Isomi M. Miake-Lye, BA; Susanne Hempel, PhD; David A. Ganz, MD, PhD; Paul G. Shekelle, MD, PhD
Note: The Agency for Healthcare Research and Quality (AHRQ) reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the AHRQ before submission of the manuscript.
Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of the RAND Corporation; U.S. Department of Veterans Affairs; University of California, Los Angeles; the AHRQ; or U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Aneesa Motala, BA; Sydne Newberry, PhD; and Roberta Shanman, MLS.
Financial Support: From the AHRQ, U.S. Department of Health and Human Services (contracts HHSA-290-2007-10062I, HHSA-290-2010-00017I, and HHSA-290-32001T). Dr. Ganz was supported by a Career Development Award from the Veterans Affairs Health Services Research & Development Service, Veterans Health Administration, U.S. Department of Veterans Affairs through the Veterans Affairs Greater Los Angeles Health Services Research & Development Center of Excellence (project VA CD2 08-012-1).
Potential Conflicts of Interest: Dr. Hempel: Grant (money to institution): AHRQ. Dr. Ganz: Grant (money to institution): AHRQ, Veterans Affairs Health Services Research and Development Service. Dr. Shekelle: Consultancy: ECRI Institute; Employment: Veterans Affairs; Grants/grants pending: AHRQ, Veterans Affairs, Centers for Medicare & Medicaid Services, National Institute of Nursing Research, Office of the National Coordinator; Royalties: UpToDate. Ms. Miake-Lye: None disclosed. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2569.
Requests for Single Reprints: Paul G. Shekelle, MD, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401; e-mail, email@example.com.
Current Author Addresses: Ms. Miake-Lye and Drs. Ganz and Shekelle: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Hempel: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.
Author Contributions: Conception and design: P.G. Shekelle.
Analysis and interpretation of the data: I.M. Miake-Lye, S. Hempel, D.A. Ganz, P.G. Shekelle.
Drafting of the article: I.M. Miake-Lye, P.G. Shekelle.
Critical revision of the article for important intellectual content: I.M. Miake-Lye, S. Hempel, D.A. Ganz, P.G. Shekelle.
Final approval of the article: I.M. Miake-Lye, S. Hempel, D.A. Ganz, P.G. Shekelle.
Provision of study materials or patients: P.G. Shekelle.
Obtaining of funding: P.G. Shekelle.
Administrative, technical, or logistic support: I.M. Miake-Lye, P.G. Shekelle.
Collection and assembly of data: I.M. Miake-Lye, S. Hempel, P.G. Shekelle.
Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG. Inpatient Fall Prevention Programs as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:390-396. doi: 10.7326/0003-4819-158-5-201303051-00005
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Published: Ann Intern Med. 2013;158(5_Part_2):390-396.
Falls are common among inpatients. Several reviews, including 4 meta-analyses involving 19 studies, show that multicomponent programs to prevent falls among inpatients reduce relative risk for falls by as much as 30%. The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs. We searched for new evidence using PubMed from 2005 to September 2012. Two new, large, randomized, controlled trials supported the conclusions of the existing meta-analyses. An optimal bundle of components was not identified. Harms were not systematically examined, but potential harms included increased use of restraints and sedating drugs and decreased efforts to mobilize patients. Eleven studies showed that the following themes were associated with successful implementation: leadership support, engagement of front-line staff in program design, guidance of the prevention program by a multidisciplinary committee, pilot-testing interventions, use of information technology systems to provide data about falls, staff education and training, and changes in nihilistic attitudes about fall prevention. Future research would advance knowledge by identifying optimal bundles of component interventions for particular patients and by determining whether effectiveness relies more on the mix of the components or use of certain implementation strategies.
Table 1. Intervention Components in Studies of Inpatient Falls Prevention Programs
Table 2. Abridged Evidence Tables
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