805 research outputs found
Clinicians’ perspectives and clinical efficacy of a health information technology tool in hospital falls risk assessment and prevention among older persons
Background
The expanding ageing population has resulted in a focus on older persons within many healthcare systems. Falls present a growing problem with a significant impact on the community and healthcare system. Identifying falls risk factors and preventing falls have become priorities for many hospital and government policies, yet the evidence for the acceptability and efficacy of such interventions remains limited. Health technology has the potential to influence the field of falls prevention. Within research and clinical use, single and multi-component health technology strategies have been trialled to identify falls risk and prevent falls incidents. These have included sensor systems, video surveillance, and electronic health records. This thesis sought to evaluate the role of health technology in falls risk assessment and prevention, its perceptions by clinicians as end-users, and its effectiveness in reducing falls in hospital. More specifically, the thesis examined clinicians’ perspectives and use of a health information technology tool. This tool incorporated an iPad™ device and automatically generated visual cues to highlight individual patients’ falls risk. Its accuracy and efficacy in identifying and addressing falls risk scenarios, was evaluated compared to a standard screening tool. The aim of this study was to ultimately develop an acceptable and usable tool, in collaboration with clinicians, to deliver effective falls prevention in hospital. Methods
Two methodologies and separate analyses were undertaken to complete this thesis: 1) An integrative review collated evidence for the effectiveness and clinicians’ perspectives of health technology use in falls prevention; and 2) an action research study evaluated clinicians’ perspectives on the health information technology tool, and informs its clinical use and efficacy in reducing hospital fall rates. Data was derived from focus group and survey research, with implementation of the health information technology tool occurring over consecutive 12-week periods on two medical wards at a single hospital setting. Both qualitative and quantitative analyses were applied to the data. Results
Integrative review evidence, presented for the first time in this thesis, highlighted the lack of robust, consistent evidence for the acceptability and efficacy of health technology measures in falls prevention. The research conducted in this thesis addressed this gap in knowledge by evaluating staff’s attitudes towards the health information technology tool. It evaluated its positive and negative aspects, barriers to use, and recommendations for improvement; alongside its accuracy and effectiveness in reducing fall rates. Overall, clinicians were supportive for incorporating the tool into clinical practice. They perceived it as a useful, timely means of alerting staff and patients to falls risk scenarios, and resulting in better quality of care and understanding of falls risk for patients. Clinicians identified issues with usability and lack of time for tool use, and highlighted potential improvements to tool design. As befitting action research methodology, the health information technology tool has undergone refinement based on clinicians’ feedback. This has resulted in improved technology, clearer functioning of selection keys, colour coding of patients’ falls risk, having an automated trigger for patient education on falls risk, and provision of more iPad™ devices for more efficient use. The falls risk scores for the health information technology tool and standard falls risk in older person screening tool were similar, and did not differentiate between falls-risk and non-risk situations. Both tools had high sensitivity and low specificity for identifying falls-risk scenarios. They had similar rates of completion by clinicians on the wards. Implementation of the intervention tool had mixed outcomes on hospital fall rates. Conclusion
This thesis contributed new information to address the knowledge gap on health technology uptake and efficacy in addressing hospital falls risk. Clinicians were willing to use the health information technology tool, and identified benefits to using the tool for themselves and their patients. The intervention tool demonstrated similar acceptability and accuracy to the standard falls risk screening tool. Staff’s concerns about usability are addressed in tool refinement, with active participation of end-users were considered key to improving intervention acceptance and usage, along with maximising useful feedback to further inform tool development. The effect of implementing the intervention tool on fall rates was mixed, highlighting the challenges of identifying and managing falls risk scenarios in hospital settings. The work arising from this thesis informed the development of a hand held android device used in the Ambience Intelligence Geriatric Management (AmbiGEM) system, incorporating printed visual cues with movement sensor alarms that alert clinicians to high-risk patient manoeuvres. Future research directions will involve evaluation of the acceptability and efficacy of the AmbiGEM system, which is currently undergoing clinical trial in two hospitals in South and Western Australia.Thesis (MPhil) -- University of Adelaide, Adelaide Medical School, 201
MyStay – Development of nurse-facilitated condition-specific multimedia resources to facilitate patient participation in postoperative care
Improved postoperative outcomes and the global drive toward the provision of patient-centred care underpins efforts to enhance the nature and capacity of patient participation in acute postoperative hospital care. In this paper, we describe the design, framework and processes used to develop a modular, procedure-specific, digital health intervention platform aimed at improving the patient experience and patient participation in care following surgery. The intervention, a multimedia application MyStay, uses bedside delivery of audio-visual and text-based information to engage postoperative patients to better participate in their care. MyStay modules are developed using an iterative, multi-method approach intended to balance procedure-specific best evidence, current clinical practice, and patient preferences. Development involves six key elements: (1) Empathise with target users, (2) Ground in evidence and behavioural theory, (3) Specify target behaviours, (4) Integration of health service standards and clinical care pathways/guidelines, (5) Build and refine the multimedia product and, (6) Pilot implementation to assess potential effectiveness and usability. To-date, we have developed four procedure-specific MyStay modules and an additional three are under development. Initial patient usage data for the Total Knee Replacement (TKR) and cardiac surgery applications indicated that users accessed a wide range of text-based and audio-visual information, most frequently recovery goals and exercises following TKR, and postoperative recovery information for the intensive care unit following cardiac surgery. As previous research that tested MyStay indicated its efficacy in optimising clinical postoperative outcomes, this framework may be useful in the development of other digital health innovations. Further research is required to assess patient and clinician engagement and determine whether MyStay is associated with improved patient outcomes across varied clinical contexts.
