400 / LUCAS: a tool for fall-risk screening

GERMANY
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Patient falls
Early warning There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
In-hospital falls in older patients are frequent adverse events. Due to frailty, acute illness and unusual environment, for example, in-hospital patients are at high risk of falling. Apart from causing pain, distress, injuries, post-fall syndrome, and poor functional outcome, falls do substantially contribute to prolonged length of hospital stay and excessive use of resources.
However, fall-prevention interventions in hospitals are still limited compared to those in the community or long-term care facilities.
Aim was to improve the identification of high-risk patients.
Description of the Patient Safety Practice
 
PURPOSE: To improve the identification of in-patients who are at high risk of falling (screening), a tool named LUCAS Fall-Risk screening was developed.
METHOD: Analyses of fall-risk factors and identification of a mix of risk-factors that fitted best to identify high-risk patients.
The LUCAS Fall-Risk screening was compared to existing screening tools by asking: (i) How many high-risk patients are identified? (ii) How many of those high-risk patients fell; and how many did not? (iii) For particular statistical indicators as: Specificity sensitivity, positive and negative predictive value; rate of fallers and falls
IMPLEMENTATION: LUCAS Fall-Risk screening was implemented in routine clinical care in a hospital-unit treating older patients. On admission, nurses use the screening-instrument to decide if a patient needs fall-risk prevention strategies. High-risk patients receive individualised fall-prevention interventions.
EVALUATION: LUCAS Fall-Risk screening shows slightly better results in identifying older in-patients at high risk compared to existing screening tools. As the instrument is short and easy to perform, it is accepted as part of medical routine care.
Attachment of relevant written information and/or photos, as appropriate
400_WP4_LUCAS_SRS_Engl.pdf
There is no specified text here
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
Baseline-data:
Renteln-Kruse von W, Krause T. Fall events in geriatric hospital in-patients. Results of prospective recording over a 3 year period. Z Gerontol Geriatr. 2004; 37:9-14. German.

In-hospital fall prevention:
Renteln-Kruse von W, Krause T. Incidence of in-hospital falls in geriatric patients before and after the introduction of an interdisciplinary team-based fall-prevention intervention. J Am Geriatr Soc. 2007; 55:2068-74. Epub 2007 Oct 29.

LUCAS-consortium:
Renteln-Kruse von W, Dapp U, Anders J, Pröfener F, Schmidt S, Deneke C, Fertmann R, Hasford J, Minder C. The LUCAS* consortium: objectives of interdisciplinary research on selected aspects of ageing and health care for older people in an urban community. Z Gerontol Geriatr. 2011; 44:250-5. doi: 10.1007/s00391-011-0224-z.

LUCAS Fall-Risk Screening
Neumann L, Hoffmann VS, Golgert S, Hasford J, Renteln-Kruse von W. In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project. J Nutr, Health, Aging 2012. doi: 10.1007/s12603-012-0390-8

There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the development of the Patient Safety Practices
During implementation of the Patient Safety Practices
During evaluation of the Patient Safety Practices
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
Not known
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
Web-Site:
LUCAS Subproject 6: In-hospital falls: http://www.albertinen.de/krankenhaeuser/geriatrische_klinik/leistungsspektrum/lucas/teilprojekt6

City of Hamburg:
Public Health Information Service:
http://www.hamburg.de/contentblob/3092126/data/pdf-gesundheit-aelterer-menschen-in-hamburg-2.pdf
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Specially trained staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Prof. Dr. med. Wolfgang von Renteln-Kruse
Country: GERMANY
Organisation: Albertinen-Haus, Geriatrics Centre, University of Hamburg; Sellhopsweg 18-22, D-22459 Hamburg
E-mail: w.renteln-kruse@albertinen.de
Phone: +49-40-5581-1350
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