1. Inledning
4.7 Slutsatser
En ökad kunskap har noterats hos sjuksköterskor beträffande utformningen av vård- planen
Läkare och sjuksköterskor informeras i högre grad än före interventionen när en pati- ent har en ökad fallrisk
Följsamheten till vårdplanen har ökat
Följsamheten till lokala anvisningar har ökat
Ingen signifikant förändring i antalet riskbedömningar och vårdplaner som upprättats har påvisats
Ingen signifikant kunskapshöjning har noterats i yrkesgrupperna
Utvärderingstid var för kort för att kunna uttala sig om antalet fallolyckor har reduce- rats. Under den tid då observationen pågick noterades ingen signifikant reducering av antalet fallolyckor
I verksamheten använder sig personalen i liten utsträckning av betydelsen av forsk- ningsresultat, klinisk erfarenhet, patienters erfarenhet och sammanhang i vården. Detta leder till sämre förutsättningar vid implementering av interventioner.
Fallpreventivt arbete måste fortsätta att bedrivas för att förhindra fallolyckor vilket medför lidande och sämre livskvalitet för patienten.
38
Referenser
Armstrong, G., Headrick, L., Madigosky, W., & Ogrinc, G. (2012). Designing education to improve care. The Joint Commission journal on quality and patient Safety, 38, 5-14. Batalden, P., & Splaine, M. (2002). What will it take to lead the continual improvement and
innovation of health care in the twentieth century? Quality Management in Health Care, 11, 45-54.
Batalden, P., & Stoltz, P.K. (1993). Framework for the continual improvement of health care: Building and applying professional and improvement knowledge to test change in daily work. The Joint commission Journal of Quality and Safety Improvement. 19, 424-447. Batchelor, F., Hill, K., Mackintosh, S., & Said, C. (2010). What works in falls prevention
after stroke a systematic review and meta- analysis. Journal of American Heart Associ- ation, 41, 1715 – 1722.
Bahtsvani, C., Uden, G., & Willman, A. (2004). Outcomes of evidence-based clinical practice guidelines: A systematic review. International Journal of Technology Assessment in Health Care, 20, 427-433.
Benn, J., Burnett, S., Parand, A., Pinto, A., Iskander, S., & Vincent, E. (2009). Perceptions of the impact of a large scale collaborative improvement programme: Experience in the UK safer patient initiative. Journal of evaluation in clinical practice, 15, 524-540. Bergman, B., & Klefsjö, B. (2007). Kvalitet från behov till användning (4:e rev. uppl.). Lund:
Studentlitteratur AB.
Berwick. B.M. (1996). A primer on leading the improvement of systems. British Medical Journal, 312, 619-622.
Boyd, R., & Stevens, J. (2009). Falls and fear of falling: burden, beliefs and behaviors. Age and ageing, 38, 423-428.
Brandrud, A.S., Schreiner, A., Hjortdahl, P., Helljesen, G.S., Nyen, B., & Nelson, E.C. (2011). Three successfactors for continual improvement in healthcare: An analysis of the report of improvement team members. British Medical Journal Quality & Safety, 20, 251-259.
Cameron, I., Murray, G., Gillespie, L., Robertson, M., Hill, K., Cumming, R., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals. The Cochrane Library, 2, 1-96.
Close, J., & Lord, S. (2011). Fall assessment in older people. Clinical review. British Medical Journal, 343, 579-582.
Cleaty-Holdforth ,J., & Leufer, T. (2008). Essential elements in developing evidence-based practice. Nursing Standard, 23, 42-46.
39
Choi, S., Lawler, E., Boenecke, C.A., Ponatoski, E.R., & Zimring, C.M. (2011). Developing a multi-systematic fall prevention model, incorporating the physical environment, the care and the technology: A systematic review. Journal advanced nursing, 67, 2501- 2524.
Cumming, R.G., Sherrington, C., Lord, S.R., Simpson, J.M., Vogler, C., Cameron, I.D., & Naganathan, V. (2008). Cluster randomised trial of a targeted multifactorial interven- tion to prevent falls among older people in hospital. British Medical Journal, 336, 758- 760.
Dykes, P C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., & Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. Journal of the Amer- ican Medical Association, 304, 1912- 1918.
Eliasson, A. (2006). Kvantitativ metod från början. Lund: Studentlitteratur AB.
