Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study

Abstract

Christine Toye,1 Susan Slatyer,2 Su Kitchen,3 Katharine Ingram,4 Mary Bronson,5 Deborah Edwards,6 Welma van Schalkwyk,7 Catherine Pienaar,8 Philippa Wharton,9 Chrianna Bharat,10 Keith D Hill11 1School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia 6102, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 2Discipline of Nursing, College of Science, Health, Engineering & Education, Murdoch University, Perth, Western Australia 6150, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 3Clinical Lead and Clinical Nurse Consultant in Falls Management, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 4Consultant Geriatrician, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 5Deputy Nurse Co Director, Medical Division, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 6Occupational Therapy Coordinator, Acute Services Emergency Department, Sir Charles Gardiner Hospital, Perth, Western Australia 6009, Australia; 7Registered Nurse, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 8Project Officer, Nursing Research, Perth Children’s Hospital and Murdoch University, Perth, Western Australia 6009, Australia; 9Project Officer, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia; 10National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales 2006, Australia; 11Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria 3199, AustraliaCorrespondence: Christine ToyeSchool of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia 6102, AustraliaTel [phone]Email [email protected]: Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of inter-professional collaboration.Methods: Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves.Results: From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11–2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time.Conclusion: Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.Keywords: inpatient, adverse events, older adults, falls, bed moves

Keywords

• inpatient
• adverse events
• older adults
• falls
• bed moves