Qualitative Research Proposal Exploring the Lived ... - IUPUI

Falls Aren’t Us:
Outcomes of Randomized
Environmental Fall Prevention Room
Intervention Study
on Incidence of Falls
in the Hospitalized Elderly Patients
Bette Cozart, MS, RN
Pamela Willson, PhD, RN, FNP, BC
Karen Stonecypher, MSN, RN
Aixa Lebron-Marquez, BSN, RN
Prairie View A/M University
Texas Woman’s University
Michael E. DeBakey VA Medical Center
Houston, Texas, U.S.A

Funding
‣ This study was funded by John Winston
Carter Research and Dissertation Grants
Texas Woman’s University
College of Nursing
Houston, Texas

Objectives
‣ To describe Fall Prevention Rooms as an
intervention that may reduce falls globally
in the clinical settings.
‣ To present outcomes of a fall prevention
randomized clinical trial.

Falls
• Nearly 10,000 elder Americans die
annually from falls
• (CDC, 2009)
• Four to 12 falls occur in patients for
every 1,000 days of hospitalization
• (Kimbell, 2002)
• Annually there are 250,000 hip fractures
costing an estimated $8 billion
• (CDC, 2009)

Research Question
‣ Do hospitalized patients, age 50 or older
who score greater than 45 on the Morse
Fall Scale report lower falls during a
seven day hospital stay when assigned to
a Fall Prevention Room than comparable
hospitalized patients assigned to a
Regular Room?

Definition
‣Fall Prevention Rooms (FPR)
‣ In-patient hospital rooms
fitted with “fall prevention”
environmental
devices and equipment

Model of Fall Prevention Room
Bed controls
at fingertips
Bed alarm
Bedside
commode
placed alongside
bed
(replaces
urinal)
Non-skid
floor
Room
illuminated
at all times
Bed trapeze
Falls
prevention
poster
Non-exit side
rails up
for support
Exit side
head rail up
for support
and foot rail
down at all
times.
Movable
hand rail
(Hemi- walker)
within reach
Non-slip floor mat absorbs fluids, food, & stool, and prevents slips

‣ Safety Variables:
• low position beds
• bed alarms
• beveled edged floor
• Mats
• shower mats
• Hipsters
• nonskid shower
• Slippers
• nonskid slippers
• double-sided nonskid
• Socks
• grab rails
FPR

Fall Definition
“Loss of upright position that results in landing
on the floor, ground or an object or furniture
or as a sudden, uncontrolled, unintentional,
non-purposeful, downward displacement of
body to the floor or ground and/or hitting
another object like a chair or stair. This does
NOT include patients assisted safely to a
lower surface by another individual.”
Fall Prevention and Management Standard of Care, MEDVAMC

Morse Fall Scale
‣ Six Items
‣ Predictive validity & inter-rater reliability
‣ Rapid & simple method
•
‣ Used widely in U.S. acute care settings

Morse Fall Scale
‣ Reliability & Validity
• 72 % sensitivity
• 51 % specificity
• 51 % accuracy
• 38 % positive predictive value
• 81 % negative predictive value
• 30 % prevalence
Morse, Morse, and Tylko (1989)

Morse Fall Scale
Points Score
1. History of falling No 0________ Yes 25________
2. Secondary diagnosis No 0________ Yes 15________
3. Ambulatory aid
none/bedrest/nurse assist 0; crutches/cane/walker15; furniture30
4. Intravenous therapy/ heparin lock No 0____ Yes 20________
5. Gait
normal/bedrest/wheelchair0_weak 10_______impaired 2________
6. Mental status
oriented to own ability 0_ overestimates / forgets limitations 15________
Morse, Morse & Tylko. (1989). Canadian Journal on Aging.

Environmental Theory:
Neuman Systems Model
‣ Hospitalization - external environmental stressor
contributing to falls
‣ Flexible line of defense - acts as protective
buffer system for the patient’s normal or stable
state
‣ FPR - acts as a flexible line of defense
environmental protective buffer for fall hazards
protecting the normal line of defense
Neuman & Fawcett (2002), p. 17

Design
‣ Two-group prospective experimental
design
‣ Controlled block randomization
• Groups of 16
‣ Inclusion Criteria
• In-patients age 50+
• High risk for falling
• > 45 points on Morse’s Scale
• 7 day hospital stay

Sample
n = 32
Randomly assigned
to FPRs
N = 120
Recruited
N = 111
Consented &
Enrolled
n = 32
Randomly assigned to
Regular Room
n = 9
declined
n = 28
n = 47
Excluded
< 7 days
n = 19

Instruments
‣ Screening
• Morse Fall Scale
• High-risk for fall = 45 points or higher
‣ FPR
• Equipment Safety Checklist
‣ Falls
• Participant Self-report
• Hospital Fall Incident Report Forms

Demographics
‣ Age
• Participants Mean age was 64 years (SD = 8.94)
‣ Gender
• Most were age 50 – 65 years (62%)
• A third were age 67 – 86 years (38%)
• Ninety-seven percent were Men
‣ Race
• White 56% (n = 36)
• African-Am 38% (n = 24)
• Hispanic 6% (n = 4)

Clinical Findings
‣ A total of 4 falls occurred during the study
timeframe
‣ (6.3 %, n = 64)
• 3 falls occurred in Regular Rooms (RR)
• (4.7%, n = 3)
• 1 falls occurred in a Fall Prevention Room (FPR)
• (1.6 %, n = 1)

In-Patient Hospital Day
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7
Fall

Results
‣ No statistically significant difference in the
number of falls for those patients assigned
to FPRs vs RRs
• Fischer’s Exact Probability Test
• (One-tail; p < .05)
• p = 0.306

Clinical Significance
50% fewer falls occurred in the FPRs

Nursing Implications
‣ The Joint Commission
• Patient Safety Goal # 9
• Reduce the risk of
patient harm resulting
from falls.
‣ Healthy People 2010
• Goal 15 is to reduce
death from falls

Recommendations
‣ Increase sample to all facility units
‣ Different populations & settings
‣ Different fall prevention equipments
• Enclosure beds, etc.
‣ Qualitative studies
• Patient’s experiences, etc.
‣ Economic costs
• Structural Design

Acknowledgments
‣ U.S. Military Veterans
• Past & Present for their service to our country
‣ Michael E. DeBakey VA Medical Center
• All Nursing Staff & Allied Personnel
‣ Baylor College of Medicine
• Dr. Nancy Petersen, Statistician
‣ POSEY Company
• Ernie Posey, CEO & David Rohrer, Sales Manager