Fall prevention in hospitals and nursing homes: Clinical practice guideline.

BACKGROUND: Falls and their consequences are particularly common in older adults in hospitals and long-term care (LTC) facilities. AIM: To avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed. METHODS: The development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta-analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions. RESULTS: A total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low-floor beds in hospitals, or body exercise interventions in frail residents. LINKING EVIDENCE TO ACTION: During the development of this guideline, particular attention was paid to collecting evidence-based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low-floor beds, alarm sensor systems, medication review, and staff education in hospitals.

Adaptation of Clinical Practice Guideline Recommendations in Hospitals for People Living With Dementia and Their Caregivers.

BACKGROUND: Dementia is common in older people in general hospitals. To improve the quality of their care, the use of nonpharmacological interventions based on the best evidence from clinical guidelines is recommended. Many international clinical guidelines exist, but their recommendations are often not used because they do not fit the local setting or the country. AIM: The aim of this study was to adapt the international clinical guidelines and their recommendations to the Austrian context regarding nonpharmacological interventions for people with dementia living in the general hospital setting. METHODS: The ADAPTE process was chosen as a method for the adaptation. A search for international clinical guidelines was conducted in seven databases within this process. The guidelines which met the inclusion and quality criteria were assessed with the AGREE II instrument by two independent reviewers. The recommendations of the guidelines were extracted. Those that did not fit the Austrian context were excluded, and recommendations with similar statements were summarized. The selected and modified recommendations were translated into German. RESULTS: Out of 206 guidelines, three met the inclusion criteria and two, the quality criteria. One hundred and fifty-two recommendations were extracted from these two guidelines, 42 of which were suitable for the Austrian setting and 20 of which had similar statements and could be summarized. Finally, 32 recommendations were identified that were applicable to the general hospital setting in Austria. LINKING EVIDENCE TO ACTION: The adaptation of clinical guidelines with the ADAPTE process generated seven topics with 32 recommendations. Many international guidelines exist, but they cannot be applied verbatim in every country due to the fact that some recommendations are not applicable with respect to the national and local context. Creating an adaption of international guidelines is an effective way to provide and link evidence from research to national nursing practice.