Please complete work on the capstone project, including the poster.
2
Falls in a Psychiatric Unit
Name
Institutional Affiliation
Date
Falls in a Psychiatric Unit
The psychiatric unit in St. Mary & Elizabeth Medical Center has been experiencing the problem of patient falls associated with medications, such as benzodiazepines, barbiturates, Prozac, and Ativan, which have a drowsiness and dizziness effect. The frequent patient falls that have occurred over the last three months have caught the attention of the head nurse in the psychiatric unit. Falls have become a safety concern as it exposes patients in the behavioral health unit to injuries that lead to additional care needs, prolonged hospital stays, and increased cost of care. Since the use of these psychiatric medications may be inevitable in mental health care, fall prevention has been documented as the priority issue that needs an urgent and effective solution. There is a need to identify an intervention to address the patient safety issue by addressing the risk factors.
The head nurse in the psychiatric unit stated that there had been challenges in monitoring patients after they had received the medications due to a large number of patients in the unit. Additionally, the nurse manager has emphasized the need to address the issue and reiterated that it is a priority patient concern. The head nurse has been given the role to explore the cause of the issue and find ways to mitigate the problem.
The prevention of patient falls after taking the medications would improve the safety and welfare of the patients, which is one of the current objectives of the psychiatric unit. The achievement will also benefit the organization as improvement of patient safety is also a priority for the facility. Fall prevention would improve treatment outcomes and help avoid the complications associated with falls, such as prolonged duration of patient stays; thus, the unit will benefit from a reduced burden of care.
Literature Review of the Problem
Research on patient falls in psychiatric facilities have associated psychotropic medications with increased fall risk.
Du et al. (2017) investigated the relationship that exists between the psychotropic medication use and falls in older adults. The researchers established that participants who had higher psychotropic medication use experienced falls. The patients that were more likely to fall had used antidepressants. The authors reported that recurrent falls were common among individuals who used psychotropic drugs. The researchers concluded that the psychotropic medication use contributed to higher fall risk in older adults. The article is important for the current project as it provides evidence that associates psychotropic medications with falls, which can be essential in identifying individuals at a higher risk when im
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www.Nursing2012.com July l Nursing2012 l 65
> PATIENT SAFETY
FALL PREVENTION is an ongoing
challenge in older patients in the
inpatient acute mental health setting
(IAMHS). Fall prevention and patient
safety committees should work
together to minimize the risk.
This article discusses why falls
occur and how to prevent them in
older adults with mental health prob-
lems in an inpatient setting. Incorpo-
rating fall prevention toolkits and
evidence-based practices is vital.
Sizing up the problem
Each year, one in every three adults
age 65 and older falls.1 Preventing or
reducing the number of falls is a
challenge in most healthcare settings,
but the challenge is even greater in
the IAMHS. In the psychiatric or
behavioral health setting, fall rates
range from 4.5 to 25 falls per 1,000
patient days.2
In the IAMHS, many factors con-
tribute to patient falls. These factors
can be intrinsic, extrinsic, situational,
or a combination.3
• Intrinsic factors associated with an
increase in falls in an IAMHS include
impaired cognition resulting from a
chronic condition such as Alzheimer
disease or an acute condition such as
delirium. In addition, psychotropic
medications and their adverse reac-
tions may increase the likelihood of
patient falls. Other intrinsic factors
that may lead to falls include mobility,
gait, vision, and balance disorders.
• Extrinsic factors (environmental
factors) that may contribute to patient
falls on the IAMHS include a lack of
support equipment, such as side rails
when patients are getting into and out
of bed, or a lack of durable medical
equipment (DME), such as walkers,
canes, and lifting devices. To add to
these problems, mental health units
have environmental restrictions to
protect patients from harm.4 For
example, wired chair and bed alarms,
side rails, and call systems with cords
can endanger patients and staff. These
issues can account for the lack of sup-
port equipment or DME.
• Situational factors (factors related
to activities) occur when patients are
attempting to perform more than one
task at a time, such as getting out of a
wheelchair while conversing.
Intervening to improve safety
Patient safety programs apply human
factors engineering concepts and a
systems approach to fall prevention.
