Evaluation of an Education Strategy versus Usual Care to Implement the STEADI Algorithm in Primary Care Clinics in an Academic Medical Center.

BACKGROUND: Although falls are the leading cause of morbidity and mortality in the US in the older adult population, there is little information regarding implementation of evidence-based fall prevention guidelines within primary care settings. The objective of this study was to address this gap in the literature by determining the effectiveness of the use of education and written materials as implementation strategies. METHODS: Using a prospective, mixed methods, controlled before-and-after study design, we studied the effect of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) education and written materials on knowledge and intention to use in primary care clinics as well as test the screening, assessment, and intervention behaviors. This manuscript details the quantitative findings of the study, using STEADI Knowledge Test, Continuing Professional Development (CPD) Reaction Questionnaire, and EMR Reports. We compared data between the study arms (usual implementation versus education implementation) using descriptive statistics, paired t-tests, and factorial ANOVAs. RESULTS: In total, data from 29 primary care staff, including physicians, APRNs, RNs, and medical assistants, were analyzed. Although we found a statistically significant difference within the education arm between immediate pretests and posttests/surveys mean scores, there was no statistically significant difference between the study arms' knowledge, intent to use STEADI, or use behaviors. The pre/immediate post education mean knowledge score increased by 1.19 (p= 0.02) and the pre/immediate post education intent to use mean increased by 0.64 (p 0.01). There was no statistically significant change between the study arms over time. CONCLUSION: Educational strategies, particularly written materials and an online module, did not increase the long-term use of the STEADI toolkit. Implementation research is needed to identify the strategies that are most effective for promoting the adoption of STEADI in primary care.

CE: Original Research: Predicting Injurious Falls in the Hospital Setting: Implications for Practice.

UNLABELLED: : BACKGROUND: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. PURPOSE: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. METHODS: The study site's adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. FINDINGS: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of "symptoms, signs, and ill-defined conditions." Having this discharge diagnosis was a significant predictor of injurious falls. CONCLUSIONS: Findings from this study may help hospital clinicians to better identify which patients are most at risk for injurious falls and to create better fall-related injury prevention interventions.

Gender Difference in Falls among Adults Treated in Emergency Departments and Outpatient Clinics.

BACKGROUND: This study examined the impact of gender on age-related increase for falls and injurious falls resulting in head injuries/fractures among adults, using data from both emergency department and clinic visits. We also estimated the percentages of falls treated in points of entry outside of emergency departments. METHODS: The study population consisted of 259,611 adults seen at emergency department, inpatient, and/or outpatient facilities between January, 2007 and June, 2012 at a US medical center. Rates of falls and injurious falls with head injuries/fractures were calculated by age and gender. RESULTS: After using both emergency department and clinic visit data, medically consulted falls and injurious falls resulting in head injuries/fractures increased with age for females aged ≥ 18 years. For males, these rates declined, reached the lowest point at age of 65-74, and then increased again. Thirty-nine percent of females and 63% of males treated their falls in clinics, instead of emergency departments. CONCLUSION: Gender disparity of medically consulted falls and related injuries exits among adults. Age and gender targeted fall injury prevention interventions need further development. Significant numbers of fall-related injuries were treated at clinics; future research is needed to determine whether fall injury surveillance should be expanded to include outpatient clinics.

Validation of the Hester Davis Scale for fall risk assessment in a neurosciences population.

BACKGROUND AND PURPOSE: Fall risk assessment is a necessary component of fall prevention programs. Accurate instruments to predict the risk of falling are paramount in identifying the correct patients in need of fall prevention measures. The purpose of this study was to prospectively validate the Hester Davis Scale (HDS) for fall risk assessment in an acute care setting in the South Central United States. METHODS: The HDS was prospectively validated in 1,904 patients on a neurosciences unit. RESULTS: Using an initial cut score of 7 produced a sensitivity of 100% and specificity of 24.9%. Receiver Operating Characteristic Analysis evidenced a cut score of 10 that would produce a more desirable sensitivity and specificity of 90.9% and 47.1%, respectively. CONCLUSION: The results of the psychometric evaluation and validation of the HDS support its use in clinical practice.

Falls in the community: state of the science.

Falls and fall-related injuries among older community-dwelling adults continue to be a major health concern in the US. Falls are the leading cause of disability and trauma-related death in persons over 65 years of age. This article discusses current approaches in community fall management and challenges with these approaches, and offers some insight for community providers regarding this issue.