Evidence Synthesis And Application To Prevent Falls Among Hospitalized Patients And Its Cost-Benefit Analysis

Objectives:Through reviewing the research progress of fall prevention in inpatients at home and abroad,the existing problems of fall prevention would be figured out.On the basis of current research,followed by a thorough literature searching,evidence appraisal and integration,expert meeting was conducted to establish an evidence-based strategic plan of prevention and management of fall prevention in inpatients.The study was to conduct a semi-experimental study to explore the feasibility and applicability of the strategic plan in fall prevention and management among hospitalized patients.The clinical outcomes and cost-effectiveness would be analyzed to show its effectiveness in patients' fall prevention.Thus to provide patients and hospitals theoretical basis in order to reduce the incidence of falls and fall realted harms in hospitals and continually improve the quality of medical care and to ensure the safety of patients.Research methods:1.Based on the conceptual framework of“Johns Hopkins nursing evidence-based practice model",the clinical practice guidelines on fall prevention and management for hospitalized patients published by domestic and foreign authors/authorities were searched systematically,and the quality of the retrieved guidelines was evaluated with the Johns Hopkins evidence level and evaluation tools.Then,recommendations in clinical practice guidelines were integrated to construct the first draft of fall prevention and management plan for inpatients.Through the expert meeting method,the acceptability and applicability of the first draft of the plan were investigated,and the operable recommendations in line with the clinical situation in China were screened out,and the final draft of the plan was finalized accordingly.2.According to the sequence of hospitalization,patients admitted from October 2015 to September 2016 were selected as the control group,and to implement conventional fall prevention management methods.Patients admitted from October 2016 to September 2017 were selected as the intervention group,and to start evidence-based fall prevention and management programs.The incidence of falls,the incidence of injuries caused by falls,and the incidence of grade 2 and above injuries caused by falls were compared between the two groups of inpatients,and the cost-benefit indicators of fall prevention measures were analyzed as well.SPSS 19.0 statistical software was used to conduct descriptive analysis of the general data of patients.Two independent samples t-test was used for the measurement data of normal distribution,and chi-square test was used for the comparison of rates.When P<0.05,the difference was considered statistically significant.Results:1.Based on the retrieval and evaluation,evaluation of evidence and synthesis,the study drafted the first work scheme content for prevention and management of inpatients falls.The method of expert meeting was utilized to discuss the structure,the project and the content of the first draft,finaily formed the inpatients fall prevention and management solutions,including fall prevention management,risk factors,risk assessment,standard preventive interventions,high-risk patients fall preventive interventions,patient engagement,post-fall intervention,post-discharge guidance and so on.2.The comparison of the occurrence of falls between the control group and the intervention group and analyze the intervention cost was then conducted.There was no statistically significant difference between the two groups in the incidence of falls(P>0.05),but the incidence of falls dropped from 0.12‰ to 0.11‰ after the implementation of the evidence-based program.The incidence of fall injury in hospitalized patients decreased from 64.58%to 43.48%(P<0.05),with statistically significant difference.The incidence of grade 2 and above injuries caused by falls in hospitalized patients decreased from 29.17%to 8.70%(P<0.05),and the difference was statistically significant.The cost-benefit analysis of the evidence-based fall prevention and management program shows that the implementation of the program can reduce patients' medical expenses and save medical costs for the hospital.Although the net benefit was negative in the first year,the net benefit reached 500,000 after 3 years.Conclusion:By reviewing the literature associated with fall prevention at home and abroad,we then conducted a thorough evidence search on best practice guidelines in fall prevention and management.After retrieval,appraisal and evaluation,evidence synthesis of the included guidelines,it is found that the overall quality of the current practical guidelines was satisfactory,the evidence content was comprehensive,and the recommendations were basically consistent.While,there was a big gap between the clinical practice and the fall guidelines' suggestions and recommendations.The stuyd has demonstrated the evidence-based scheme of fall prevention and management for inpatients was feasible.The feasibility and effectiveness of the scheme were clinically verified by the semi-experimental research methods.Compared with the control group,the intervention group showed significantimprovement in reducing the incidence of fall-related injuries and the incidence of fall-related injuries of grade 2 and above.Cost-benefit analysis of fall prevention shows that evidence-based fall prevention and management measures could reduce the associated health cost for both patients and hospital.