Wednesday, 27 January 2016

Patient falls in hospital are frequent and harmful but are they preventable?

An SPHPM study on interventions to decrease falls and fall injuries in acute hospitals has been published in the British Medical Journal (BMJ).

Associate Professor Anna Barker and Ms Renata Morello from SPHPM’s Falls and Bone Health Team, led a cluster randomised control study involving 31,411 patients in 24 acute wards in six Australian hospitals between 2012 and 2013, the largest undertaken worldwide to date.

“Falls are one of the largest causes of patient harm in Australian hospitals, with more than 30,000 falls recorded in 2013-14 – they are a national safety and quality priority,” Associate Professor Anna Barker, Chief Investigator on the study said.

The research involved testing the nurse-led ‘6-PACK’ program which involves completing a fall-risk tool and implementing one or more of six interventions: a ‘falls alert’ sign; supervision of patients in the bathroom; ensuring patients’ walking aids are within reach; a toileting regime; use of a low-low bed; and use of a bed/chair alarm.

Associate Professor Barker said the key findings of the trial were that despite the introduction of the 6-PACK program improving fall-risk tool completion and the use of fall prevention strategies recommended by best practice guidelines, the study observed that there was no effect on falls or fall injuries compared with usual care. Falls remain a frequent and substantial source of harm for patients in acute hospitals.

"The study indicates an absence of high-quality evidence that falls can be prevented in acute wards. Solutions to the issue of in-hospital falls, the most frequent patient safety incident in hospitals, are urgently required,” Associate Professor Barker said.

Falls have negative consequences for the patient, hospital staff and the healthcare system. They can cause fractures, increased staff stress and workload, healthcare costs and length of stay. According to a preliminary examination of deaths reported to the Coroners Court of Victoria, approximately 60 deaths from falls occurred in Victorian hospitals in 2015.

Ms Renata Morello said that patients who experience an in-hospital fall almost doubled their length of stay in hospital, and the hospital bears a significant burden in costs whether or not the fall resulted in injury.

“Our findings raise questions about the expenditure of staff time on the delivery of interventions that have been shown to be ineffective,” Associate Professor Barker said.

“The challenge remains to develop innovative ways to prevent falls in hospital and to reduce the additional resource burden associated with these events.”

Listen to Chief Investigator Anna Barker talk about the research findings below in this video.

You can also read more about the study in an editorial over at the BMJ website.

The Falls and Bone Health Team is part of SPHPM's Health Services Research Unit (HSRU).

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