Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic 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 SEARCH STRATEGY: A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken.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 A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository.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.