Topic: Implementation of a Fall Prevention Bundle in Inpatient Rehabilitation Setting to Reduce Fall Incidence and Improve Patient Safety For this assignment, you will submit your SYNTHESIZED COMPREHENSIVE LITERATURE REVIEW using the a

Rubric

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Topic: Implementation of a Fall Prevention Bundle in Inpatient Rehabilitation Setting to Reduce Fall Incidence and Improve Patient Safety

For this assignment, you will submit your SYNTHESIZED COMPREHENSIVE LITERATURE REVIEW using the articles from the evaluation table below.

The reader should be able to distinguish how your scholarly project fits within the research and how it is significant.

Important components to include in the assignment are:

You will use articles from the evaluation tables previously submitted. See evaluation tables below. Please select at least 10-15 articles from the evaluation tables provided below for this literature review.
Theoretical framework: Describe any theoretical or conceptual frameworks that serve as a guide for your project, summarize the frameworks, and explain how they relate to and provide support for your problem or population of interest.
Synthesis and analysis of evidence (research) related to the problem or population of interest: Address the overall strengths, weaknesses, limitations, and gaps of the research. It is very important that this section provide a comprehensive review of the literature and contain a minimum of 8 pages and 10-15 articles from the evaluation tables provided below.

· For this assignment, you will submit your comprehensive literature review using the articles from the

· evaluation table below.

· Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.

· The reader should be able to distinguish how your scholarly project ts within the research and

· how it is signicant. The literature review should provide a theoretical basis for your work, show what

· has been done by others, and set the stage for your work. You should be able to identify the GAP in the

· literature, which your project is going to be striving to !ll.

· Important components to include in the assignment are:

· · Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide

· for your project, summarize the frameworks, and explain how they relate to and provide support for

· your problem or population of interest.

· · Synthesis and analysis of evidence (research) related to the problem or population of

· interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is

· very important that this section provide a comprehensive review of the literature and contain a

· minimum of ten pages with 10 articles

For this assignment, you will submit your comprehensive literature review using the articles from the

evaluation table below.

Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.

The reader should be able to distinguish how your scholarly project ts within the research and

how it is signicant. The literature review should provide a theoretical basis for your work, show what

has been done by others, and set the stage for your work. You should be able to identify the GAP in the

literature, which your project is going to be striving to !ll.

Important components to include in the assignment are:

· Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide

for your project, summarize the frameworks, and explain how they relate to and provide support for

your problem or population of interest.

· Synthesis and analysis of evidence (research) related to the problem or population of

interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is

very important that this section provide a comprehensive review of the literature and contain a

minimum of ten pages with 10 articles

For this assignment, you will submit your comprehensive literature review using the articles from the

evaluation table below.

Your literature review should present the strengths, weaknesses, and gaps in your current knowledge.

The reader should be able to distinguish how your scholarly project ts within the research and

how it is signicant. The literature review should provide a theoretical basis for your work, show what

has been done by others, and set the stage for your work. You should be able to identify the GAP in the

literature, which your project is going to be striving to !ll.

Important components to include in the assignment are:

· Theoretical framework:$Describe any theoretical or conceptual frameworks that serve as a guide

for your project, summarize the frameworks, and explain how they relate to and provide support for

your problem or population of interest.

· Synthesis and analysis of evidence (research) related to the problem or population of

interest:$Address the overall strengths, weaknesses, limitations, and gaps of the research. It is

very important that this section provide a comprehensive review of the literature and contain a

minimum of ten pages with 10 articles.

Rubric Criteria:

· Thoroughly appraised appropriate evidence sources and provided a descriptive and detailed analysis of the research reviewed

· Anchored the clinical problem or topic in a theoretical or conceptual model that is clearly described. Clearly and thoroughly described the components of the model and the relationship of the model to the problem or topic

· Presented a literature review that is well organized and demonstrates logical sequencing based on the topic or clinical problem.

· Reached detailed conclusions based on the literature reviewed and included the strengths and gaps of the current research.

· Clearly demonstrated how the project fits within the existing evidence.

