Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments

Abstract

Purpose

Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety.

Materials and methods

Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees’ perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire).

Results

Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: −2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety.

Conclusion

The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.

Keywords:

• accidental falls
• accident prevention
• adverse effects
• patient safety
• safety culture

Acknowledgments

The authors thank the research coordinators Synnøve Herje and Elisabeth Tennøy Bjerkan, Clinical Research Unit, and research assistant Veronika Dybvik, Orthopedic department, Møre og Romsdal Hospital Trust for collecting the data from the medical records. They also thank Møre og Romsdal Hospital Trust for the funding.

Author contributions

BR has planned the study, has been responsible for the practical work including collecting of the data, has prepared the data files for the analyses, and has drafted the manuscript. BAT-P has supervised the local activities and taken part in all parts of the project including the analyses and preparation of the manuscript. SL has together with PGF been responsible for the statistical analyses. PGF has been the administrator of the project after the data were collected and processed further for the analyses, has performed most of the analyses, and has finalized the manuscript for publication. All authors have given valuable comments on the manuscript and approved the last version. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.