August 22, 1997

Nursing home spills not inevitable: study

Nursing home spills not inevitable: study

The high rate of falls and fall-related injuries suffered in nursing homes can be substantially improved by implementing structured safety programs, a Vanderbilt University Medical Center researcher has found.

In a study published in this week's issue of the Journal of the American Medical Association, investigators, led by Dr. Wayne A. Ray, professor of Preventive Medicine, found that the risk of injurious falls in nursing homes could be greatly reduced by implementing intervention programs tailored to nursing home residents.

The intervention program targeted four primary areas of concern regarding high-risk elderly populations in nursing homes ‹ environmental and personal safety, wheelchair safety, psychotropic drugs, and transferring and ambulation. The randomized, controlled study compared seven pairs of Middle Tennessee nursing homes, with one facility in each pair randomly assigned to the intervention program.

It was found that study residents in intervention facilities had 19 percent fewer recurrent fallers and 31 percent fewer injurious falls. Not surprisingly, the intervention program proved most effective for nursing home residents who closely followed the program's recommendations. It was also highly effective among residents who had three or more falls in the year prior to the study.

In this high-risk group, residents in the intervention facilities had 50 percent fewer falls resulting in injuries than did residents in control facilities.

"These are fairly substantial decreases," said Ray. "We showed that a structured program can significantly reduce falls and injuries in nursing homes. These adverse events are not inevitable."

In the study, individual nursing home residents underwent an assessment of the four major target areas for intervention. The study team then made recommendations for changes, which were monitored for one year.

The most commonly recommended changes were:

€ environment and personal safety ‹ label wheelchairs, other equipment, furniture or other belongings with the patient's name; repair or replace furniture; use properly fitting shoes; remove clutter and maintain area around bed.

€ wheelchair safety ‹ adjust and repair brakes; clean and lubricate moving parts; install anti-tip rods; add brake extensions.

€ psychotropic drugs ‹ taper and discontinue benzodiazepine; change benzodiazepine to P.R.N.; reduce antipsychotic dose; implement behavior management plan.

€ transferring and ambulation ‹ increase observation of resident; toilet and nourish at least every two hours; always assist resident during transfer; remind resident of safe transferring techniques.

"Some of the components of the intervention program seem like common sense things to do," Ray said. "But until now, no one had studied them in a sytematic and structured way, and there were no studies showing conclusively that these preventive measures could reduce falls and fall-related injuries.

"We strongly encourage other facilities to implement intervention programs of this type."