· Used correct spelling, grammar, and professional vocabulary. Cited all sources using APA format.

Evaluation Table 1

First
Author (Year)

Conceptual
Framework

Design/Method

Sample&
setting

Major
Variables Studied (and Definitions)

Measurement

Data
Analysis

Findings

Appraisal:
Worth to Practice

https://doi.org/10.1001/jamanetworkopen.2020.25889

Guo, X., Wang, Y., Wang, L., Yang, X., Yang, W., Lu, Z., & He, M. (2022). Effect of a fall prevention strategy for the older patients: A quasi‐experimental study. Nursing Open, 10(2). https://doi.org/10.1002/nop2.1379

Heng, H., Kiegaldie, D., Shaw, L., Jazayeri, D., Hill, A.-M., & Morris, M. E. (2022). Implementing patient falls education in hospitals: a mixed-methods trial. Healthcare, 10(7), 1298. https://doi.org/10.3390/healthcare10071298

Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., Hogan, D. B., Hunter, S. W., Kenny, R. A., Lipsitz, L. A., Lord, S. R., Madden, K. M., Petrovic, M., Ryg, J., Speechley, M., Sultana, M., Tan, M. P., van der Velde, N., Verghese, J., & Masud, T. (2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review. JAMA Network Open, 4(12), e2138911–e2138911. https://doi.org/10.1001/jamanetworkopen.2021.38911

Scheidenhelm, S., Astroth, K. S., DeLong, K., Starkey, C., & Wolfe, D. (2020). Retrospective analysis of factors associated with a revised fall prevention bundle in hospitalized patients. JONA: The Journal of Nursing Administration, 50(11), 571–577. https://doi.org/10.1097/nna.0000000000000939

Evaluation Table 2

First Author (Year)

Conceptual Framework

Design/Method

Sample & Setting

Major Variables
Studied (and Definitions)

Measurement

Data Analysis

Findings

Appraisal: Worth to
Practice

Bargmann & Brundrett
(2020)

Iowa Model

Evidence-based practice

26-bed medical-surgical telemetry
unit in a 352-bed Level 1 military trauma center

Fall rate: the number of falls
per 1,000 patient days.

Patient education: Structured education on fall risk and
prevention.

Staff compliance: adherence to
fall prevention interventions.

Audit of adherence to fall
prevention interventions, patient surveys, fall rate tracking

Comparison of pre-and
post-implementation fall rates, staff compliance rates, and patient understanding
of fall risk

55% decrease in fall rate.

89% staff compliance with
interventions.

Longest consecutive fall-free
days since 2015: 87 and 88 days.

Proves that the implementation of
a fall prevention bundle reduces fall incidence and improves patient safety.

Davenport et al.
(2020)

Modifiable fall-risk factors

Secondary analysis

400 older adult patients in an
academic urban emergency department

Fall-risk factors: modifiable
conditions contributing to falls.

Provider identification: the rate
of missed opportunities to diagnose risk factors.

Intervention strategies: actions
taken to mitigate fall risk.

Chart review of patient records,
comparison with standardized fall assessment

Quantification of missed
opportunities, statistical comparison of identified vs. unidentified risk
factors

96% of modifiable fall-risk
factors were missed by providers.

Specifically, visual acuity and
high-risk medications are the most overlooked factors.

Highlights that significant gaps
in fall-risk identification exist and thus emphasizes the need for improved
screening protocols.

Goldberg et al.
(2020)

Geriatric Acute and Post-acute
Fall Prevention

Randomized controlled trial

110 noninstitutionalized older
adults over 65 years old in two urban academic emergency departments

Fall-related emergency department
visits: the number of visits within six months.

Hospitalizations: all-cause and
fall-related.

Adherence to pharmacy and
physical therapy recommendations

Patient surveys, electronic
health record review, adherence tracking

Negative binomial regression
models, adjusted incidence rate ratios, sensitivity analyses

55% reduction in fall-related
emergency department visits.

57% reduction in all
hospitalizations.

Moderate adherence to
recommendations: pharmacy at 73% and physical therapy at 68%.

