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RWJ 08-275 – HSR&D Study

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RWJ 08-275
Evidence Based Nursing Practices and Falls in VA and Non-VA Hospitals
Gary E. Rosenthal MD
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: December 2008 - November 2009

BACKGROUND/RATIONALE:
Unintentional falls in hospitals are a major concern due to their frequency and associated morbidity. Because of the demographics of the veteran population, VA medical centers are at high risk for adverse events relating to falls. Nursing represents the largest segment of the VA inpatient workforce, yet little is known about processes of care that nurses in the VA use to prevent falls in hospitalized patients. This study capitalized on larger parent study funded through the Robert Wood Johnson Foundation's Interdisciplinary Quality Research Initiative that sought to examine the linkages between falls prevalence and injury from falls, system-centered factors, and nursing processes of care to prevent falls in hospitals.

OBJECTIVE(S):
This study compared falls prevention process and outcomes in VA and non-VA hospitals participating in the parent study. The specific aims were to:

Compare system-centered factors, fall prevention processes, and rates of falls and injuries from falls in VA and non-VA hospital units.

Compare the adoption of evidence-based practices for falls prevention in VA and non-VA hospital units.

Determine the unique contribution of the nursing practice environment on fall prevalence and fall injury.

METHODS:
The parent study used a prospective repeated measures design to collect data from 170 non-VA and 7 VA medical and surgical units from 55 hospitals in 14 states. Each of the 7 VA units was matched to 1-2 non-VA units according to hospital bed size and type of unit. Data were collected during two time points-January-March 2008 (Quarter 1) and January-March 2009 (Quarter 5)-and included outcome measures, falls prevention process measures, and system factors. Data were obtained from surveys of staff nurses, interviews of nurse managers, reviews of patients' medical records, and hospital clinical measurement systems.

FINDINGS/RESULTS:
Fall rates were not significantly different (p>.1) in VA and non-VA units during Quarter 1 (5.1 vs. 3.6 per 1000 inpatient days) and Quarter 5 (5.1 vs. 4.6 per 1000 inpatient days). Moreover, no significant differences were seen in fall injury rates (1.6 vs. 1.3 injuries per 1000 inpatient days in VA and non-VA units in Quarter 1 and 1.7 vs. 1.4 injuries in Quarter 5). Total hours per patient day for all nursing personnel and registered nurses were similar in VA and non-VA units, as was nursing turnover. Data from chart abstraction found no differences in the use of fall risk assessment tools on admission. However, the mean number of fall prevention interventions on VA units was somewhat lower, although differences were only significant for Quarter 5. Staff nurse perceptions of the use of fall risk assessments, falls prevention interventions, toileting rounds, and physical restraints were similar. Nurse manager perceptions of falls assessment and prevention practices were also similar, with the exception of higher satisfaction with fall rates of VA managers in Quarter 5.

IMPACT:
This study advances understanding of the relative use of evidence based falls prevention strategies in VA and non-VA hospitals and of the environment for nursing based practices. The study also provides insight into the linkages between nursing processes, systems of care, and patient outcomes in VA hospitals and represents an important step in building a network of VA hospitals dedicated to implementing best nursing practices.

PUBLICATIONS:
None at this time.


DRA: Sensory Loss, Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: Clinical practice guidelines, Falls, Nursing
MeSH Terms: none

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