Topic: Implementation of a Fall Prevention Bundle in Inpatient Rehabilitation Setting to Reduce Fall Incidence and Improve Patient Safety For this assignment, you will submit your SYNTHESIZED COMPREHENSIVE LITERATURE REVIEW using the a
Rubric
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Topic: Implementation of a Fall Prevention Bundle in Inpatient Rehabilitation Setting to Reduce Fall Incidence and Improve Patient Safety
For this assignment, you will submit your SYNTHESIZED COMPREHENSIVE LITERATURE REVIEW using the articles from the evaluation table below.
The reader should be able to distinguish how your scholarly project fits within the research and how it is significant.
Important components to include in the assignment are:
- You will use articles from the evaluation tables previously submitted. See evaluation tables below. Please select at least 10-15 articles from the evaluation tables provided below for this literature review.
- Theoretical framework: Describe any theoretical or conceptual frameworks that serve as a guide for your project, summarize the frameworks, and explain how they relate to and provide support for your problem or population of interest.
- Synthesis and analysis of evidence (research) related to the problem or population of interest: Address the overall strengths, weaknesses, limitations, and gaps of the research. It is very important that this section provide a comprehensive review of the literature and contain a minimum of 8 pages and 10-15 articles from the evaluation tables provided below.
· For this assignment, you will submit your comprehensive literature review using the articles from the
· evaluation table below.
· Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.
· The reader should be able to distinguish how your scholarly project ts within the research and
· how it is signicant. The literature review should provide a theoretical basis for your work, show what
· has been done by others, and set the stage for your work. You should be able to identify the GAP in the
· literature, which your project is going to be striving to !ll.
· Important components to include in the assignment are:
· · Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide
· for your project, summarize the frameworks, and explain how they relate to and provide support for
· your problem or population of interest.
· · Synthesis and analysis of evidence (research) related to the problem or population of
· interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is
· very important that this section provide a comprehensive review of the literature and contain a
· minimum of ten pages with 10 articles
For this assignment, you will submit your comprehensive literature review using the articles from the
evaluation table below.
Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.
The reader should be able to distinguish how your scholarly project ts within the research and
how it is signicant. The literature review should provide a theoretical basis for your work, show what
has been done by others, and set the stage for your work. You should be able to identify the GAP in the
literature, which your project is going to be striving to !ll.
Important components to include in the assignment are:
· Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide
for your project, summarize the frameworks, and explain how they relate to and provide support for
your problem or population of interest.
· Synthesis and analysis of evidence (research) related to the problem or population of
interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is
very important that this section provide a comprehensive review of the literature and contain a
minimum of ten pages with 10 articles
For this assignment, you will submit your comprehensive literature review using the articles from the
evaluation table below.
Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.
The reader should be able to distinguish how your scholarly project ts within the research and
how it is signicant. The literature review should provide a theoretical basis for your work, show what
has been done by others, and set the stage for your work. You should be able to identify the GAP in the
literature, which your project is going to be striving to !ll.
Important components to include in the assignment are:
· Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide
for your project, summarize the frameworks, and explain how they relate to and provide support for
your problem or population of interest.
· Synthesis and analysis of evidence (research) related to the problem or population of
interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is
very important that this section provide a comprehensive review of the literature and contain a
minimum of ten pages with 10 articles.
Rubric Criteria:
· Thoroughly appraised appropriate evidence sources and provided a descriptive and detailed analysis of the research reviewed
· Anchored the clinical problem or topic in a theoretical or conceptual model that is clearly described. Clearly and thoroughly described the components of the model and the relationship of the model to the problem or topic
· Presented a literature review that is well organized and demonstrates logical sequencing based on the topic or clinical problem.
· Reached detailed conclusions based on the literature reviewed and included the strengths and gaps of the current research.
· Clearly demonstrated how the project fits within the existing evidence.
· Used correct spelling, grammar, and professional vocabulary. Cited all sources using APA format.
