WORKIN G P A P E R Review of the Evidence on Falls Prevention in Hospitals Task 4 Final Report SUSANNE HEMPEL, SYDNE NEWBERRY, ZHEN WANG, PAUL G. SHEKELLE, ROBERTA SHANMAN, BREANNE JOHNSEN, TANJA PERRY, DEBRA SALIBA, AND DAVID A. GANZ WR-907-AHRQ February 2012 Prepared for thhe Agency for Heealthcare Research and Quality, Contract No. HHSA290201000017I, PRISM No. HHSA29032001T, Task Order #1 This product is part of the RAND Health working paper series. RAND working papers are intended to share researchers’ latest findings and to solicit informal peer review. They have been approved for circulation by RAND Health but have not been formally edited or peer reviewed. Unless otherwise indicated, working papers can be quoted and cited without permission of the author, provided the source is clearly referred to as a working paper. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. is a registered trademark. iii Table of contents Table of contents ..................................................................................................................................................... iii Table of figures ....................................................................................................................................................... iii Abstract ....................................................................................................................................................................iv Introduction ............................................................................................................................................................... 1 Evaluations of interventions ...................................................................................................................................... 1 Search and review sources .................................................................................................................................... 2 Inclusion and exclusion criteria ............................................................................................................................ 3 Participants ....................................................................................................................................................... 3 Interventions ..................................................................................................................................................... 4 Comparator / design ......................................................................................................................................... 4 Outcome ........................................................................................................................................................... 4 Setting ............................................................................................................................................................... 4 Data abstraction .................................................................................................................................................... 4 Results................................................................................................................................................................. 45 Study characteristics ....................................................................................................................................... 45 Interventions ................................................................................................................................................... 45 Outcomes and results ...................................................................................................................................... 46 Successful approaches .................................................................................................................................... 47 Evaluations of tools ................................................................................................................................................. 48 Search and review sources .................................................................................................................................. 48 Inclusion criteria ................................................................................................................................................. 49 Data extraction .................................................................................................................................................... 49 Results................................................................................................................................................................. 73 Fall risk assessment scales .............................................................................................................................. 73 Other measures used as falls predictors .......................................................................................................... 74 Falls reporting methods .................................................................................................................................. 74 Other tools used in falls prevention ................................................................................................................ 74 Potentially relevant tools not specific to falls or falls prevention ................................................................... 74 Selection of tools ............................................................................................................................................ 74 Conclusion............................................................................................................................................................... 75 References ............................................................................................................................................................... 75 Acknowledgments ................................................................................................................................................... 76 Appendix ................................................................................................................................................................. 77 Published resources ............................................................................................................................................. 77 Search strategy .................................................................................................................................................... 81 Contacted project leads ....................................................................................................................................... 82 References of included hospital intervention evaluations in acute settings (Evidence table 1) .......................... 83 References of subacute hospital intervention evaluations (with abstracts) ......................................................... 86 References of included tool evaluations (Evidence table 2) ............................................................................... 89 Other example tools and interventions ................................................................................................................ 91 Table of figures Table 1: Evidence Table of Interventions to Reduce Falls in Acute Care Hospitals ..................................................... 6 Table 2: Evidence Table of Evaluations of Tools to Support the Reduction of Falls in Hospitals .............................. 51 iv Abstract To facilitate the development of a hospital falls prevention resource guide, we systematically reviewed and documented the existing evidence base for interventions to prevent falls in hospitals, provided an overview of the performance of existing tools with known measurement properties, and compiled available online resources. The search identified a large number of published fall prevention intervention evaluations. Almost all interventions were multi-component in nature and included fall risk assessments and education for staff and patients and/or families. Intervention complexity and organizational implications varied widely. The review also identified a wide variety of tools for the prevention of falls in hospitals; the majority of the documented tools were fall risk assessment scales. Very few tools, such as the Morse Fall Scale and the STRATIFY scale, have been applied in a number of studies and have generalizable reliability and validity estimates. The documented evidence-based interventions and tools may assist in the development of programs to prevent falls in hospitals. Which tools and interventions are suitable for use in individual hospitals must be evaluated in the context of existing approaches, resources, and individual needs. The identified material will be integrated into the AHRQ toolkit as resources to guide fall prevention approaches for hospitals. 1 Introduction To facilitate the development of a hospital falls prevention resource guide, we systematically reviewed and documented the existing evidence base for interventions to prevent falls in hospitals, provided an overview of the performance of existing tools with known measurement properties, and compiled available resources. There are a number of potentially relevant resources available to support the prevention and reduction