Experience Framework
This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len
Designing health IT to support falls prevention in hospitals: Findings from a realist review.
Inpatient falls are an international patient safety concern, accounting for 30-40% of reported safety incidents in acute hospitals. They can cause both physical (e.g. hip fractures) and non-physical harm (e.g. reduced confidence) to patients. We used an approach known as a realist review to identify theories about what interventions might work for whom in what contexts, focusing on what supports and constrains effective use of multifactorial falls risk assessment and falls prevention interventions. One of these theories suggested that staff will integrate recommended practices into their work routines if falls risk assessment tools, including health IT, are quick and easy to use and facilitate existing work routines. Synthesis of empirical studies undertaken in the process of testing and refining this theory has implications for the design of health IT, suggesting that while health IT can support falls prevention through automation, such tools should also allow for incorporation of clinical judgement
Characteristics of the Middle-Age Adult Inpatient Fall: A Dissertation
Falls remain one of the most reportable, serious and costly type of adverse events costing an estimated 27,000 depending on the injury. The research often focuses on the elderly and their risk for falls and injury. Increasingly higher rates of falls are being reported in the middle-age inpatient 45 to 64 years of age. While predictors of falls and injuries have been studied across all adult inpatients, research has not specifically addressed fall risk characteristics in the middle-age. The World Health Organization’s (WHO), “Risk factor model for fall in older age”, framework was adapted for the middle-age inpatient. This framework identifies extrinsic and intrinsic variables from four risk factor groupings of biological, socioeconomic, behavioral, environmental and related outcomes to describe characteristics of the middle-age inpatient’s fall injury risk. Hitcho et al. (2004) seminal article was also used to identify pertinent inpatient characteristics. The purpose of this exploratory retrospective quantitative study described fall risk factors specific to the middle-age inpatient. The aims: (1) described risk factors of falls and fall injury; (2) described unit specific data, fall numbers with type of falls, injuries from falls, and prevention strategies (3) compare the incidence of fall and injury rates in the middle-age (45- 64) patients to the other hospital adult age-groups (ages 21-44 and 65-90). This study used retrospective hospital occurrence data to identify middle-age inpatient falls and related characteristics reported by staff. Chart review of inpatient falls identified 439 individual falls occurring from January 2012 through July 2014. The study sample included inpatients that fell either one-time or had a repeat fall during the study period. Analysis for data included use of descriptive statistics, crosstabs, and Poisson regression. Outcomes collected included demographics, admitting diagnosis, chief complaints, cormorbities, and discharge status, type of falls and areas of falls. There was no significant difference in rates of falls between units or in staffing ratios that had a bearing on the middle-age inpatient. Fall prevention interventions were found to be universally applied, not specific to the individual, nor based on outcomes of risk screening of anticipated physiological risk factors. In comparison of the middle-age inpatient population with those age 65 -90 years of age the rates per 1000 patient days for both falls (p=.637) and injuries (p=.626) had no significant difference. Males fell at a significantly higher rate (p=.000) than females in the middle-age inpatient and those aged 64-90 years. The middle-age inpatient fell at an alarming rate of 42% of all falls.
This research provided insight into a population with acute and multiple chronic disease conditions and comorbidities that contribute to altered mental status, abnormal gait and frequently awaking at night to void. This population often overestimates their limitations and strives to maintain their autonomy. The age of the patient should not influence staff assessment of alertness and orientation. The findings of the characteristics in this research provide rich information for further research in how to include the middle-age patient in clinical decision making and education of this age group
The Impact of Remote Video Monitoring on Costs and Patient Outcomes
Background: Reducing patient falls remains a challenge for many acute care hospitals. Sitters (1:1 observation) are often utilized as an intervention to mitigate this. This costly intervention has drained both personnel and financial resources, forcing hospitals to find less costly alternatives to achieve the same safety outcomes. Remote video monitoring technology (RVM) is an innovative technology that supports the monitoring of multiple patients by one observer from a remote location and is an effective alternative in reducing patient falls and/or injury and associated costs.
Aim: The goal of this evidence-based practice initiative was to evaluate the effectiveness of RVM compared to standard care (1:1 observation) on the following outcomes: patient falls, sitter utilization, sitter costs, patient satisfaction, and staff satisfaction.