Evaluation Table 1
|
First
Author (Year) |
Conceptual
Framework |
Design/Method |
Sample&
setting |
Major
Variables Studied (and Definitions) |
Measurement |
Data
Analysis |
Findings |
Appraisal:
Worth to Practice |
|
Fall Tailoring Interventions for
Patient Safety (Fall TIPS) |
Nonrandomized controlled trial using
stepped-wedge design and interrupted time-series analysis |
37,231 patients; 14 medical units in
3 academic hospitals (Boston, New York City) |
Fall TIPS toolkit; a patient and
family engagement tool. Fall rate: the number of falls per
1,000 patient days. Injurious fall rate: number of falls
causing injury per 1,000 patient-days. |
Audits of patient/family engagement Rate of injurious falls. Rate of falls |
Poisson regression; generalized
estimating equations |
15% reduction in overall falls; 34%
reduction in injurious falls |
Provides strong evidence for the
implementation of the intervention to improve patient safety. |
|
|
Guo
et al. (2022) |
Patient Engagement |
Longitudinal quasi-experimental
study |
116 patients (58 intervention, 58
control) in a teaching hospital in China |
Patient-centered fall prevention
strategy. Number of falls: frequency of falls
during hospitalization. Knowledge-Attitude-Practice (KAP)
scores measuring patient understanding, attitudes, and behaviors; Modified Fall Efficacy Scale
(MFES)scores indicate patient confidence in avoiding falls. |
Nurse-recorded fall data;
standardized KAP and Modified Fall Efficacy Scale instruments |
Descriptive statistics and
inferential tests (t-tests, chi-square, rank-sum tests) |
Falls reduced from 3 in the control
group to 0 in the intervention group; significant improvements in KAP and
efficacy scores |
Effective intervention with clear
outcome improvements. |
|
Heng
et al. (2022) |
Falls Prevention Education |
Mixed-methods study |
37 patients (27 intervention, 10
control) and 7 health professional interviews in a private acute hospital in
Australia |
Falls prevention education
intervention. Patient knowledge about falls:
self-reported understanding. Behavior change: adoption of fall
prevention measures. Level of patient engagement;
interaction during sessions |
Pre- and post-test surveys;
semi-structured qualitative interviews |
Descriptive statistics; thematic
analysis |
Improved patient knowledge and
engagement. |
Practical insights for enhancing
education-based falls prevention. |
|
Montero-Odasso
et al. (2021) |
Clinical Practice Guidelines |
Systematic review |
15 clinical practice guidelines from
various settings for adults aged 60 and older |
Adoption of clinical practice
guidelines for fall prevention. Patient fall rate: Frequency of
falls among older adults. Patient injury rate: Incidence of
injuries resulting from falls. Risk stratification: Identification
of high-risk individuals using assessment tools. |
AGREE-II tool. GRADE scores. |
Descriptive statistics;
inter-guideline agreement evaluation |
High overall guideline quality with
strong agreement on key recommendations. Inconsistencies in recommendations
for cognitive factors, and fall prevention education |
Provides a reference for developing
evidence-based interventions. |
|
Scheidenhelm
et al. (2020) |
Donabedian Quality Model |
Retrospective review |
Adult inpatients from a 149-bed
community hospital across multiple units |
Fall incidence: number of falls per patient day. Occurrence of fall-related injuries.
Patient fall risk score, rounding time: time between patient checks. Restroom
time. Use of medications affecting the
central nervous/cardiovascular systems. |
Standardized fall reports and
detailed chart reviews |
Descriptive statistics; univariate
and multivariate regression, including logistic regression |
Reduction in falls from 0.0033 to
0.0024 falls per patient day. Lower injury rates, reduced injury
risk. The risk for older adults remained
high. |
Supports the use of a bundle in
reducing falls and injuries. |
References
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries. JAMA Network Open, 3(11), 1–10. https://doi.org/10.1001/jamanetworkopen.2020.25889
Guo, X., Wang, Y., Wang, L., Yang, X., Yang, W., Lu, Z., & He, M. (2022). Effect of a fall prevention strategy for the older patients: A quasi‐experimental study. Nursing Open, 10(2). https://doi.org/10.1002/nop2.1379
Heng, H., Kiegaldie, D., Shaw, L., Jazayeri, D., Hill, A.-M., & Morris, M. E. (2022). Implementing patient falls education in hospitals: a mixed-methods trial. Healthcare, 10(7), 1298. https://doi.org/10.3390/healthcare10071298
Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., Hogan, D. B., Hunter, S. W., Kenny, R. A., Lipsitz, L. A., Lord, S. R., Madden, K. M., Petrovic, M., Ryg, J., Speechley, M., Sultana, M., Tan, M. P., van der Velde, N., Verghese, J., & Masud, T. (2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. JAMA Network Open, 4(12), e2138911–e2138911. https://doi.org/10.1001/jamanetworkopen.2021.38911
Scheidenhelm, S., Astroth, K. S., DeLong, K., Starkey, C., & Wolfe, D. (2020). Retrospective analysis of factors associated with a revised fall prevention bundle in hospitalized patients. JONA: The Journal of Nursing Administration, 50(11), 571–577. https://doi.org/10.1097/nna.0000000000000939
Evaluation Table 2
|
First Author (Year) |
Conceptual Framework |
Design/Method |
Sample & Setting |
Major Variables
Studied (and Definitions) |
Measurement |
Data Analysis |
Findings |
Appraisal: Worth to
Practice |
|
Bargmann & Brundrett
(2020) |
Iowa Model |
Evidence-based practice |
26-bed medical-surgical telemetry
unit in a 352-bed Level 1 military trauma center |
Fall rate: the number of falls
per 1,000 patient days. Patient education: Structured education on fall risk and
prevention. Staff compliance: adherence to
fall prevention interventions. |
Audit of adherence to fall
prevention interventions, patient surveys, fall rate tracking |
Comparison of pre-and
post-implementation fall rates, staff compliance rates, and patient understanding
of fall risk |
55% decrease in fall rate. 89% staff compliance with
interventions. Longest consecutive fall-free
days since 2015: 87 and 88 days. |
Proves that the implementation of
a fall prevention bundle reduces fall incidence and improves patient safety. |
|
Davenport et al.
