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Task: Fall Prevention Among Hospitalized Adults On A Cardiac.

Task: Fall Prevention Among Hospitalized Adults On A Cardiac

Task: Fall Prevention Among Hospitalized Adults On A Cardiac

 

271 Vaccari E, Lenardt MH, Willig MH, Betiolli SE, Oliveira ES.Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study. Online braz j nurs [internet] 2014 Sep [cited year month day]; 13 (3):271-81. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4753

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ISSN: 1676-4285

271

Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study Élide Vaccari1, Maria Helena Lenardt1, Mariluci Hautsch Willig1, Susanne Elero Betiolli1, Edinaldo Silva de Oliveira2

1 Paraná Federal University 2 Federal University of Paraná

ABSTRACT Aim: To evaluate the safety of the individual and collective physical environment to prevent falls on the part of the hospitalized elderly. Method: This is a descriptive cross-sectional and quantitative study. A total of one hundred and twenty seven (127) beds and their physical structure were evaluated in three units. Data were collected by means of a checklist. For analysis, the SPSS v.20.0 software was used, and descriptive statistics was employed as well as the Fisher’s exact test for any association between the variables. Results: safety variables related to the movement of individuals showed a lack of compliance with safety standards (77.7%), and showed no statistical significance with regard to the incidence of falls. The physical structure of the public areas of the hospital were not adapted to facilitate the movement of persons (42.8%) and little consideration had been given to other health facilities (66.6%). Discussion: It is necessary to pay attention to non-conformities in order to decrease the risk of falling. Conclusion: It is necessary to ensure that the hospital environment adheres to technical standards and that the nursing staff pays attention to the environment in order to ensure safety and to prevent falls on the part of the elderly.

Descriptors: Accidental Falls; Geriatric Nursing; Health Facility Environment.

272 Vaccari E, Lenardt MH, Willig MH, Betiolli SE, Oliveira ES.Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study. Online braz j nurs [internet] 2014 Sep [cited year month day]; 13 (3):271-81. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4753

INTRODUCTION

Several factors inherent to the aging pro- cess may cause a progressive loss of ability on the part of the elderly in adapting to their envi- ronment, especially in terms of changing loca- tion, such as in a hospital. Thus, the evaluation of the environment of the patient is essential to develop strategies to help prevent falls.

Thinking about safe areas in which the el- derly spend the majority of their time is a major challenge. A closer look is necessary since the environment can be a facilitator or a barrier to the physical performance of these individuals(1). In this sense, the hospital environment needs to be safe, foster rapid adaptation, provide security, functionality and comfort, and compensate for the limitations imposed by the aging process(2).

The term “patient safety” is widely used, but rarely defined clearly. In its most elementary form, it can be defined as “…the act of avoiding, preventing and improving adverse outcomes or injuries arising in the hospital care process”(3:32).

Ordinance No. 2095 of 2013(4) approved the Basic Protocols for Patient Safety, and among these, there is the “Protocol for the Prevention of Falls” whose purpose is “…to reduce the oc- currence of falls of patients in care facilities”. In particular this relates to hospitalized patients, during the entire period of their hospitalization. According to the protocol, “…all patients should have their risk of falling assessed”; the outcome of the assessment must be recorded in medical records and preventive measures that are appro- priate to each patient should be prescribed and implemented(5: 1).

The hospital environment is a strange world to the elderly and can lead to stressful experien- ces, albeit that human illness alone is an event that generates anxiety and insecurity(6).

The physical environment and its structu- re, the furniture arrangement, and the ways in

which material is used have an important role to play in the occurrence of falls on the part of the elderly, accounting for approximately 30% to 50% of these events(7). The falls suffered by hos- pitalized patients is one of the most important occurrences in terms of breaches in safety, and are often responsible for an increased hospita- lization time and a worse recovery(8).

In Brazil, an investigation into falls on the part of the hospitalized elderly in Belo Horizon- te showed that, in 1000 beds, approximately 3% to 13% of individuals fall on a daily basis(9). Another study conducted in nine wards of the Clinical Hospital of Porto Alegre, showed 58 specific events of falls from beds. The data revealed that most accidents occurred with regard to elderly patients (57%), male (50.9%), at night (56.60%) and in the clinical hospitali- zation sector (58%)(10).

The fall is a multifactorial event of great complexity and, when associated with an en- vironment and a context of care, it raises the need for an investigation and for continuing education on the key risk factors, the incidence, the consequences, and specific preventive me- asures(11). Given the above, the objective of this study is to evaluate the safety of the individual and collective physical environment in terms of the prevention of falls on the part of the hospi- talized elderly.

METHODS

This is a quantitative, descriptive and cross-sectional study, conducted in a large teaching hospital that specializes in high com- plexity healthcare in the city of Curitiba, Paraná. The study was conducted in three units – in the wards of the Men’s Medical Clinic, the Women’s Medical Clinic and in General Surgery. The sam- ple consisted of the evaluation of a single use

Task: Fall Prevention Among Hospitalized Adults On A Cardiac.

