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International Journal of Environmental... Nov 2022Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.
PURPOSE
Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).
METHODS
This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.
RESULTS
In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).
CONCLUSIONS
Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.
Topics: Humans; Patient Safety; Latin America; Organizational Culture; Safety Management; Hospitals; Surveys and Questionnaires
PubMed: 36361273
DOI: 10.3390/ijerph192114380 -
Journal of Advanced Nursing Apr 2020To summarise available reviews on nursing handover (NH) and patient safety (PS), providing a set of evidence-based recommendations for clinical practice and research.
AIMS
To summarise available reviews on nursing handover (NH) and patient safety (PS), providing a set of evidence-based recommendations for clinical practice and research.
DESIGN
Umbrella review.
DATA SOURCES
We systematically searched PubMed, CINAHL, and Cochrane Library CENTRAL databases up to October 2018.
REVIEW METHODS
Retrieved reviews were critically evaluated using the Checklist for Systematic Review and Research Syntheses. Then, an iterative approach and two different frameworks were adopted to categorize the findings in: (a) practice; and (b) research recommendations.
RESULTS
A total of 17 reviews were included: among them, 16 reported a range of recommendations for clinical practice to promote PS by reducing adverse events. For what concerns research, 16 reviews recommended specific strategies to improve and strengthen research and its quality in the field of NHs and PS.
CONCLUSION
Changing nursing handover practices to increase PS is complex: it means changing the culture, roles and behaviour of any given clinical nursing setting. To be effective, the change requires a tailored approach, time and implementation strategies including education and support. Future studies should address the flexibility required by handovers in daily practice and the multiple needs with the aim of increasing the robustness of the available evidence on NHs. These should also embrace the Complex Interventions Research Framework.
IMPACT
Several reviews have been performed as summaries of research and practice evidence on NHs, but no summary of the established clinical and research recommendations on NHs and PS has been provided to date. Standardized handovers supported by technological solutions, facilitating face-to-face contact between nurses, possibly alongside bedside reports, can improve PS. Well-designed longitudinal studies, on a wide scale, in different settings, based on a strong rationale and focused on measuring the association between handover and patients' safety issues are recommended.
Topics: Humans; Nursing Staff; Patient Handoff; Patient Safety
PubMed: 31815307
DOI: 10.1111/jan.14288 -
The Cochrane Database of Systematic... Sep 2018Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
OBJECTIVES
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
SELECTION CRITERIA
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
DATA COLLECTION AND ANALYSIS
One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
MAIN RESULTS
Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence).
AUTHORS' CONCLUSIONS
In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
Topics: Accidental Falls; Aged; Aged, 80 and over; Calcium, Dietary; Exercise; Female; Hospitals; Humans; Male; Nursing Homes; Randomized Controlled Trials as Topic; Safety Management; Vitamin D; Vitamins
PubMed: 30191554
DOI: 10.1002/14651858.CD005465.pub4 -
British Journal of Sports Medicine Apr 2017To examine the effects of stepping interventions on fall risk factors and fall incidence in older people. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine the effects of stepping interventions on fall risk factors and fall incidence in older people.
DATA SOURCE
Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, CENTRAL) and reference lists of included articles from inception to March 2015.
STUDY SELECTION
Randomised (RCT) or clinical controlled trials (CCT) of volitional and reactive stepping interventions that included older (minimum age 60) people providing data on falls or fall risk factors.
RESULTS
Meta-analyses of seven RCTs (n=660) showed that the stepping interventions significantly reduced the rate of falls (rate ratio=0.48, 95% CI 0.36 to 0.65, p<0.0001, I=0%) and the proportion of fallers (risk ratio=0.51, 95% CI 0.38 to 0.68, p<0.0001, I=0%). Subgroup analyses stratified by reactive and volitional stepping interventions revealed a similar efficacy for rate of falls and proportion of fallers. A meta-analysis of two RCTs (n=62) showed that stepping interventions significantly reduced laboratory-induced falls, and meta-analysis findings of up to five RCTs and CCTs (n=36-416) revealed that stepping interventions significantly improved simple and choice stepping reaction time, single leg stance, timed up and go performance (p<0.05), but not measures of strength.
CONCLUSIONS
The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. This clinically significant reduction may be due to improvements in reaction time, gait, balance and balance recovery but not in strength. Further high-quality studies aimed at maximising the effectiveness and feasibility of stepping interventions are required.
SYSTEMATIC REVIEWS REGISTRATION NUMBER
CRD42015017357.
Topics: Accidental Falls; Aged; Controlled Clinical Trials as Topic; Gait; Humans; Middle Aged; Physical Therapy Modalities; Postural Balance; Randomized Controlled Trials as Topic; Reaction Time
PubMed: 26746905
DOI: 10.1136/bjsports-2015-095452 -
BMJ (Clinical Research Ed.) Jul 2019To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.
REVIEW METHODS
Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I statistic, and publication bias was evaluated.
RESULTS
Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).