(2020) |
Modifiable fall-risk factors |
Secondary analysis |
400 older adult patients in an
academic urban emergency department |
Fall-risk factors: modifiable
conditions contributing to falls. Provider identification: the rate
of missed opportunities to diagnose risk factors. Intervention strategies: actions
taken to mitigate fall risk. |
Chart review of patient records,
comparison with standardized fall assessment |
Quantification of missed
opportunities, statistical comparison of identified vs. unidentified risk
factors |
96% of modifiable fall-risk
factors were missed by providers. Specifically, visual acuity and
high-risk medications are the most overlooked factors. |
Highlights that significant gaps
in fall-risk identification exist and thus emphasizes the need for improved
screening protocols. |
|
Goldberg et al.
(2020) |
Geriatric Acute and Post-acute
Fall Prevention |
Randomized controlled trial |
110 noninstitutionalized older
adults over 65 years old in two urban academic emergency departments |
Fall-related emergency department
visits: the number of visits within six months. Hospitalizations: all-cause and
fall-related. Adherence to pharmacy and
physical therapy recommendations |
Patient surveys, electronic
health record review, adherence tracking |
Negative binomial regression
models, adjusted incidence rate ratios, sensitivity analyses |
55% reduction in fall-related
emergency department visits. 57% reduction in all
hospitalizations. Moderate adherence to
recommendations: pharmacy at 73% and physical therapy at 68%. |
Provides evidence that a
structured, multidisciplinary approach improves patient safety and reduces
costly fall-related events. |
|
Kelley et al. (2023) |
Fall safety agreement |
Quality improvement project |
Three surgical units in an urban
hospital |
Fall rate: the number of falls
reported. Staff adherence: compliance with
fall prevention interventions. Patient education: structured
education and agreement signing. |
Weekly data collection on staff
adherence, patient education completion, and fall rates |
Comparison of pre-and
post-implementation adherence rates, patient education rates, and fall
incidence |
80.8% staff adherence. 92% patient education completion. 67.1% implementation of the Fall
T.I.P.S. tool and no falls were reported during the project. |
Provides evidence that a fall
prevention bundle is effective in reducing fall incidence and
improving patient safety. |
|
Pop et al. (2020) |
Multifactorial fall prevention |
Quality improvement project |
Emergency department (ED) in a
676-bed urban academic medical center |
Fall risk screening: Identification of at-risk
patients. Multifactorial interventions:
fall prevention measures. Staff engagement: involvement in
implementation. |
Audit of adherence to fall
prevention interventions, patient education completion, fall rate tracking |
Comparison of pre-and
post-implementation fall rates, staff compliance rates, and patient education
effectiveness |
96% of ED arrivals screened for
fall risk. 86% of at-risk patients received
fall precautions. The quarterly fall rate reduced
to 0.27 falls per 1,000 visits. |
Provides evidence that a tailored
fall prevention bundle that incorporates multifactorial interventions and
staff engagement improves fall risk identification and prevention. |
References
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Military Medicine, 185(2), 28–34. https://doi.org/10.1093/milmed/usz411
Davenport, K., Alazemi, M., Sri-On, J., & Liu, S. (2020). Missed Opportunities to Diagnose and Intervene in Modifiable Risk Factors for Older Emergency Department Patients Presenting After a Fall. Annals of Emergency Medicine, 0(0). https://doi.org/10.1016/j.annemergmed.2020.06.020
Goldberg, E. M., Marks, S. J., Resnik, L. J., Long, S., Mellott, H., & Merchant, R. C. (2020). Can an emergency department–initiated intervention prevent subsequent falls and health care use in older adults? A randomized controlled trial. Annals of Emergency Medicine, 76(6). https://doi.org/10.1016/j.annemergmed.2020.07.025
Kelley, R. J., Gutchell, V., & O’Neill, K. (2023). Preventing Falls in the Surgical Setting by Implementing a Fall Prevention Bundle. Journal of PeriAnesthesia Nursing, 38(4), e27. https://doi.org/10.1016/j.jopan.2023.06.025
Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention. Journal of Emergency Nursing, 46(2), 225-232.e3. https://doi.org/10.1016/j.jen.2019.11.010
Evaluation Table 3
|
First Author
(Year) |
Conceptual
framework |
Design/Method |
Sample &
setting |
Major Variables
(and Definitions) |
Measurement |
Data Analysis |
Findings |
Appraisal: Worth
to Practice |
|
Burns et al.
