UF receives NIH grant to improve strategies for inpatient fall prevention

Ronald Shorr, MD, MS
Dr. Ron Shorr

University of Florida investigators have received a $2 million grant from the National Institute on Aging to address a common and costly problem in hospitals and other health care facilities: patient falls.

Led by Ron Shorr, M.D., M.S., a research professor in the department of epidemiology at the UF College of Public Health and Health Professions and UF College of Medicine, and Lorraine Mion, Ph.D., R.N., FAAN, a research professor in the College of Nursing at The Ohio State University, the new project will employ a coaching strategy to help health care providers  in hospitals limit both patient falls and the use of bed alarms.

The Centers for Medicare & Medicaid Services considers patient falls with injury a “never event,” indicating a serious safety problem at a health care institution. Hospitals are not reimbursed for costs involved in the diagnosis and management of inpatient fall-related injuries. While hospitals have come a long way from using bed restraints to prevent patient falls, they may have become too reliant on bed alarms, Shorr said.

Previous research by Shorr and others has demonstrated that bed alarms, which are triggered when a patient leaves the bed, are not effective at preventing patient falls in hospitals. The rate of bed alarm false positives can be as high as 99%, leading to “alarm fatigue” among staff and major disruptions to patients.

“Despite this, our group has recently shown that more than one-third of hospital patients are undergoing fall prevention alarm monitoring,” said Shorr, the director of the Geriatric Research Education and Clinical Center at the Malcom Randall Veterans Affairs Medical Center. “Falls in the hospital require a very nuanced discussion and not a ‘plug and chug’ solution. These problems, in many ways, are more complex than some of the other medical problems we’ve put a lot of resources into understanding.”

For the new project, Shorr will partner with colleagues at The Ohio State University, Moffitt Cancer Center and Children’s Mercy Hospital in Kansas City to develop and deliver a curriculum that helps health care providers assess and apply fall prevention interventions based on the needs of individual patients.

“Many nursing units use a fall risk score for patients. If the score is over a certain number, than you should have preventive measures in place,” Shorr said. “But there are lots of ways to get to a higher fall risk score and so what we’re really trying to do is have providers think about why would this person be at a high fall risk? And rather than putting a band-aid on the problem, like an alarm, how do we think proactively to address the issues that may make a patient at risk for falls.”

Shorr and his team will create an educational program using coaching and tailored strategies that includes talking with nursing and other hospital staff to troubleshoot challenges with particular patients. The coaching will be tested in 30 nursing units across the country with researchers also comparing the effectiveness of a high-intensity coaching approach versus low-intensity.

“I really don’t want this project to add work for hospital staff and my hope is by having less noise and less running back and forth to silence the alarms, it will actually give some time back,” Shorr said. “I’m excited because this is a project that gets back to patient-centered care and can help people today.”