CONCLUSIONS
Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.
Topics: Cross-Sectional Studies; Evidence-Based Practice; Humans; Observational Studies as Topic; Patient Harm; Patient Safety; Prevalence; Quality Improvement; Retrospective Studies; Severity of Illness Index
PubMed: 31315828
DOI: 10.1136/bmj.l4185 -
The Cochrane Database of Systematic... Jul 2018Falls and fall-related injuries are common, particularly in those aged over 65, with around one-third of older people living in the community falling at least once a... (Review)
Review
BACKGROUND
Falls and fall-related injuries are common, particularly in those aged over 65, with around one-third of older people living in the community falling at least once a year. Falls prevention interventions may comprise single component interventions (e.g. exercise), or involve combinations of two or more different types of intervention (e.g. exercise and medication review). Their delivery can broadly be divided into two main groups: 1) multifactorial interventions where component interventions differ based on individual assessment of risk; or 2) multiple component interventions where the same component interventions are provided to all people.
OBJECTIVES
To assess the effects (benefits and harms) of multifactorial interventions and multiple component interventions for preventing falls in older people living in the community.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, trial registers and reference lists. Date of search: 12 June 2017.
SELECTION CRITERIA
Randomised controlled trials, individual or cluster, that evaluated the effects of multifactorial and multiple component interventions on falls in older people living in the community, compared with control (i.e. usual care (no change in usual activities) or attention control (social visits)) or exercise as a single intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed risks of bias and extracted data. We calculated the rate ratio (RaR) with 95% confidence intervals (CIs) for rate of falls. For dichotomous outcomes we used risk ratios (RRs) and 95% CIs. For continuous outcomes, we used the standardised mean difference (SMD) with 95% CIs. We pooled data using the random-effects model. We used the GRADE approach to assess the quality of the evidence.
MAIN RESULTS
We included 62 trials involving 19,935 older people living in the community. The median trial size was 248 participants. Most trials included more women than men. The mean ages in trials ranged from 62 to 85 years (median 77 years). Most trials (43 trials) reported follow-up of 12 months or over. We assessed most trials at unclear or high risk of bias in one or more domains.Forty-four trials assessed multifactorial interventions and 18 assessed multiple component interventions. (I not reported if = 0%).Multifactorial interventions versus usual care or attention controlThis comparison was made in 43 trials. Commonly-applied or recommended interventions after assessment of each participant's risk profile were exercise, environment or assistive technologies, medication review and psychological interventions. Multifactorial interventions may reduce the rate of falls compared with control: rate ratio (RaR) 0.77, 95% CI 0.67 to 0.87; 19 trials; 5853 participants; I = 88%; low-quality evidence. Thus if 1000 people were followed over one year, the number of falls may be 1784 (95% CI 1553 to 2016) after multifactorial intervention versus 2317 after usual care or attention control. There was low-quality evidence of little or no difference in the risks of: falling (i.e. people sustaining one or more fall) (RR 0.96, 95% CI 0.90 to 1.03; 29 trials; 9637 participants; I = 60%); recurrent falls (RR 0.87, 95% CI 0.74 to 1.03; 12 trials; 3368 participants; I = 53%); fall-related hospital admission (RR 1.00, 95% CI 0.92 to 1.07; 15 trials; 5227 participants); requiring medical attention (RR 0.91, 95% CI 0.75 to 1.10; 8 trials; 3078 participants). There is low-quality evidence that multifactorial interventions may reduce the risk of fall-related fractures (RR 0.73, 95% CI 0.53 to 1.01; 9 trials; 2850 participants) and may slightly improve health-related quality of life but not noticeably (SMD 0.19, 95% CI 0.03 to 0.35; 9 trials; 2373 participants; I = 70%). Of three trials reporting on adverse events, one found none, and two reported 12 participants with self-limiting musculoskeletal symptoms in total.Multifactorial interventions versus exerciseVery low-quality evidence from one small trial of 51 recently-discharged orthopaedic patients means that we are uncertain of the effects on rate of falls or risk of falling of multifactorial interventions versus exercise alone. Other fall-related outcomes were not assessed.Multiple component interventions versus usual care or attention controlThe 17 trials that make this comparison usually included exercise and another component, commonly education or home-hazard assessment. There is moderate-quality evidence that multiple interventions probably reduce the rate of falls (RaR 0.74, 95% CI 0.60 to 0.91; 6 trials; 1085 participants; I = 45%) and risk of falls (RR 0.82, 95% CI 0.74 to 0.90; 11 trials; 1980 participants). There is low-quality evidence that multiple interventions may reduce the risk of recurrent falls, although a small increase cannot be ruled out (RR 0.81, 95% CI 0.63 to 1.05; 4 trials; 662 participants). Very low-quality evidence means that we are uncertain of the effects of multiple component interventions on the risk of fall-related fractures (2 trials) or fall-related hospital admission (1 trial). There is low-quality evidence that multiple interventions may have little or no effect on the risk of requiring medical attention (RR 0.95, 95% CI 0.67 to 1.35; 1 trial; 291 participants); conversely they may slightly improve health-related quality of life (SMD 0.77, 95% CI 0.16 to 1.39; 4 trials; 391 participants; I = 88%). Of seven trials reporting on adverse events, five found none, and six minor adverse events were reported in two.Multiple component interventions versus exerciseThis comparison was tested in five trials. There is low-quality evidence of little or no difference between the two interventions in rate of falls (1 trial) and risk of falling (RR 0.93, 95% CI 0.78 to 1.10; 3 trials; 863 participants) and very low-quality evidence, meaning we are uncertain of the effects on hospital admission (1 trial). One trial reported two cases of minor joint pain. Other falls outcomes were not reported.