(2022) |
Fall risk
screening |
Prospective
longitudinal cohort study |
1,905
community-dwelling older adults in the U.S. |
Fall incidence:
occurrence of falls within 12 months.
|
Monthly
fall-tracking surveys; baseline and final assessments |
Sensitivity,
specificity, likelihood ratios, logistic regression |
Sensitivity ranged
between 22.5 and 68.7%; specificity ranged between 57.9 and 89.4% with
variation by age and sex. |
Highlights that no
screening tool is a one-size-fits-all. Thus, risk screening should be
tailored to patient characteristics. |
|
Ganz & Latham
(2020) |
Multifactorial
fall prevention. |
Clinical practice
review. |
Community-dwelling
older adults who are over 65 years old. |
Fall incidence:
rate of falls per year. Injury severity:
fractures, dislocations, concussions.
|
Patient surveys;
ED visit records; cost analysis |
Statistical
comparison of fall rates, intervention effectiveness, cost-benefit |
Falls occur in 29%
annually. 10% have multiple
falls. Exercise programs
and multifactorial interventions reduce risk. |
Suggests that an
effective fall prevention bundle should combine exercise with a comprehensive
risk assessment. |
|
Montero-Odasso et
al. (2022) |
Multifactorial
fall prevention. |
Expert consensus
guidelines. |
Global
recommendations for older adults in healthcare. |
Fall risk
assessment: identification of high-risk individuals.
|
A systematic
review of guidelines; expert voting; and stakeholder feedback. |
Delphi process;
comparison of existing vs. new evidence |
Multidomain
interventions reduce incidence; patient-centered approaches enhance adherence |
Emphasizes that
fall prevention bundles should contain tailored components and patient
engagement. |
|
Morris et al. (2022) |
Fall prevention
interventions. |
Systematic review
and meta-analysis. |
Hospitalized
adults across 43 studies. |
Falls rate ratios
(RaR): falls per 1,000 bed days.
|
Falls rate
tracking; odds ratio calculations; review criteria. |
Meta-analysis of
23 studies; statistical comparison of intervention effectiveness |
Education of
patients and staff reduced falls (RaR = 0.70; OR = 0.62). Bed/chair alarms
and sensors showed no significant impact. |
Highlights that
technology alone provides limited benefits. Instead, education is the most
effective component of a rehab fall bundle. |
|
Spoon et al.
(2024) |
ERIC
implementation strategies. |
Systematic review. |
48 hospital-based
fall prevention studies. |
Implementation
strategies: methods promoting interventions.
|
Adherence audits;
fall rate tracking; strategy classification. |
Pre- vs
post-implementation comparisons of fall rates, adherence, and strategy
effectiveness. |
Median fall-rate
decline of 0.9 per 1,000 patient days. Median adherence
is 65%; most studies employed educational strategies. |
Reiterates that
need to apply strategies, such as education, for consistent fall reduction in
rehab settings. |
References
Burns, E. R., Lee, R., Hodge, S. E., Pineau, V. J., Welch, B., & Zhu, M. (2022). Validation and comparison of fall screening tools for predicting future falls among older adults. Archives of Gerontology and Geriatrics, 101, 104713. https://doi.org/10.1016/j.archger.2022.104713
Ganz, D. A., & Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. New England Journal of Medicine, 382(8), 734–743. https://doi.org/10.1056/nejmcp1903252
Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., Aguilar-Navarro, S., Alexander, N. B., Becker, C., Blain, H., Bourke, R., Cameron, I. D., Camicioli, R., Clemson, L., Close, J., Delbaere, K., Duan, L., Duque, G., Dyer, S. M., & Freiberger, E. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), 1–36. https://doi.org/10.1093/ageing/afac205
Morris, M., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), 1–12. https://doi.org/10.1093/ageing/afac077
Spoon, D., de Legé, T., Oudshoorn, C., van Dijk, M., & Ista, E. (2024). Implementation strategies of fall prevention interventions in hospitals: a systematic review. BMJ Open Quality, 13(4), e003006. https://doi.org/10.1136/bmjoq-2024-003006
Evaluation Table 4
|
First Author
(Year) |
Conceptual
Framework |
Design/Method |
Sample &
Setting |
Major Variables
Studied (and Their Definitions) |
Measurement |
Data Analysis |
Findings |
Appraisal |
|
Dykes et al.
