Impact of Patient-Engaged Video Surveillance on Nursing Workforce Safety: Patient Aggression/Violence.

BACKGROUND: Health care workers are 4 times more likely to suffer violence than workers in other industries. PURPOSE: The aim was to examine types of patients' verbal/physical abuse against the nursing workforce observed through patient-engaged video surveillance (PEVS) and interventions initiated by monitor technicians. METHODS: A descriptive study was conducted to analyze all types of patient-initiated abuse, physical and verbal, reported from 73 hospitals and patient response to PEVS. RESULTS: Of 150 434 patients whom RNs enrolled into 24-hour PEVS, 5034 patients (3%) were identified by RNs as at risk for aggressive/violent behavior as their primary or secondary reason for PEVS enrollment, and 32 (0.60%) patients exhibited such behavior. A total of 221 patients demonstrated aggressive/violent behaviors, 32 (15%) were identified as at risk, and 189 (85%) were not. However, 5002 (99%; 5002/5034) of the patients identified as a risk for aggressive/violent behaviors did not exhibit these behaviors. CONCLUSIONS: Patient-engaged video surveillance is an effective method to track and trend patient aggression toward nursing staff, increasing patient and nursing workforce safety. Because 99% of the patients who exhibited aggressive/violent behavior were not identified by RNs as at risk, organizations should consider adding violence risk tools as part of patients' admission assessment.

Outcomes of Patient-Engaged Video Surveillance on Falls and Other Adverse Events.

Patient-engaged video surveillance implemented in 71 hospitals over 1 year revealed low rates in assisted and unassisted falls, room elopement, and line, tube, or drain dislodgement per 1000 days of surveillance. Monitor technicians interacted 20.5 times per day with patients who fell and initiated alarms for urgent unit staff response 2.38 times per day, and this accounted for the low fall rate (1.50 falls/1000 days of surveillance) in an adult population. Data on adverse events and timeliness of nursing response to actual urgent and emergent patient conditions provides evidence of the rapid contribution of patient-engaged video surveillance to patient safety.

Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices.

PROBLEM: Rehabilitation nurses know the impact of injury on function, independence, and quality of life, complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, and social and financial resources. Multidisciplinary teams are essential to provide expert, age specific health care delivery to this vulnerable population across settings of care. PURPOSE: The purpose of this article is to apply level of evidence rating scales to identify the best practice interventions to prevent falls on rehabilitation units. KEY FINDINGS AND CLINICAL RELEVANCE: The evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative.

On the basis of fall injury program characteristics across multiple inpatient medical-surgical units from 6 medical centers, we developed and implemented an operational strategic plan to address fall and injury prevention program attributes and enhance program infrastructure and capacity. Expert faculty provided lectures and served as coaches and mentors through triweekly conference calls and collaborative e-mail exchange. Statistically significant findings support improved fall and injury prevention program components and processes at the organizational and unit levels.

Perceived Benefits of Group Exercise Among Individuals With Peripheral Neuropathy.

Exercise and training programs improve strength, functional balance, and prevent falls in a variety of populations. This article presents the qualitative findings related to the perceived benefits of participants in a randomized controlled trial that compared the effectiveness of group exercise on gait and balance in persons with peripheral neuropathy (PN). Participants with moderately severe PN were randomized into groups that received 10-week classes of Functional Balance Training (FBT) or Tai Chi or education alone. Perceptions of the intervention were overwhelmingly positive regardless of the study group. Perceived benefits reported by participants in the FBT and Tai Chi groups included awareness of how to deal with the effects of neuropathy by implementing balance strategies and a heightened sense of walking to prevent falls. This study offers a guide to design future exercise studies that promote simple balance exercises that can be performed in group settings.

Reducing falls and fall-related injuries in mental health: a 1-year multihospital falls collaborative.