To help prevent repeat fa
Capstone Project: Prevention of Falls in Psychiatric Patient Population
Applications in Evidence-Based Practice for BSN I
and
Leadership & Management
NUR4827
Professor Charlyn V. Myatt
Running head: FALL RATES IN PSYCHIATRIC PATIENT POPULATION 1
Capstone Project: Prevention of Falls in Psychiatric Patient Population
Capstone Part I: Integrated Literature Review
Introduction to Problem
The purpose of this paper is to search the literature to see if the use of simple orthostatic blood pressure monitoring can assist in reducing the number of falls on an in-patient psychiatric unit along with patient and staff education on prevention of falls. “The financial burden associated with patient falls is approximately $20.2 billion each year, and as many as 25 percent of elderly patients who fall will die from the fall or from related complications” (Davis, 2012, p. 1). In- patient falls have become a financial burden to hospitals because the Centers fo
Psychotropic Medications and Risk for Falls Among
Community-Dwelling Frail Older People:
An Observational Study
Francesco Landi,
1
Graziano Onder,
1,2
Matteo Cesari,
1,2
Christian Barillaro,
1
Andrea Russo,
1
and Roberto Bernabei,
1
on Behalf of the
Silver Network Home Care Study Group
1
Department of Gerontology-Geriatrics, Catholic University of Sacred Heart, Rome, Italy.
2
Sticht Center on Aging, Wake Forest University-Baptist Medical Center,
Winston Salem, North Carolina.
Background. Injuries due to falls are one of the most important public health concerns for all ages, but especially for
frail elderly people. Although a small number of falls have a single cause, the majority have many different causes
resulting from the interactions between intrinsic or extrinsic risk factors.
Methods. We conducted an observational study on data from a large population of community-dwelling elderly people
to tests the hypothesis that the current use of different classes of psychotropic medications, including antipsychotic agents,
benzodiazepines, nonbenzodiazepine sedative-hypnotics, and antidepressants, increases the risk for falls. We analyzed
data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected
data on patients admitted to home care programs (n ¼ 2854).
Results. After adjusting for all potential confounders, users of any psychotropic drugs had an increased risk of fall of
nearly 47% (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.24–1.74). Similarly, compared with nonusers,
users of atypical antipsychotic drugs also had an increased risk of falling at least once (OR, 1.45; 95% CI, 1.00–2.11).
Among benzodiazepine users, patients taking agents with long elimination half-life (OR, 1.45; 95% CI, 1.00–2.19) and
patients taking benzodiazepines with short elimination half-life (OR, 1.32; 95% CI, 1.02–1.72) had an increased risk
of falls. Patients taking antidepressants did not show a higher risk of falling compared to nonusers (OR, 0.92; 95% CI,
0.83–1.41).
Conclusions. Our data suggest that, among psychotropic medications, antipsychotic agents and benzodiazepines are
associated with an increased risk of falls. Our findings do not support the hypothesis that preferential prescribing of short-
acting benzodiazepines instead of long-acting agents or atypical antipsychotic medications instead of typical agents will
substantially decrease fall risk associated with the use of these classes of drugs.
FALLS and their related injuries represent one of themajor health service problems among the elderly
population. Falls are responsible for considerable immobil-
ity, morbidity, and mortality among elderly people (1,2). In
the United States and other Western countries, it has been
estimated that 35%–40% of commun
Psychotropic drugs and the risk of fall injuries,
hospitalisations and mortality among older adults
Kristina Johnell1, Gudrun Jonasdottir Bergman2, Johan Fastbom1,2, Bengt Danielsson2, Natalia Borg2 and
Peter Salmi2
1Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and
Stockholm University, Stockholm, Sweden
2The Swedish National Board of Health and Welfare (Socialstyrelsen), Stockholm, Sweden
Correspondence to: K. Johnell, PhD, Professor, E-mail: [email protected]
Objective: To investigate whether psychotropics are associated with an increased risk of fall injuries,
hospitalizations, and mortality in a large general population of older adults.
Methods: We performed a nationwide matched (age, sex, and case event day) case–control study
between 1 January and 31 December 2011 based on several Swedish registers (n=1,288,875 persons
aged ≥65years). We used multivariate conditional logistic regression adjusted for education, number
of inpatient days, Charlson co-morbidity index, dementia and number of other drugs.