Provides evidence that a
structured, multidisciplinary approach improves patient safety and reduces
costly fall-related events.

Kelley et al. (2023)

Fall safety agreement

Quality improvement project

Three surgical units in an urban
hospital

Fall rate: the number of falls
reported.

Staff adherence: compliance with
fall prevention interventions.

Patient education: structured
education and agreement signing.

Weekly data collection on staff
adherence, patient education completion, and fall rates

Comparison of pre-and
post-implementation adherence rates, patient education rates, and fall
incidence

80.8% staff adherence.

92% patient education completion.

67.1% implementation of the Fall
T.I.P.S. tool and no falls were reported during the project.

Provides evidence that a fall
prevention bundle is effective in

reducing fall incidence and
improving patient safety.

Pop et al. (2020)

Multifactorial fall prevention

Quality improvement project

Emergency department (ED) in a
676-bed urban academic medical center

Fall risk screening:

Identification of at-risk
patients.

Multifactorial interventions:
fall prevention measures.

Staff engagement: involvement in
implementation.

Audit of adherence to fall
prevention interventions, patient education completion, fall rate tracking

Comparison of pre-and
post-implementation fall rates, staff compliance rates, and patient education
effectiveness

96% of ED arrivals screened for
fall risk.

86% of at-risk patients received
fall precautions.

The quarterly fall rate reduced
to 0.27 falls per 1,000 visits.

Provides evidence that a tailored
fall prevention bundle that incorporates multifactorial interventions and
staff engagement improves fall risk identification and prevention.

References

Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Military Medicine, 185(2), 28–34. https://doi.org/10.1093/milmed/usz411

Davenport, K., Alazemi, M., Sri-On, J., & Liu, S. (2020). Missed Opportunities to Diagnose and Intervene in Modifiable Risk Factors for Older Emergency Department Patients Presenting After a Fall. Annals of Emergency Medicine, 0(0). https://doi.org/10.1016/j.annemergmed.2020.06.020

Goldberg, E. M., Marks, S. J., Resnik, L. J., Long, S., Mellott, H., & Merchant, R. C. (2020). Can an emergency department–initiated intervention prevent subsequent falls and health care use in older adults? A randomized controlled trial. Annals of Emergency Medicine, 76(6). https://doi.org/10.1016/j.annemergmed.2020.07.025

Kelley, R. J., Gutchell, V., & O’Neill, K. (2023). Preventing Falls in the Surgical Setting by Implementing a Fall Prevention Bundle. Journal of PeriAnesthesia Nursing, 38(4), e27. https://doi.org/10.1016/j.jopan.2023.06.025

Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a Comprehensive Bundled Intervention for ED Fall Prevention. Journal of Emergency Nursing, 46(2), 225-232.e3. https://doi.org/10.1016/j.jen.2019.11.010

Evaluation Table 3

First Author
(Year)

Conceptual
framework

Design/Method

Sample &
setting

Major Variables
(and Definitions)

Measurement

Data Analysis

Findings

Appraisal: Worth
to Practice

Burns et al.
(2022)

Fall risk
screening

Prospective
longitudinal cohort study

1,905
community-dwelling older adults in the U.S.

Fall incidence:
occurrence of falls within 12 months.

Screening tool effectiveness: sensitivity and specificity of fall-risk tools.

Monthly
fall-tracking surveys; baseline and final assessments

Sensitivity,
specificity, likelihood ratios, logistic regression

Sensitivity ranged
between 22.5 and 68.7%; specificity ranged between 57.9 and 89.4% with
variation by age and sex.

Highlights that no
screening tool is a one-size-fits-all. Thus, risk screening should be
tailored to patient characteristics.

Ganz & Latham
(2020)

Multifactorial
fall prevention.

Clinical practice
review.

Community-dwelling
older adults who are over 65 years old.

Fall incidence:
rate of falls per year.

Injury severity:
fractures, dislocations, concussions.

Fear of falling: psychological impact post-fall.

Patient surveys;
ED visit records; cost analysis

Statistical
comparison of fall rates, intervention effectiveness, cost-benefit

Falls occur in 29%
annually.