Evans, D., Hodgkinson, B., Lambert, L., Wood, J., & Kowanko, I. (1998).Falls in acute hos- pitals: a systematic review. International Journal of evidence based healthcare, 1, 1-56. Fonda, D., Cook, J., & Sandler, V. (2006). Reducing serious falls- related injuries in hospital.
Medical Journal of Australia, 184, 379-382.
Jadad, A. (2000). Randomiserade kontrollerade kliniska prövningar. En handledning för den som tar del av prövningsresultat. Lund: Studentlitteratur AB.
Healey, F., (2004). Using targeted risk factor reduction to prevent falls in older inpatients: A randomized controlled trial. Age and Ageing, 33, 390-395
Kline, N. E., Thom, B., Quashie, W., Brosnan, P. & Dowling, M. (2009). A model for care delivery to reduce falls in a major cancer center. Hämtad 2013-03-19 från
www:ahrq.gov/downloads/pub/advances2/vol1/Advances—Kline_32.pdf
Kitson, A., Harvey, G., & Mc Cormack, B. (1998). Enabling the implementation of evidence based practice: A conceptual framework. British Medical Journal Quality & Safety in Health Care, 7, 149-158.
Koh, S.L.S., Hafizah, N., Lee, J.Y., Loo, Y.L., & Muthu, R. (2009). Impact of a fall preven- tion progamme in acute hospital settings in Singapore. Singapore Medical Journal, 50, 425- 432.
Lach, H., Spoelstra, S.L., Given, B.A., & Given, C.W. (2011). Fall prevention in hospitals: An integrated review. Clinical Nursing research, 21, 92-112.
Langley, G.J., Moen, R., Nolan, K.M., Nolan, T.W., Norman, C.L., & Provost, L.P. (2009). The improvement guide: a practical approach to enhancing organizational perfor- mance (2nd ed.). San Francisco: Jossey-Bass.
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care; Quality and safety in health care, 13, 185-190.
40
Montgomery, D. (2005). Introduction to Statistical Quality Control. Hoboken, New Jer- sey: John Wiley & Sons.
Morse, J. M. (2009). Preventing patient falls: Establishing a fall prevention program. (2nd ed.). Thousand Oaks, California: SAGE.
National Institute for Health and Clinical Excellence. (2011). Review of clinical (GC 21) – Clinical practice guideline for the assessment and prevention of falls in older people. London: National Institute for Health and Clinical Excellence, Centre for clinical prac- tice.
Nelson, E. C., Batalden, P.B., & Godfrey, M. M. (2007). Quality by design a clinical mi- crosystems approach (1:th ed.). San Francisco: Jossey-Bass/Wiley
Norusis M. J. (2002) SPSS 11.0 guide to data analysis. Upper Saddle River, New Jersey: Prentice Hall.
Region Skåne. (2012). Om kliniken. Hämtad 2012-02-17 från <http://www.skane.se/sv/Webbplatser-Internt/Sus-intern/a-o/divisionen-for-hjarna- hjarta-lungor-och-karl/kliniker-inom-divisionen/Neurologiska-kliniken-SUS/Om- kliniken/>
Nyberg, L., & Gustafson, Y. (1995). Patient falls in stroke rehabilitation. A challenge to reha- bilitation strategies. Journal of American Heart Association, 26, 838-42.
Odell, C., & Barta, K. (2011).Teaching evidence- based practice: The bachelor of science in nursing essentials at work at bed side. Journal of Professional nursing: official journal of American Association of Colleges of Nursing, 27, 370-377.
Pearson, K., & Coburn, A. (2011) Evidence- based falls prevention in critical access hospi- tals. (Policy Brief # 24). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.
Polit, D., & Beck, C. (2006). Essentials of nursing research. Methods, appraisal and utiliza- tion (6: th ed.). Philadelphia: William & Wilkins.
Pronovost, P., Berenholtz, S., Dorman, T., Lipsett, PA., Simmonds, T., & Haraden, C. (2003). Improving communication in the ICU using daily goals. Journal of critical care, 18, 71- 75.
Ranij, S.R., & Shojania, K.G. (2008). Implementing patient safety intervention in your hospi- tal: What to try and what to avoid. Medical clinics of North America North, 92, 275- 293.