Results: Antidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42;
95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and
death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased
the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization
(4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted:
2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n=58,984),
a dose–response relationship was found between number of psychotropics and mortality risk (4 psycho-
tropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25).
Conclusions: Our findings support a cautious prescribing of multiple psychotropic drugs to older pa-
tients. # 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley &
Sons, Ltd.
Key words: aged; dementia; psychotropic drugs; Sweden
History: Received 11 August 2015; Revised 01 March 2016; Accepted 15 March 2016; Published online 25 April 2016 in Wiley
Online Library (wileyonlinelibrary.com)
DOI: 10.1002/gps.4483
Introduction
Mental disorders are a concern in old age (Volkert
et al., 2013). Pharmacological treatment with
psychotropic drugs (i.e. antipsychotics, anxiolytics,
hypnotics, and antidepressants) is usually standard
treatment and provision of psychotherapy is scarce
in this age group (Alvidrez and Arean 2002). In
addition to treatment of mental health problems, such
as depression, anxiety, and insomnia, psychotopic
drugs are also prescrib
ORIGINAL RESEARCH ARTICLE
Psychotropic Drug-Related Fall Incidents in Nursing Home
Residents Living in the Eastern Part of The Netherlands
Sarah I. M. Janus1 • Gezinus H. Reinders1 • Jeannette G. van Manen1 •
Sytse U. Zuidema2 • Maarten J. IJzerman1
Published online: 8 April 2017
� The Author(s) 2017. This article is an open access publication
Abstract
Background Older people are more susceptible to falls
than younger people. Therefore, as the Dutch population
ages, the total number of falls and costs associated with
them will rise. The use of psychotropic drugs is associated
with an increased risk of falling. To create tailored fall-
prevention programmes, information on the magnitude of
the association between fall incidents and specific psy-
chotropic drugs or drug classes is needed.
Objective The goal of this study was to delineate the
associations between fall incidents and specific psy-
chotropic drugs or drug classes.
Methods In this retrospective cohort study, electronic
patient records, medication records and fall incident reports
were collected for 1415 residents receiving somatic or
psychogeriatric care in 22 nursing homes in the eastern part
of the Netherlands from May 2012 until March 2015.
Using a Cox proportional hazards model, we analysed the
magnitude of the association between psychotropic drugs
and the risk of falling for users and non-users of the psy-
chotropic drugs or drug classes.
Results Antipsychotics (adjusted hazard ratio [aHR] 1.49;
95% confidence interval [CI] 1.12–2.00) and hypnotics and
sedatives (aHR 1.51; 95% CI 1.13–2.02) increase the risk
of falling. There was no difference between the risk
incurred by typical and atypical antipsychotics. However,
within these groups, there were differences between the
most commonly prescribed drugs: haloperidol and queti-
apine were seen to have an association with falls, whereas
pipamperone and risperidone were not.
Conclusions The results suggest falls may be associated
with individual drugs rather than drug classes. Within the
drug classes, clear differences are evident between indi-
vidual drugs. Future fall-prevention programmes should
highlight the differential risks involved with the use of
specific psychotropic drugs, and doctors should take the
fall risk into account when choosing specific drugs.
Key Points
Falls within the nursing home population may be
associated with individual drugs rather than drug
classes.
Differences exist between individual drugs within
drug classes.
1 Introduction
Over 40% of nursing home residents experienc
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Preventing falls among older people with mental health problems: a systematic
review
BMC Nursing 2014, 13:4 doi:10.1186/1472-6955-13-4
Frances Bunn ([email protected])
Angela Dickinson (a.m.d[email protected])
Charles Simpson ([email protected])
Venkat Narayanan ([email protected])
Deborah Humphrey ([email protected])
Caroline Griffiths (caroline.griffith[email protected])
Wendy Martin ([email protected])
Christina Victor ([email protected])
ISSN 1472-6955
Article type Research article
Submission date 13 June 2013
Acceptance date 10 February 2014
Publication date 19 February 2014
Article URL http://www.biomedcentral.com/1472-6955/13/4
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© 2014 Bunn et al.
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