Research Round-Up (Jan 2024)
Posted Le 26 janvier 2024
With the New Year upon us, the Loop team is looking for new ways to ensure everyone has the latest evidence available to them. As the Loop Knowledge Broker, I receive regular information requests from Loop members, and I work with requesters to determine the scope of their question and suggest possible sources of information to meet their needs. I also keep an eye out for new publications that would be of interest to Loop members.
These quarterly ‘Research Round-Up’ posts will include citations to recent publications that may be of interest to Loop members and findings from recent information requests.
We hope you find this information helpful!
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Recent publications
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Recent information requests
Several recent requests focused on preventing falls and reducing fall-injuries in acute care or hospitals.
Let’s look at these three requests, the key research/resources suggested and the questions that could not be answered.
1. What designs and practices are available for use in acute care that can ensure patients with dementia can have staff and environment that: value quality of life, dignity and flexibility on fall risk?
Search results on dementia-friendly hospitals and care facilities highlight the importance of system, environment, and staff culture changes, which can be difficult to implement. Options for education and changing models of care are:
c) A practical example comes from William Osler Health System in Ontario where a summer 2023 research project “Evaluating the effectiveness of the Butterfly Model of Care for elderly patients with dementia” identified a decrease in the frequency of falls of patients after implementing this model.
2. Is there research (and best practices) that demonstrate that restraints in any form are ineffective in preventing falls and may cause greater safety risks?
We discussed existing provincial policies, Clinical Practice Guidelines and educational information on restraints as a last resort in hospitals. Recent research such as:
a. the Canadian CADTH review on avoidance of physical restraint use, and
b. the 2022 Cochrane Systematic Review on interventions for preventing and reducing the use of physical restraints
found no evidence that restraint use reduces falls and may increase the risk of falling and risk of pressure ulcers and incontinence. The risk‐averse organisational culture in hospitals with policies on safety through restraints rather than safe mobility may be barriers to restraint reduction.
3. Are there examples/practices of highlighted fall risk alert in Electronic Health Record (EHR) systems?
Initial searches found studies on using EHRs in hospitals to record fall risks and care plans, but not prompts, alerts or highlights about fall risk. In expanding to other alerts, there was a 2022 study of a randomized control trial on “Interruptive Electronic Alerts for Choosing Wisely Recommendations” (not fall risk) and 2021 systematic review of Drug Allergy Alerts, both which caution about ‘alert fatigue’, similar to the frequency of bed alarms being problematic. We are still looking for fall risk alert research or acute care practices like an electronic version of yellow wristband designating risk.
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Don’t forget!
The Loop Knowledge Centre offers Evidence Summaries based on members’ information requests, ‘hot topics’ on the Loop Discussion board and emerging areas of evidence. You can also submit an information request if the information you’re looking for is not covered in the Evidence Summaries.
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Links:
Championing dementia education: adapting an effective Scottish dementia education program for Canadian acute health care providers: https://pubmed.ncbi.nlm.nih.gov/36352769/
A narrative review of staff views about dementia care in hospital through the lens of a systems framework: https://journals.sagepub.com/doi/10.1177/17449871221142104
Evaluating the effectiveness of the Butterfly Model of Care for elderly patients with dementia: https://www.williamoslerhs.ca/en/news/meet-our-2023-summer-student-research-program-students.aspx
Avoidance of Physical Restraint Use among Hospitalized Older Adults: A Review of Clinical Effectiveness and Guidelines: https://www.ncbi.nlm.nih.gov/books/NBK545889/
2022 Cochrane Systematic Review on interventions for preventing and reducing the use of physical restraints: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9404383/
Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161518/
A systematic review of drug allergy alert systems: https://www.sciencedirect.com/science/article/pii/S1386505621002999?via%3Dihub