Despite much research on falls occurring on medical-surgical units and in long-term care settings, falls on inpatient psychiatry units are understudied. On the basis of fall injury program characteristics across multiple inpatient psychiatry units, we developed and implemented an operational strategic plan to address each falls prevention program element and enhance program infrastructure and capacity. Expert faculty provided lectures, coaching, and mentoring through biweekly conference calls and collaborative e-mail exchange. Findings support continued efforts to integrate measures to reduce serious fall-related injuries.

Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: a three-group randomized clinical trial.

OBJECTIVE: Older patients with a distal symmetric polyneuropathy are at markedly increase risk for falls and fall-related injuries. Despite this, few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group. DESIGN: One hundred older patients with distal symmetric polyneuropathy were randomized to one of three interventions: functional balance training, Tai Chi, or education-only control. The subjects in each group received instruction in ten 1-hr weekly sessions. Outcome measures were determined at baseline and the end of the 10-wk intervention. Gait, balance, and falls self-efficacy were assessed with various well established clinical (Berg Balance Scale, 8 Foot Up and Go Test, and Modified Falls Efficacy Scale) and laboratory-based measures (three-dimensional gait analysis and NeuroCom limits of stability and sensory organization tests). RESULTS: The Tai Chi subjects demonstrated a decreased (faster) Timed Up and Go and increased stride length and time spent in single limb support at the end of intervention as compared with baseline. The functional balance training group demonstrated a significant increase in ankle plantar flexor power and near significant decreases in step width and step width variability. No changes in the education-only control group were observed. CONCLUSIONS: Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.

Hospital-based fall program measurement and improvement in high reliability organizations.

Falls and fall injuries in hospitals are the most frequently reported adverse event among adults in the inpatient setting. Advancing measurement and improvement around falls prevention in the hospital is important as falls are a nurse sensitive measure and nurses play a key role in this component of patient care. A framework for applying the concepts of high reliability organizations to falls prevention programs is described, including discussion of the core characteristics of such a model and determining the impact at the patient, unit, and organizational level. This article showcases the components of a patient safety culture and the integration of these components with fall prevention, the role of nurses, and high reliability.

Minnesota Hospital Association Statewide Project: SAFE from FALLS.

Since 2007, the Minnesota Hospital Association (MHA) has developed, managed, and promoted a statewide fall and injury reduction program to reduce inpatient falls and injuries, SAFE from FALLS. Because of statewide success in reducing falls from 2007-2010, the MHA set the goal in 2010 to eliminate serious fall-related injuries, especially head injuries. The outcomes that large-scale, multifacility health care organizations can have in reducing hospital-based falls resulting in serious injury (25% reduction) are presented, along with lessons learned.

Incidence and cost of serious fall-related injuries in nursing homes.

BACKGROUND: Fall-related injuries (FRIs) result in morbidity and mortality for patients, as well as unnecessary expense to health care institutions. OBJECTIVES: (a) Estimate the incidence of falls and FRIs with a nursing home as the source of admission in Veterans Administration (VA) and non-VA facilities. (b) Estimate the cost of hospitalizations for each level of FRI severity. RESEARCH DESIGN: Retrospective analysis of falls and FRI resulting in a hospitalization whose source of admission was a VA nursing home. DATA: Falls and FRIs were obtained from Minimum Data Set (MDS) reports (January 2007-June 2009). Costs were obtained from the VA Decision Support System reports and Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) reports (2000-2006). MEASURES: Incidence of falls, fracture incidence, number of hospitalizations for FRIs, and costs associated with hospitalization for by level of FRI severity. RESULTS: Fall incidence was 10.6% in VA and 13.1% in CMS facilities. Fracture incidence was 0.9% in VHA and 1.65% in CMS facilities. Over a 3-year period, there were 2,400 admissions to VHA hospitals for FRI, with 55.4% hip fractures and10.1% intracranial injuries, with an average cost of US$23,723 per admission. Over a 9-year period, there were 141,308 admissions from nursing homes to non-VA hospitals for FRIs, with 38.8% hip fractures, 35.7% other fractures, and 11.1% intracranial injuries, with an average cost of US$31,507 per admission. CONCLUSIONS: Prevention program emphasis should shift away from a focus on preventing falls as a measure of quality care to decreasing FRIs. These findings support implementation of injury prevention programs for the elderly that reduces risk for injury as the primary outcome.