Rosswum M.-A., & Larrabee, J.H. (2007). A model for change to evidence-based practice. Journal of nursing scholarship, 31, 317-322.
Rycroft-Malone, J. (2004). The PARIHS framework- a framework for guiding the implemen- tation of evidence- based practice. Journal of Nursing Care Quality, 4, 297-304.
41
Rycroft-Malone, J., Kitson, A., Harvey, G., Mc Cormack, B., Seers, K., & Titchen, A. (2002). Ingredients for change: Revisiting a conceptual framework. Quality and Safety in Health Care, 11, 174-180.
Skånes universitetssjukhus (2011). Handbok Fallprevention- Riskbedömning och preventiva åtgärder (2:a rev. uppl.). Malmö: Skånes universitetssjukhus.
Skånes universitetssjukhus & Primärvården Skåne (2012). Lokalt vårdprogram fallprevention Malmö- Riskbedömning och preventiva åtgärder. Malmö: Malmö stad och Skånes uni- versitetssjukhus, Malmö.
Socialstyrelsen (2006). God vård- om ledningssystem för kvalitet och patientsäkerhet i hälso- och sjukvården. Stockholm: Socialstyrelsen.
Socialstyrelsen (2010). Personalutbildning för att förebygga fallskador bland äldre - En del- rapport i utvärderingen av kompetensstegen. Stockholm: Socialstyrelsen.
SOSFS 2005:12. Ledningssystem för kvalitet och patientsäkerhet i hälso- och sjukvården. Kungälv: Socialstyrelsen.
Statens Folkhälsoinstitut (2009). Fallolyckor bland äldre – en samhällsanalys och effektiva preventionsåtgärder. Östersund: Statens folkhälsoinstitut.
Stenvall, M., Olofsson, B., Lundström, M., Englund, U., Borssen, B., & Svensson, O. (2007). Multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. International osteoporosis, 18, 167-175.
Sveriges Kommuner och landsting (2011). Nationell satsning för ökad patientsäkerhet. Säk- rare vård och omsorg. Handbok i grundläggande patientsäkerhetsarbete.Stockholm: Sveriges kommuner och landsting.
Sörmlands landsting och kommuner (2010). Gemensamt program för fallprevention i Sörm- land. I alla fall. Hämtad från
http://www.landstingetsormland.se/PageFiles/4758/Rev%20av%20Program%20f%C3 %B6r%20fallprevention%20inkl%20bilagor.pdf
Thomson, D.S., Estabrooks, C.A., Scott- Findley, S., Moore, K., & Wallin, L. (2007). Inter- ventions aimed at increasing research use in nursing: A systematic review. Implementa- tion Science, 2(15), 1-16. doi:10.1186/1748-5908-2-15
Thurman, D.J., Stevens, J.A., & Rao, J.K. (2008). Practice parameter: Assessing patients in a neurology practice for risk of falls (an evidence- based review): Report of the quality standards subcommittee of the american academy of neurology. Neurology, 70, 473- 479.
Trost, J. (2012). Enkätboken (5:e rev. uppl.). Lund: Studentlitteratur AB.
Tsur, A., & Segal, Z. (2010). Falls in stroke patients: risk factors and risk management. The Israel Medical Association Journal,12, 216-219.
Uden G.,& Ehnfors, M. (1999). Use of initial risk assessment and recording as the main nurs- ing intervention in identifying risk of fall. Journal of Advanced Nursing, 29, 145-152.
42
Voermans, N.C., Snijders, A.H., Schoon, Y., & Bloem, B.R. (2007). Why old people fall (and how to stop them). Practical Neurology, 7, 158-171.
Vårdhandboken (2013). Fallprevention. Hämtad 17 februari 2013, från http://vardhandboken.se/Texter/Utskriftssida/?pid=1829
Wensing, M., Wollersheim, H., & Grol, R. (2006). Organizational interventions to implement improvements in patient care: A structured review of reviews. Implementation Science, 1(2), 1-9. doi:10.1186/1748-5908-1-2
WMA Declaration of Helsinki (2008). Ethical principles for medical research involving hu-
man subjects. Hämtad 17 februari 2013, från
http://www.wma.net/en/30publications/10policies/b3/
World Health Organization (2007) WHO Global report on falls prevention in older age. Ge- neva: World Health Organization.
43