Falls in Acute Hospitals; A Systematic Review

Objectives The objective of this review was to present the best available information for the effectiveness of interventions designed to reduce the incidence of falls in patients during hospitalisation. The review also provides a narrative summary of the characteristics of patients who fall, major hospital environmental factors that contribute to falls, and interventions that are currently employed or being trialled. Inclusion Criteria Types of Participants Adult patients in acute care hospitals or other similar institutions. Types of Intervention Interventions which assessed the risk of falling in adult hospital patients or other interventions used to minimise the risk of falling in adult hospital patients. Types of Outcome Measures Outcome measure of interest was the number of patient falls during hospitalisation. Types of Studies This review considered any randomised or quasi-randomised controlled trials that addressed the effectiveness of risk assessment or other interventions that minimised the number of falls. In addition to this, studies using other research methods were assessed for inclusion in the review as part of the narrative summary. Search Strategy The search sought to identify both published and unpublished studies, and utilised a range of electronic databases using accepted search techniques, and included CINAHL, MEDLINE, Embase, Current Contents, Cochrane Library and Psychlit. Assessment of Quality Methodological quality of RCT were assessed by two reviewers using a developed checklist. All studies were categorised according to the strength of the evidence using a published scale. Data Collection and Analysis Randomised controlled trial research design was rarely used in identified studies and therefore statistical techniques were not used to combine studies. Evidence was synthesised by brief narrative summaries, or in some cases by listing significant information. Results Based on the abstract or title, 194 were papers were retrieved, of which 100 met the inclusion criteria and are cited in this report. Four unpublished reports were identified. Of the 100 papers, there were only two RCT that met the inclusion criteria. Increased Risk of Falling A large number of studies have addressed risk factors associated with patient falls, but many had potential sources of error because of the study design utilised, or their conduct. Commonly identified risk factors for falling identified by case control or cohort studies include; age, mental status, history of falls, medications, toileting needs and poor mobility. Most falls were reported to have occurred at the patient’s bedside. Transferring from bed or chair was the most frequently identified patient activity at the time of the fall. Assessment of Risk Screening tools aim to provide early detection of problems and to allow interventions aimed at preventing falls to be initiated. No one risk assessment tool can be recommended, and the usefulness of these assessment tools in clinical practice has yet to be demonstrated. Fall Prevention Interventions Two small RCT evaluated fall prevention interventions in the acute hospital setting but neither demonstrate a beneficial effect when using pressure alarms or identification wrist bracelets. While many other studies were identified that attempted to evaluate fall prevention interventions, their usefulness is limited because of issues such as small sample size, research design, and quality. The most common approach taken to prevent patient falls has been the use of multiple interventions aimed at minimising the risks associated with falling. Results of studies are contradictory and the effectiveness of this approach has yet to be demonstrated. TRUNCATED AT 600 WORDS