Methods: This evidence-based practice initiative was conducted on adult non-suicidal, verbally directable patients across two medical-surgical units in a large academic medical center. A pre/post-study design was used to compare data on patient falls, sitter utilization, sitter costs, patient satisfaction, and staff satisfaction before and after RVM implementation on two inpatient hospital units.
Results: There was an 18% decrease in patient falls across both units after RVM implementation. After RVM implementation, there was a statistically significant decrease in both the mean total number of combined sitter hours and combined sitter dollars (t (4) =2.517, p=.033), with a 45% decrease in sitter hours and a 45% decrease in sitter dollars across both units. Additionally, mean staff satisfaction ratings were significantly higher post-implementation compared to pre-implementation (p\u3c.05). This technology did not impact patient satisfaction scores.
Conclusion: Utilizing RVM as an alternative to 1:1 observation can improve patient safety by potentially decreasing patient falls, decreasing sitter utilization and costs, and improving staff satisfactio
The Use of Tailored Interventions to Prevent Falls: A Quality Improvement Project in the Telemetry Unit
Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion.
Practice problem: The objectives of the fall initiative program were increasing adherence to documentation of data from the Morse Fall Assessment and tailored interventions in the electronic health record. The goal of the project was to promote patient safety by decreasing the fall rate per 1000 patient days to below the national benchmark of 3.44/1000 patient days.
Intervention: The project was piloted in two telemetry units over 12 weeks using the Iowa Model of Evidence-based Practice. Telemetry staff received one-on-one education from the educator in the unit using a tailored intervention poster. The Nurse Champion observed 58 rooms and conducted chart documentation to ensure universal fall precautions were carried out during every shift. Incidence of falls was tracked daily, and post fall huddles were conducted after any incidents.
Outcome: The average monthly fall rate after implementation was 2.47/1000 patient days, which was below the national benchmark.
Conclusion: The fall assessment documentation in two telemetry units at DHR Health can be adapted or implemented hospital-wide. The results showed a statistically significant correlation between the Morse fall score assessment on EHR and monthly fall events (p=0. 0078). Champions were able to identify interventions and areas that needed to be improved such as education, patient engagement and stakeholder buy-in
Clinical Practice Guideline for Preventing Falls in Geriatric Patients
AbstractFalls among geriatric patients within the acute care setting constitute significant threats to their physical and mental health and quality of life. Falls, with or without injuries, can prolong the length of stay at the hospital and cause early placement in an aged care institution. The etiology of falls is a multifactorial phenomenon involving cumulative risks shared by many adults. In answering the practice focused question, the purpose of this doctorate project was to develop an evidenced-based clinical practice guideline (CPG) to provide a standardized guide to provide ready access to the evidence-based interventions found to be most effective in fall prevention. Following Walden University’s CPG manual and the AGREE II model, I developed a CPG based on peer reviewed articles and published clinical practice guidelines gathered from an in-depth literature search. The AGREE II instrument was used by the content panel to review and evaluate the newly developed CPG, and end users provided an evaluation for content and useability. Content experts also provided a summative evaluation. The AGREE scores ranged from 78% to 97% with an overall score of 94%, and end users responded with positive feedback indicating a well-developed CPG, which both strongly recommended be implemented. In the summative evaluation, two of the reviewers misunderstood the instructions included in the evaluation; the third panelist commented on how effective the project was on providing relevant information on how to best prevent falls. The anticipated social change from reducing falls is an increase in the quality of life and well-being for older adults along with a reduced fear of falling, depression, and anxiety
Applying Knowledge Translation in Rehabilitation: An Exploration of What it Means to Change Clinical Practice
Health care providers are often required to implement evidence-based recommendations into the care they deliver. Resources that support health care providers’ efforts are a useful knowledge translation strategy. This thesis describes the development and usability evaluation of an evidence-informed clinical practice implementation toolkit to support implementation efforts. Two studies were undertaken to provide insight into what was needed to support health care providers, and to inform the development of the toolkit. A retrospective evaluation analyzed the performance of a team implementing a pressure ulcer risk assessment for patients with spinal cord injury. The rates of adherence to the risk assessment and action plan were low at both admission and reassessment. A phenomenology of practice study was conducted to understand the experiences of implementation by health care providers. This study identified five essential themes of the experience: decision making, implementation as a process, lived time, lived human relation, and lived space. The principles of integrated knowledge translation, the Knowledge Exchange Framework, and toolkit development resources were used in this study. This toolkit contains a simplified, phased implementation process based on the Active Implementation Frameworks, and is accompanied by tools. The toolkit received very positive usability ratings: 92% of respondents learned something new from reviewing the toolkit; 100% of respondents said the toolkit was well organized; 92% of respondents said the toolkit was easy to use; 92% of respondents would recommend the toolkit to a colleague; and 92% of respondents showed intention to use the toolkit. This body of work contributes to the fields of knowledge translation and implementation science by generating insight into and appreciation of the process, context, and stakeholders in relation to implementing evidence-based guidelines into routine care delivery practices
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