10% have multiple
falls.

Exercise programs
and multifactorial interventions reduce risk.

Suggests that an
effective fall prevention bundle should combine exercise with a comprehensive
risk assessment.

Montero-Odasso et
al. (2022)

Multifactorial
fall prevention.

Expert consensus
guidelines.

Global
recommendations for older adults in healthcare.

Fall risk
assessment: identification of high-risk individuals.

Intervention strategies: tailored multidomain approaches.

Patient engagement: involvement in planning.

A systematic
review of guidelines; expert voting; and stakeholder feedback.

Delphi process;
comparison of existing vs. new evidence

Multidomain
interventions reduce incidence; patient-centered approaches enhance adherence

Emphasizes that
fall prevention bundles should contain tailored components and patient
engagement.

Morris et al. (2022)

Fall prevention
interventions.

Systematic review
and meta-analysis.

Hospitalized
adults across 43 studies.

Falls rate ratios
(RaR): falls per 1,000 bed days.

Falls risk: odds of being a faller; intervention vs control.

Falls rate
tracking; odds ratio calculations; review criteria.

Meta-analysis of
23 studies; statistical comparison of intervention effectiveness

Education of
patients and staff reduced falls (RaR = 0.70; OR = 0.62).

Bed/chair alarms
and sensors showed no significant impact.

Highlights that
technology alone provides limited benefits. Instead, education is the most
effective component of a rehab fall bundle.

Spoon et al.
(2024)

ERIC
implementation strategies.

Systematic review.

48 hospital-based
fall prevention studies.

Implementation
strategies: methods promoting interventions.

Adherence rates: compliance with interventions.

Fall rate reduction: change in falls per 1,000 patient days.

Adherence audits;
fall rate tracking; strategy classification.

Pre- vs
post-implementation comparisons of fall rates, adherence, and strategy
effectiveness.

Median fall-rate
decline of 0.9 per 1,000 patient days.

Median adherence
is 65%; most studies employed educational strategies.

Reiterates that
need to apply strategies, such as education, for consistent fall reduction in
rehab settings.

References

Burns, E. R., Lee, R., Hodge, S. E., Pineau, V. J., Welch, B., & Zhu, M. (2022). Validation and comparison of fall screening tools for predicting future falls among older adults. Archives of Gerontology and Geriatrics, 101, 104713. https://doi.org/10.1016/j.archger.2022.104713

Ganz, D. A., & Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. New England Journal of Medicine, 382(8), 734–743. https://doi.org/10.1056/nejmcp1903252

Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., Aguilar-Navarro, S., Alexander, N. B., Becker, C., Blain, H., Bourke, R., Cameron, I. D., Camicioli, R., Clemson, L., Close, J., Delbaere, K., Duan, L., Duque, G., Dyer, S. M., & Freiberger, E. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), 1–36. https://doi.org/10.1093/ageing/afac205

Morris, M., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), 1–12. https://doi.org/10.1093/ageing/afac077

Spoon, D., de Legé, T., Oudshoorn, C., van Dijk, M., & Ista, E. (2024). Implementation strategies of fall prevention interventions in hospitals: a systematic review. BMJ Open Quality, 13(4), e003006. https://doi.org/10.1136/bmjoq-2024-003006

Evaluation Table 4

First Author
(Year)

Conceptual
Framework

Design/Method

Sample &
Setting

Major Variables
Studied (and Their Definitions)

Measurement

Data Analysis

Findings

Appraisal

Dykes et al.
(2023)

Evidence-based
fall prevention.

Economic evaluation.

10,176 patients
with falls and 29,161 matched controls in 8 U.S. hospitals.

Fall incidence:
number of falls pre/post-intervention.

Cost of falls: financial burden per event.

Cost savings: net avoided costs per 1,000 patient days.

Interrupted time
series; matched case-control cost analysis.

Pre/post-fall-rate
comparison; economic impact assessment.

19% reduction in
falls; 20% reduction in injurious falls; $14,600 net savings per 1,000
patient days.

