Final Synthesis Paper
University of North Dakota
Peer review provided by: Cynthia Anderson
Background and Rationale
Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term care settings (Shimada, Tiedemann, Lord, & Suzuki, 2009). These guidelines included “staff education programs; gait training and advice on the appropriate use of assistive devices; and review and modification of medications” (Shimada et al., 2009, page 825). However, according to Shimada et al. (2009), these interventions have helped prevent falls in long-term care residents who are independently mobile and cognitively intact, but have limited effectiveness on those who are not as independently ambulatory and cognitively impaired.
Some research studies suggest that scheduled patient rounding leading to enhanced supervision will decrease the number of falls in residents of long-term care communities. Interventions included in this scheduled patient rounding include, but are not limited to, checking rooms every hour, offering and assisting with toileting, removing obstacles in resident’s rooms, and providing a diversion activity for those who are more subject to wandering (Shimada et al., 2009).
Many facilities, however, continue to utilize bed alarms in place of scheduled rounding as part of comprehensive fall prevention programs (Hubbartt, Davis, & Kautz, 2011). This alarm can be heard throughout the entire unit once a presumed fall risk patient attempts to get out of bed without using his or her call light. Can the use of bed alarms be an adequate substitute to frequent, scheduled patient rounding in preventing falls? PICO Question
The population selected for this literature review is residents of long-term care facilities. These residents are typically in need of further care to carry out their activities of daily living. Due to the increase in home care opportunities, the population that currently resides in long-term care facilities consists more of individuals with higher level of disability and cognitive impairment, making them higher fall risks (Spector, Fleishman, Pezzin & Spillman, 2001).
The identified intervention is scheduled patient rounding. As listed above, scheduled patient rounding is having a provider check on the patient at least hourly to enhance supervision of residents. During the scheduled patient rounding, the provider may survey the scene for safety, offer and assist with toileting, and provide diversion activities to those who are subject to wandering.
The comparison intervention is the use of bed alarms. The idea is that if the patient tries to get out of bed without assist, the bed alarm will sound and a staff member will assist the patient out of bed diminishing the need for scheduled rounding.
The outcome is a decrease in fall rates. Decreasing falls will help prevent the 20-30% of people who suffer moderate to severe trauma such as head injuries, hip fractures, and skin breakdown due to falls (CDC, 2012).
Thus, this leads to the PICO question: In residents of long-term care facilities, does a scheduled patient rounding program or the generalized use of bed alarms cause a greater reduction in the annual fall rate?
The clinical question that is deemed significant for further review is: In residents of long-term care facilities, does hourly rounding or the generalized use of bed alarms cause a...
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