Where are your monitoring apps that detect falls? I see at least 8 fall detection apps in the Google Play store. Not that
I'm going to get one. If I fall I'll figure out a way to get up and
continue on. If I can find this stuff in minutes whomever you have working on this is totally incompetent.
Or these:
Trials begin with a new fall detector for the elderly that automatically notifies the emergency services September 2014
Postural transitions detection and characterization in healthy and patient populations using a single waist sensor June 2020
The latest here:
‘Patient unable to express why he was on the floor, he has aphasia.’ A content thematic analysis of medical records and incident reports on the falls of hospital patients with communication disability following stroke
Funding information:
This research was funded by an Australian Government Research Training Program Scholarship and a Jumbunna Postgraduate Research Scholarship.
Abstract
Background
People with communication disability following stroke are at risk of falls during inpatient rehabilitation. However, they are often excluded from hospital falls research, and little is known about the circumstances or outcomes of their falls to inform risk management strategies.
Aims
To examine hospital medical records and incident reports relating to falls of patients with communication disability following stroke for content codes, categories and themes relating to communication.
Methods & Procedures
This medical record chart review examined data on 72 patients and 265 falls. A content thematic analysis was used to identify how patient communication is characterized in relation to falls, and their prevention and management strategies.
Outcomes & Results
The data reflected that staff viewed patients having difficulty following simple instructions as contributing to falls. Gaining the attention of staff and communicating basic needs were also considered to be contributing factors for falls. Patients were often described as experiencing a fall when taking a risk or attempting to address an unmet basic need. Furthermore, written notes for patients with more severe communication disability reflected that the patient's communication impairments prevented staff from establishing the circumstances of some falls and complicated the assessment for injury following a fall.
Conclusions & Implications
The medical records and incident reports of patients with communication disability following stroke reveal that hospital staff recognize the impact of communication disability as potential risk factors for falls for this group. It was difficult for staff to report the circumstances of the fall for patients with severe communication disability. Despite the recognition of communication as a potential contributing factor, few medical record entries documented strategies related to communication interventions to improve patients’ ability to understand instructions, gain attention or communicate basic needs.
WHAT THIS PAPER ADDS
What is already known on the subject
- People with stroke are at a high risk of falls during their hospital admission. However, little is known about the circumstances of their falls and the influence of communication disability on these falls.
What this paper adds to existing knowledge
- Patients with communication disability have unique factors that contribute to their falls in the hospital. Patients were described as experiencing a fall when taking a risk or attempting to address an unmet need, and these falls were often related to a patient's difficulties communicating their basic needs, gaining attention from staff, and following simple instructions.
What are the potential or actual clinical implications of this work?
- Communication disability as a risk factor for a fall, and fall prevention strategies tailored to the communication disability, were typically identified and documented by physiotherapists, occupational therapists and nursing staff. The inclusion of speech pathologists in fall risk assessment, management, and prevention strategies may provide crucial information regarding the patient's communication disability that may enhance their fall prevention plan.
INTRODUCTION
Falls in hospital impose a high-cost impact on health services and patients; including injury, loss of functional capacity and increased length of hospital stay (Batchelor et al., 2012; Hill et al., 2007; Morello et al., 2015). People with stroke are at a high risk of falls, with between 14% and 65% of patients falling at least once during their hospital admission (Batchelor et al., 2012; Walsh et al., 2016). Risk factors for falls in patients with stroke include balance impairments, difficulties with self-care and activities of daily living, and neglect (Campbell & Matthews, 2010; Denissen et al., 2019)).
Communication disability, specifically related to aphasia, dysarthria, apraxia of speech, and cognitive communication difficulties, affects an estimated 64% of people with stroke (Mitchell et al., 2020, O'Halloran et al., 2009) and can lead to barriers to their effective communication with hospital staff (O'Halloran et al., 2012; Simmons-Mackie & Kagan, 2007; Sullivan et al., 2020, 2023) and adverse events in hospital (Hemsley et al., 2013). People with communication disability following a stroke are three times more likely to experience adverse events, including falls, during their hospital admission (Bartlett et al., 2008) when compared with people without communication disability. However, there is limited research evaluating strategies suggested to improve patient safety for those with communication disability in hospitals (Hemsley & Balandin, 2014). Indeed, patients with communication disability are often excluded from falls research because of their communication impairments (Hemsley et al., 2019). Although a recent systematic review and meta-analysis did not find an association between communication disability and falls, the findings of the review were limited by the majority of the 15 included studies either excluding participants with severe communication disability or not reporting on the severity of participants’ communication disability (Sullivan et al., 2020). Associations between communication disability were reported in four of the studies which also specified the inclusion of patients with severe communication disability. A secondary analysis of the same studies indicated that there was little information in research to date regarding the circumstances and contributing factors to falls in hospital for people with communication disability following stroke (Sullivan et al., 2021).
The reports of patients with communication disability following stroke and their family members suggest that this group may have unique factors that contribute to falls in the hospital, including difficulties gaining attention through the call ball system, and communicating their needs to staff (e.g., the need for the toilet, hunger, pain) (Hemsley et al., 2013; Sullivan & Harding, 2019). Furthermore, people with communication disability reportedly have difficulties following instructions, such as those required to transfer from a bed to a chair, which in some circumstances has resulted in a fall (Sullivan et al., 2020; Zdobysz et al., 2005). The combination of these communication difficulties may result in people engaging in risk-taking behaviours such as attempting to walk to the toilet alone to meet their own needs (Sze et al., 2001).
A recent study examining the medical records and incident reports relating to the context and circumstances of falls in patients with communication disability after stroke, over an 8-year period, found that a substantial number of falls were unwitnessed falls or rolls from the bed (Sullivan et al., 2023). Patients typically found on the floor by staff also had equipment such as floor line beds and bed and/or chair alarms used in an effort to prevent the falls and protect the patient from injury (Sullivan et al., 2023). Furthermore, many falls had reportedly occurred with unknown contributing factors, as the severity of the person's communication disability meant they were unable to recount the details of the fall. Nonetheless, where circumstances of the fall could be reported, the falls were largely attributed to patient factors, such as balance impairments, weakness, and neglect (Sullivan et al., 2023).
The insights of hospital staff documenting the falls in medical records and incident reports may further assist in identifying ways to reduce the risk and incidence of falls in this vulnerable population. Knowing more about the circumstances and contributing factors for falls in people with communication disability following stroke may provide further insights into the impact of communication disability on falls and on falls-prevention strategies. The written accounts of hospital staff at the time of a fall, required in the medical records and incident reports, could reveal more about the influence of communication disability on falls. This documentation may also provide insights into the ways that staff respond to these incidents, including any follow-up strategies in relation to communication. Therefore, the aim of this study was to examine the written texts contained in hospital medical records and incident reports on falls, for content relating to communication disability and communication strategies; to contribute to an in-depth understanding of ways to further understand and manage falls risk and prevention strategies for this vulnerable group.
No comments:
Post a Comment