AUTHORS' CONCLUSIONS
Multifactorial interventions may reduce the rate of falls compared with usual care or attention control. However, there may be little or no effect on other fall-related outcomes. Multiple component interventions, usually including exercise, may reduce the rate of falls and risk of falling compared with usual care or attention control.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Exercise; Female; Fractures, Bone; Hospitalization; Humans; Independent Living; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 30035305
DOI: 10.1002/14651858.CD012221.pub2 -
Frontiers in Public Health 2022To improve the quality of life of older adult in their later years, by increasing the physical activity participation of older adult, the occurrence of falls accident...
OBJECTIVE
To improve the quality of life of older adult in their later years, by increasing the physical activity participation of older adult, the occurrence of falls accident scores in older adult can be prevented. This paper comprehensively summarizes the origin, development, participation forms, and fitness effects of the Otago exercise program (OEP).
METHODS
Using PubMed, web of science, CNKI, dimensional spectrum, and other databases, search for research papers from 2005 to April 2021 by using keywords such as Otago project exercise; aged, Fall; Cognitive function, Balance ability, Lower limb strength, Fall efficiency, and so on. PEDro Scale was used to check the quality of the literatures.
RESULTS
A total of 34 papers were included after searching for kinds of literature related to the subject of this paper and after careful review by researchers.
CONCLUSIONS
Otago exercise programme is beneficial to improve the cognitive function of older adult, enhance their lower limb muscle strength and dynamic and static balance ability, and then improve the gait stability and posture control ability of older adult, which has significant positive benefits for the prevention of falls in older adult. OEP is helpful to improve the falling efficiency of older adult, help older adult overcome the fear of falling, and form a positive emotion of "exercise improves exercise," to reduce the harm caused by sedentary behavior and the incidence of depression and improve their subjective wellbeing. Although OEP has significant positive effects on improving the health and physical fitness of older adult, preventing falls, and restoring clinical function, the corresponding neural mechanism for preventing falls is not very clear. At the same time, how OEP can be combined with emerging technologies to maximize its benefits needs to be further discussed in the future.
Topics: Humans; Aged; Accidental Falls; Exercise Therapy; Quality of Life; Fear; Exercise
PubMed: 36339194
DOI: 10.3389/fpubh.2022.953593 -
Revista Da Escola de Enfermagem Da U S P 2016To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). (Review)
Review
OBJECTIVE
To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU).
METHOD
A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors.
RESULTS
Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU.
CONCLUSION
The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care.
OBJETIVO
Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI).
MÉTODO
Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos.
RESULTADOS
Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP.
CONCLUSÃO
A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.
Topics: Accidental Falls; Critical Care Nursing; Cross Infection; Humans; Medication Errors; Patient Safety; Pressure Ulcer; Workload
PubMed: 27680056
DOI: 10.1590/S0080-623420160000500020 -
JBI Database of Systematic Reviews and... Dec 2017Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the... (Review)
Review
BACKGROUND
Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions.
OBJECTIVES
To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting.
INCLUSION CRITERIA TYPES OF PARTICIPANTS
All adult patients admitted to medical or surgical acute care units for any condition or illness.
TYPES OF INTERVENTION(S)
Patient-centered intervention strategies to reduce falls compared to usual care.
TYPES OF STUDIES
Randomized control trials.
TYPES OF OUTCOMES
Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries.
SEARCH STRATEGY
A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository.
METHODOLOGICAL QUALITY
Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute.
DATA EXTRACTION
Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute.
DATA SYNTHESIS
Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form.
RESULTS
Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5).
CONCLUSIONS
Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.
Topics: Accidental Falls; Aged; Female; Hospitals; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Patient-Centered Care; Randomized Controlled Trials as Topic; Safety Management
PubMed: 29219876
DOI: 10.11124/JBISRIR-2016-003331 -
Stomatologija 2020The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines...
The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines (Google, Researchgate and PubMed) was carried out. The keywords used for search were sodium hypochlorite, injury, cellulitis, apical extrusion, ulcer, endodontics. Full text articles of the articles were collected from the year 2007 to 2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.
Topics: Accidents; Endodontics; Sodium Hypochlorite
PubMed: 32706342
DOI: No ID Found