(2023) |
Evidence-based
fall prevention. |
Economic evaluation. |
10,176 patients
with falls and 29,161 matched controls in 8 U.S. hospitals. |
Fall incidence:
number of falls pre/post-intervention.
|
Interrupted time
series; matched case-control cost analysis. |
Pre/post-fall-rate
comparison; economic impact assessment. |
19% reduction in
falls; 20% reduction in injurious falls; $14,600 net savings per 1,000
patient days. |
Demonstrates
substantial cost benefits of fall prevention bundles. |
|
Heng et al. (2020) |
Patient education
model. |
Scoping review. |
43 studies on
hospital fall prevention interventions. |
Falls incidence:
rate per 1,000 bed-days.
|
Systematic review
of education programs; thematic intervention analysis. |
Comparison of
design principles; assessment of engagement and knowledge retention. |
Education reduces
falls and injuries; program quality and delivery mode influence outcomes;
well-designed education improves risk perception. |
Highlights that
high-quality, structured patient education is critical for effective fall
prevention in rehab. |
|
Li & Surineni
(2024) |
Comprehensive fall
prevention. |
Narrative review. |
Hospitalized
patients in inpatient settings. |
Fall incidence:
annual number of falls.
|
A literature
synthesis of intervention studies. |
Comparative
analysis of traditional vs. emerging strategies. |
Nearly 1 million
falls annually; 250,000 injuries; emerging tech shows promise alongside
traditional measures. |
Emphasizes the
need for multifaceted bundles combining education, tailored interventions,
and technology in rehab fall prevention. |
|
Randell et al.
(2024) |
Multifactorial
risk assessment. |
Realist review
& multisite case study. |
Three NHS Trusts;
orthopaedic and older person wards. |
Leadership:
resource authority.
|
Observations; 50
staff and 31 patient/carer interviews; 60 record reviews. |
Theory
testing/refinement via stakeholder data; realist synthesis. |
Unclear leadership
roles; documentation burden; limited multidisciplinary approaches; need
better patient communication strategies. |
Identifies
organizational and communication barriers, guiding structured leadership and
engagement in rehab fall prevention bundles. |
|
Turner et al.
(2022) |
Fall prevention
strategies |
Cross-sectional
descriptive study |
60 general adult
hospital units in the U.S. |
Practices:
visibility, bed modifications, monitoring, education.
|
Survey of practice
adherence and strategy use. |
Comparison of
practice consistency across units. |
Wide variation in
practices; resource-intensive strategies underused; limited interdisciplinary
approaches. |
Reveals the need
for tailored, resource-appropriate strategies and interdisciplinary
collaboration in inpatient rehab settings. |
References
Dykes, P. C., Bowen, M. C., Lipsitz, S., Franz, C., Adelman, J., Adkison, L., Bogaisky, M., Carroll, D., Carter, E., Herlihy, L., Lindros, M. E., Ryan, V., Scanlan, M., Walsh, M.-A., Wien, M., & Bates, D. W. (2023). Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. JAMA Health Forum, 4(1), e225125. https://doi.org/10.1001/jamahealthforum.2022.5125
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1–12. https://doi.org/10.1186/s12877-020-01515-w
Li, S., & Surineni, K. (2024). Falls in hospitalized patients and preventive strategies: A narrative review. The American Journal of Geriatric Psychiatry: Open Science, Education, and Practice, 5, 1–9. https://doi.org/10.1016/j.osep.2024.10.004
Randell, R., McVey, L., Wright, J., Zaman, H., Cheong, V.-L., Woodcock, D. M., Healey, F., Dowding, D., Gardner, P., Hardiker, N. R., Lynch, A., Todd, C., Davey, C., & Alvarado, N. (2024). Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. Health and Social Care Delivery Research, 12(5), 1–194. https://doi.org/10.3310/JWQC5771
Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2022). Fall prevention practices and implementation strategies. Journal of Patient Safety, 18(1), e236–e242. https://doi.org/10.1097/pts.0000000000000758