Demonstrates
substantial cost benefits of fall prevention bundles.

Heng et al. (2020)

Patient education
model.

Scoping review.

43 studies on
hospital fall prevention interventions.

Falls incidence:
rate per 1,000 bed-days.

Patient education: structured risk/prevention teaching.

Educational design quality: effectiveness and delivery mode.

Systematic review
of education programs; thematic intervention analysis.

Comparison of
design principles; assessment of engagement and knowledge retention.

Education reduces
falls and injuries; program quality and delivery mode influence outcomes;
well-designed education improves risk perception.

Highlights that
high-quality, structured patient education is critical for effective fall
prevention in rehab.

Li & Surineni
(2024)

Comprehensive fall
prevention.

Narrative review.

Hospitalized
patients in inpatient settings.

Fall incidence:
annual number of falls.

Injury severity: fractures, TBIs.

Prevention strategies: alarms, sitters, video, sensors.

A literature
synthesis of intervention studies.

Comparative
analysis of traditional vs. emerging strategies.

Nearly 1 million
falls annually; 250,000 injuries; emerging tech shows promise alongside
traditional measures.

Emphasizes the
need for multifaceted bundles combining education, tailored interventions,
and technology in rehab fall prevention.

Randell et al.
(2024)

Multifactorial
risk assessment.

Realist review
& multisite case study.

Three NHS Trusts;
orthopaedic and older person wards.

Leadership:
resource authority.

Shared responsibility: nursing supervision.

Facilitation: risk assessment documentation.

Patient participation: communication of risk.

Observations; 50
staff and 31 patient/carer interviews; 60 record reviews.

Theory
testing/refinement via stakeholder data; realist synthesis.

Unclear leadership
roles; documentation burden; limited multidisciplinary approaches; need
better patient communication strategies.

Identifies
organizational and communication barriers, guiding structured leadership and
engagement in rehab fall prevention bundles.

Turner et al.
(2022)

Fall prevention
strategies

Cross-sectional
descriptive study

60 general adult
hospital units in the U.S.

Practices:
visibility, bed modifications, monitoring, education.

Implementation strategies: quality management, planning, education,
restructuring.

Survey of practice
adherence and strategy use.

Comparison of
practice consistency across units.

Wide variation in
practices; resource-intensive strategies underused; limited interdisciplinary
approaches.

Reveals the need
for tailored, resource-appropriate strategies and interdisciplinary
collaboration in inpatient rehab settings.

References

Dykes, P. C., Bowen, M. C., Lipsitz, S., Franz, C., Adelman, J., Adkison, L., Bogaisky, M., Carroll, D., Carter, E., Herlihy, L., Lindros, M. E., Ryan, V., Scanlan, M., Walsh, M.-A., Wien, M., & Bates, D. W. (2023). Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program. JAMA Health Forum, 4(1), e225125. https://doi.org/10.1001/jamahealthforum.2022.5125

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1–12. https://doi.org/10.1186/s12877-020-01515-w

Li, S., & Surineni, K. (2024). Falls in hospitalized patients and preventive strategies: A narrative review. The American Journal of Geriatric Psychiatry: Open Science, Education, and Practice, 5, 1–9. https://doi.org/10.1016/j.osep.2024.10.004

Randell, R., McVey, L., Wright, J., Zaman, H., Cheong, V.-L., Woodcock, D. M., Healey, F., Dowding, D., Gardner, P., Hardiker, N. R., Lynch, A., Todd, C., Davey, C., & Alvarado, N. (2024). Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. Health and Social Care Delivery Research, 12(5), 1–194. https://doi.org/10.3310/JWQC5771

Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2022). Fall prevention practices and implementation strategies. Journal of Patient Safety, 18(1), e236–e242. https://doi.org/10.1097/pts.0000000000000758

Topic: Implementation of a Fall Prevention Bundle in Inpatient Rehabilitation Setting to Reduce Fall Incidence and Improve Patient Safety For this assignment, you will submit your SYNTHESIZED COMPREHENSIVE LITERATURE REVIEW using the a

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