Task: Fall Prevention Among Hospitalized Adults On A Cardiac.

273 Vaccari E, Lenardt MH, Willig MH, Betiolli SE, Oliveira ES.Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study. Online braz j nurs [internet] 2014 Sep [cited year month day]; 13 (3):271-81. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4753

environment, involving 127 beds occupied by patients of 60 years or more, and the physical structure of collective use, during the period April to July 2013.

Data were collected by means of a checklist. In the individual use environment, which refers to the room or space for private use in a ward, the following safety variables were investigated: presence of bars on beds, locks on the wheels, a bell, an auxiliary light, locks in the sliding fur- niture, easy access to belongings, free access to the bathroom, use of non-slip footwear and the arrangement of furniture around the bed. To evaluate the physical structure of collective use, the checklist was based on NBR 9050/2004 of the Brazilian Association of Technical Stan- dards(12), and considered the variables internal circulation, vertical circulation and restrooms. In order to support the recording of the physical environment, a digital photographic camera model S. PL120 was used.

Data were coded and organized using com- puter software Excel 2007, typed and submitted to conference twice to ensure the reliability of the results. For statistical analysis, the Statistical Package for Social Sciences – SPSS v.20.0 was used, and descriptive statistics (absolute and relative frequency) were employed in terms of the safety variables related to the physical structure of the collective use facilities. In order to ascertain the association between the di- chotomic qualitative measures in terms of the safety of the environment for individual use and the occurrence of falls, we used the Fisher exact test, indicated for use with independent random samples. The results were considered statistically significant when p<0.05, as a safety margin of 95% being due to chance with a 5% chance of error. The study was approved by the Ethics Committee of the investigated institution under registry CAAE 14066113.2.0000.0096 opi- nion number 231,500.

RESULTS

As can be seen in Table 1, in the individual use environment, of the nine items evaluated, 7 (77.7%) are not in accordance with the safety standards of NBR 9050/2004. It is noteworthy that in terms of the conformity with safety stan- dards with regard to the beds, 127 (100%) had protective bars and lockable wheels, and only 2 beds (1.6%) were found to be unlocked. In all environments there was an individual bedside light; however, the location thereof did not offer easy access to the patient, either in terms of hei- ght or in terms of the positioning of the switch. In addition, 14 (11%) of the bedside lamps did not work, either due to a lack of light bulbs or due to electrical problems (Table 1).

As can be seen in Table 1, a bell for calling for assistance existed in all the beds and ba- throoms. However 23 (18.1%) were not close to the patient, making it impossible for them to request support. As for the assessment of move- ment and the organization of the environment, 13 (10.2%) of the elderly did not have easy access to their belongings, 122 (96.1%) had sliding fur- niture without locks (a nightstand), and for 25 (19.7%), access to the bathroom was not free of objects, as there were chairs, sinks and garbage containers in the way.

The association between the safety va- riables of the environment for individual use and the occurrence of falls was not statisti- cally significant. However, it has revealed a worrying percentage of 9 events (7%) among the elderly who were hospitalized during the study period.

In terms of the evaluation of the physical structure for collective use, of the 14 items as- sessed with regard to internal circulation, 6 of them (42.8%) were not in accordance with the NBR 9050/2004 guidelines (Table 1).

Task: Fall Prevention Among Hospitalized Adults On A Cardiac.

 

274 Vaccari E, Lenardt MH, Willig MH, Betiolli SE, Oliveira ES.Safety of the hospital environment in terms of preventing falls on the part of the elderly: a descriptive study. Online braz j nurs [internet] 2014 Sep [cited year month day]; 13 (3):271-81. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/4753

In Table 1, we can see the following non- -compliances: in the three wards surveyed, the floor was not coated with non-slip material; the public phone was not at the minimum dis- tance of 1.5 m in front of the door of any of the five elevators on the floor; there was no signs indicating “Risk of Fall”, or non-slip strips and handrail on either sides of the bed ladder; the route to be taken by the patient was not free and unhindered.

The vertical circulation related to the use of elevators was standardized in all three wards and were in compliance with safety standards, except with regard to the existence of tactile signaling for warning purposes on the door of the elevators (Table 2).

In terms of sanitary facilities (Table 3), it appears that of the six items assessed, four (66.6%) do not conform to the ISO 9050/2004 standards. There were no standardized bars on the side and behind the toilet bowls for support and transfer

in any of the three wards. The toilet bowls were not at the proper height, the floor was not slip resistant and was uneven, and no signs indica- ting “Risk of Falls” is displayed. It is inferred that the toilet bowls of the three wards were not in accordance with the NBR 9050/2004 standards, thus becoming a predisposing factor to falls. Task: Fall Prevention Among Hospitalized Adults On A Cardiac.