Fall Prevention Decision Making of Acute Care Registered Nurses.

OBJECTIVE: The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND: The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS: Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS: Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS: Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.

The effects of information and communication technologies on informal caregivers of persons living with dementia: A systematic review.

INTRODUCTION: Information and communication technology (ICT) has emerged as promising to support health care consumers, including informal caregivers. This systematic review seeks to evaluate the state of the science of ICT interventions on the health of informal dementia caregivers. METHODS: We searched PubMed, CINAHL, Web of Science, and PsycINFO using concepts associated with ICT, dementia, and caregiver. Studies were assessed using the Quality Assessment Tool for Quantitative Studies. RESULTS: We identified 657 full-text publications. After removal of duplicates and title, abstract, and full-text screening, the quality of 12 studies was assessed. Studies varied in technology, implementation, results, and intervention evaluation. DISCUSSION: The methodological quality of the ICT intervention studies among dementia family caregivers was moderate to strong, yet outcome measurement was not uniform. The evidence is strongest for various forms of telephone-based interventions. However, there is a need for research that includes heterogeneous participants based on gender, race, and ethnicity.

A data-driven and practice-based approach to identify risk factors associated with hospital-acquired falls: Applying manual and semi- and fully-automated methods.

BACKGROUND AND PURPOSE: Electronic health record (EHR) data provides opportunities for new approaches to identify risk factors associated with iatrogenic conditions, such as hospital-acquired falls. There is a critical need to validate and translate prediction models that support fall prevention clinical decision-making in hospitals. The purpose of this study was to explore a combined data-driven and practice-based approach to identify risk factors associated with falls. PROCEDURES: We conducted an observational case-control study of EHR data from January 1, 2013 to October 31, 2013 from 14 medical-surgical units of a tertiary referral teaching hospital. Patients aged 21 or older admitted to medical surgical units were included in the study. Manual and semi- and fully-automated methods were used to identify fall risk factors across four prediction models. Sensitivity, specificity, and the Area under the Receiver Operating Characteristic (AUROC) curve were calculated for all models using 10-fold cross validation. FINDINGS: We confirmed the significance of a set of valid fall risk factors (i.e., age, gender, fall risk assessment, history of falling, mental status, mobility, and confusion) and identified set of new risk factors (i.e., # of fall risk increasing drugs, hemoglobin level, physical therapy initiation, Charlson Comorbity Index, nurse skill mix, and registered nurse staffing ratio) based on the most precise prediction approach, namely stepwise regression. CONCLUSIONS: The use of semi- and fully-automated approaches with expert clinical knowledge over expert or data-driven only approaches can significantly improve identifying patient, clinical, and organizational risk factors of iatrogenic conditions, including hospital-acquired falls.

Associations between hyponatraemia, volume depletion and the risk of falls in US hospitalised patients: a case-control study.

OBJECTIVE: We aimed to determine if abnormal laboratory values which may indicate volume depletion are associated with increased odds of experiencing a hospital-acquired fall. DESIGN: Matched case-control study. SETTING: Four hospitals located in the Southeast USA. PARTICIPANTS: Data from 699 adult fallers and 1189 matched controls (non-fallers) were collected via chart review from 2005 to 2010. Controls were matched to cases by nursing unit, time of fall and length of stay. OUTCOME MEASURES: The primary exposures included serum sodium, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio and haematocrit. Conditional logistic regression with m:n matching was used to determine adjusted and unadjusted ORs. RESULTS: Serum sodium levels were strongly associated with falls. In models controlling for demographic and other fall risk factors, patients with serum sodium levels of 125 mEq/L or less were associated with increased odds of experiencing a fall as compared with those with serum sodium levels of greater than 134 mEq/L (adjusted OR (aOR)=5.08, 95% CI 1.43 to 18.08). Conversely, elevated BUN, creatinine and elevated BUN/creatinine ratios were not associated with increased odds of experiencing a fall (aOR=0.64, 95% CI 0.49 to 0.84; aOR=0.70, 95% CI 0.54 to 0.92 and aOR=0.77, 95% CI 0.58 to 1.04, respectively.) CONCLUSIONS: Laboratory indices that may indicate volume depletion appear to be unrelated to falls. However, hyponatraemia does appear to be a risk factor for falls, and those with serum sodium levels below 126 mEq/L are at especially high risk. It may be that other deficits associated with hyponatraemia, like altered mental status, are associated with risk of experiencing a hospital-acquired fall. These results indicate that abnormal laboratory values, like low sodium, can be useful for identifying hospitalised patients at risk of falling. Therefore, further investigation into abnormal laboratory values as predictors of hospital-acquired falls is warranted.

The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV.

BACKGROUND: The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. OBJECTIVE: This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. METHODS: This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. RESULTS: Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. CONCLUSIONS: This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.

Impact of the CMS No-Pay Policy on Hospital-Acquired Fall Prevention Related Practice Patterns.

BACKGROUND AND OBJECTIVES: In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for costs related to patient falls. This study aimed to examine whether the CMS no-pay policy influenced four fall prevention practices: bed alarms, sitters, room changes, and physical restraints. RESEARCH DESIGN AND METHODS: Using electronic medical record data collected from four hospitals between 2005 and 2010, this secondary observational analysis examined the associations between the CMS no-pay policy and nursing interventions and medical orders related to fall prevention. Multivariable generalized linear mixed models with logit link function and accommodation for matching was used to assess the associations between the CMS no-pay policy and nursing interventions and medical orders. RESULTS: After the CMS policy change, nurses were more likely to perform one or more fall-related interventions (adjusted odds ratio (aOR): 1.667; 95% confidence interval (CI): 1.097-2.534). Of the four prevention practices, the use of bed alarms (aOR: 2.343; 95% CI: 1.409-3.897) increased significantly after the CMS policy change. DISCUSSION AND IMPLICATIONS: The CMS no-pay policy increased utilization of fall prevention strategies despite little evidence that these measures prevent falls.