010). Statistics show that about 1.9% to 3% of acute care hospitalizations experience patient falls. Furthermore, between 2% and 15% of inpatients experience at least a fall during their hospital stay. Bathrooms and inpatient rooms have been cited as the most common places where falls occur (Aranda-Gallardo et al., 2013). These falls devastate patients, clinicians and generally the healthcare system. According to Walsh et al. (2011), a single fall could instill the fear of falling, spiraling down to reduction of mobility and loss of function, further exposing the victim to greater risk of fall. Falls could be injurious, in which case they increase hospital costs and prolong the length of stay. Quigley and White (2013) estimate a 60% increase in hospital costs for patients who experience falls as compared to other hospitalized patients. By 2020, acute care hospitals would need about $54.9 billion to treat 30% of injuries resulting from falls. Thus, acute hospital falls are a serious global health problem. Resolving this problem would call for adoption of effective fall risk assessment tools. As argued by Dykes et al. (2010), fall risk assessment presents a baseline measure for the status of the fall risk to enlighten on counteractive interventions. However, current evidence provides insufficient argument for linking specific fall prevention tools with decreased falls in acute hospital setting. It is the devastating effect of falls in acute hospitals and the lack of evidence on effectiveness of risk assessment tools that inform the choice of this topic seeking to assess whether fall risk screening tools reduce falls in acute hospital stays. Barriers to Resolution of the Problem One of the major barriers to resolving the problem of falls in acute hospital settings has been reluctance to adopt efficient and effective technologies in developing fall risk assessment tools. Dykes et al. (2010) observe that with this regard, health information technology, HIT has been minimally used in fall risk assessment. Such tools help improve communication and facilitate information access for decision support. Therefore, without such technologies, the risk assessment tools would be rendered ineffective. Another barrier is the unreliability of risk assessment tools. The common strategy in fall risk prevention has been risk assessment. According to Aranda-Gallardo et al. (2013), about 78% of falls are anticipated physiologic, where the falls are anticipated and associated with specific risk factors. Thus, using appropriate instruments, acute care hospitals have sought to measure such risks for deterrent approaches to be undertaken. According to Aranda-Gallardo et al. (2013), the Morse Fall Scale, MFS has been commonly used as a risk assessment tool. However, the scholar observes that the use of such valid risk assessment tools alone would not be sufficient enough to prevent falls. Even the most excellent validated tools could fail to predict significant number of falls. Therefore, whereas acute care hospitals continue to rely on these assessment tools, they have marginal positive influence on curbing falls. Best Practices Appreciating the fact that the use of risk assessment tools alone would not reduce the risk of falls in acute hospital stays, it would be useful to adopt an integrated approach to dealing with the risk of falls in an effort to curb the associated injuries and costs. From a review of past studies by Aranda-Gallardo et al. (2013), use of bed alarms, sitters, rounding and ensuring patients are close to nurse stations are common and effective interventions. Additionally, there could be restraints, including bedrails, especially targeted for patient fall risks such as for visually impaired patients. These refer to environmental changes that seek to make patients safe from falling in the hospital. Making information accessible is another best practice that could be adopted in acute care hospitals to curb on fall risk. In a study by Walsh et al. (2011), it was found that nurses who responded to the needs of patients unfamiliar to them exposed such patients to the risk of falling. Even though MFS could provide information on fall risk of patients, they were found to be largely incomplete. Thus, Dykes et al. (2010) advocate for incorporation of modern technology in developing risk assessment tools. This would ensure that as much information on fall risks of patients would be captured, information that would be useful in preventing falls among patients deemed unfamiliar to nurses. For an intervention to be successful, it would incorporate varied strategies and target the fall risk of an individual patient as opposed to being focused on one aspect of falls prevention. These strategies would be interdisciplinary, calling for the participation of nursing, physical therapy, quality officers and pharmacy among other functions in the hospital. Thus, using fall risk assessment tools together with collaboration and adoption of varied fall prevention approaches would effectively curb fall risks in acute hospital stays. References Aranda-Gallardo, M., Morales-Asencio, J. M., Canca-Sanchez, J. C., Barrero-Sojo, S., Perez-Jimenez, C., Morales-Fernandez, A,… Mora-Banderas, A. M. (2013). Instruments for assessing the risk of falls in acute hospitalized patients: A systematic review and meta-analysis. BMC Health Services Research, 13, 122 – 137 Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F.,… Middleton, B. (2010). Fall prevention in acute care hospitals. The Journal of the American Medical Association, 304(17), 1912 – 1918. doi: 10.1001/jama.2010.1567 Polit, D. F. & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins Quigley, P. A. & White, S. V. (2013). Hospital-based fall program measurement and improvement in high reliability organizations. The Online Journal of Issues in Nursing, 18(2). Retrieved 19 November 2014 from http://nursingworld.org/ Walsh, W., Hill, K. D., Bennell, K., Vu, M & Haines, T. P. (2011). Local adaptation and evaluations of a falls risk prevention approach in acute hospitals. International Journal for Quality in Healthcare, 23(2), 134 – 141. doi: 10.1093/intqhc/mzq075 Read More