Central nervous system medication changes and falls in nursing home residents.

We investigated the role of changes in 6 mutually exclusive medication categories on the risk of falling in nursing home residents. The 6 categories were: gastrointestinal, hypoglycemics, antibiotics, central nervous system (CNS) acting, cardiovascular disease agents, and analgesics. A change was defined as a new start, a dose change, an as-needed dose, or a discontinuation. Incident reports were used to determine the fall date and time. Medication records were abstracted to identify the date of changes before the date of each fall. The 158 residents who fell had 419 recorded falls during 2002 and 2003; they were on average 80.5 years old (SD 8.1; range 65-103), and 67% were men. Within 1-3 days of a change in any CNS medication (antipsychotic, sedative, antidepressant, or antiseizure), the fall risk (odds ratio) increased 3.4-fold (95% confidence interval 1.2-9.5) using 7-9 days prior as comparable control days. No changes in other medication categories had a significant effect on fall risk. These data suggest that the risk of falls among nursing home residents is significantly elevated within 3 days of a CNS medication change.

Administration and union partnership: one Magnet hospital's story.

For each hospital that has achieved Magnet designation as an organization of excellence, a unique story exists about its experience. Our story of excellence is founded in a long partnership between administration and union leadership spanning 2 decades. We recognize that excellence is not a steady state, rather a continued commitment to improved patient, staff, and organizational outcomes. This article provides a glimpse into one hospital's story-administration and union partnership in achieving and sustaining the American Nurses Credentialing Center's Magnet designation.

Reducing serious injury from falls in two veterans' hospital medical-surgical units.

A large veteran's hospital participated in a year-long collaborative project across 9 hospitals to reduce serious injury from falls in acute care, targeting medical-surgical units. The primary objective of this project was to develop and test a set of interventions (bundles) to prevent serious physical injury (fractures and hemorrhagic bleeds) from patient falls. The interventions were implemented using tests of change on 2 medical-surgical units focused on engaging unit-based staff and combining innovations for vulnerable populations at greatest risk for injury if they fall.

Strategies to reduce risk of fall-related injuries in rehabilitation nursing.

Rehabilitation nurses are in a critical position to lead interdisciplinary team fall prevention management, including injury risk reduction. This article provides an update for rehabilitation nurses on evidence-based strategies to reduce patients'risk of fall-related injuries. This content builds on existing literature by focusing on knowledge to promote patient responses that reduce the risk of falls and ultimately fall-related injuries. Although rehabilitation nurses understand the complex nature of falls, addressing the intrinsic and extrinsic risk factors that increase the risk of fall-related injuries requires both individually based treatment programs and a system-wide commitment. A plethora of literature discusses fall risks and falls, but this article profiles the at-risk patient and describes current and emerging evidence-based interventions to protect patients from fall-related injuries by reducing risk factors. This discussion is limited to exercise, environmental redesign, osteoporosis prevention, and hip protectors.

Veterans' fall risk profile: a prevalence study.

The Veterans Health Administration (VHA) serves the health care needs of an adult, predominantly male, and aging population. The aging profile of VHA patients is 25% greater than the civilian sector (DVA 2001). Aged patients are at higher risk for falls. In February 2002, 6 VHA medical centers profiled their inpatients' fall risk profile as one aspect of program initiatives targeted at reducing veterans' fall risk and fall-related injuries, participating in a one-day collection of fall risk measurement using the Morse Fall Scale (MFS) for all inpatients (n = 1819), acute and long-term care units. Data results are reported for age, MFS score, and the relationship between age and score, and by type of ward/unit, ie, predominately acute and critical care or long-term care. The results of this prevalence study documented that the veteran inpatient population are at high-risk for anticipated physiological falls. This Veteran Integrated Services Network-wide Deployment of an Evidence-based Program to Prevent Patient Falls study was completed as part of a nationally funded clinical initiative, National Program Initiative 20-006-1.