Background: Different definitions of constipation have been used to estimate its prevalence in th... more Background: Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. Methods: The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. Results: Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). Conclusions: The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.
A comparison of patients managed in specialist versus non-specialist A comparison of patients man... more A comparison of patients managed in specialist versus non-specialist A comparison of patients managed in specialist versus non-specialist inpatient A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia rehabilitation units in Australia
To develop a falls risk screening tool (FRST) sensitive to the traumatic brain injury rehabilitat... more To develop a falls risk screening tool (FRST) sensitive to the traumatic brain injury rehabilitation population. Falls are the most frequently recorded patient safety incident within the hospital context. The inpatient traumatic brain injury rehabilitation population is one particular population that has been identified as at high risk of falls. However, no FRST has been developed for this patient population. Consequently in the traumatic brain injury rehabilitation population, there is the real possibility that nurses are using falls risk screening tools that have a poor clinical utility. Multisite prospective cohort study. Univariate and multiple logistic regression modelling techniques (backward elimination, elastic net and hierarchical) were used to examine each variable's association with patients who fell. The resulting FRST's clinical validity was examined. Of the 140 patients in the study, 41 (29%) fell. Through multiple logistic regression modelling, 11 variables were identified as predictors for falls. Using hierarchical logistic regression, five of these were identified for inclusion in the resulting falls risk screening tool: prescribed mobility aid (such as, wheelchair or frame), a fall since admission to hospital, impulsive behaviour, impaired orientation and bladder and/or bowel incontinence. The resulting FRST has good clinical validity (sensitivity = 0.9; specificity = 0.62; area under the curve = 0.87; Youden index = 0.54). The tool was significantly more accurate (p = .037 on DeLong test) in discriminating fallers from nonfallers than the Ontario Modified STRATIFY FRST. A FRST has been developed using a comprehensive statistical framework, and evidence has been provided of this tool's clinical validity. The developed tool, the Sydney Falls Risk Screening Tool, should be considered for use in brain injury rehabilitation populations.
Nursing students have reported bioscience to be challenging and difficult to understand. This mig... more Nursing students have reported bioscience to be challenging and difficult to understand. This might have a negative impact upon their ability to understand patients' clinical conditions and nursing practice. We sought information about students' experiences with bioscience. A total of 126 final year nursing students completed a questionnaire. The findings showed that the majority of participants considered bioscience subjects to require more work compared to nursing subjects (65.9%), and that they would like a better understanding of bioscience (73.8%), but understood that bioscience forms the foundation of nursing practice (76.2%). Younger participants without secondary school science rated bioscience harder than nursing subjects and spent more time studying bioscience compared to older participants. Participants without any secondary school science lacked an ability to apply bioscience concepts to patient conditions. These results showed that nursing students, especially those without secondary school science, would benefit from improved bioscience integration with nursing practice. Nursing and bioscience educators should consider greater alignment of bioscience with nursing practice subjects, especially earlier in the curriculum.
To examine patient characteristics that contribute to falls in the inpatient traumatic brain inju... more To examine patient characteristics that contribute to falls in the inpatient traumatic brain injury (TBI) rehabilitation setting. A three-round modified Delphi technique that engaged a multidisciplinary panel of 11 health experts was used. Group median score and disagreement index were used to measure agreement between participants about patient characteristics that contribute to falls. All panel members participated in each questionnaire round. Several factors (such as, a fall since admission to hospital, cognitive impairment and motor impairment) were interpreted as contributing to falls in the TBI rehabilitation setting; but others were not (such as, antecedent falls and medication class). Some salient themes identified in participants' comments include: (1) the need to differentiate between what is an activity (e.g., mobility) and impairment (e.g., ataxic gait)-based falls risk factor; (2) over the course of a 24-h day and inpatient rehabilitation stay, a patient's risk of falling is not linear; and (3) Functional Independence Measure and predictors of TBI severity have varied sensitivity in predicting falls. In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient's rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance. Implications for Rehabilitation Clinicians should be mindful that the rehabilitation context can present unique falls risk factors, some of which emerge at different times during a patient's rehabilitation. Over the course of a patient's rehabilitation their risk of falling is not linear; therefore, rehabilitation clinicians should undertake periodic falls risk screening. The utility value and statistical significance of falls risk factors are both important aspects to consider when determining their clinical utility.
Multiple factors contribute to the development, maintenance and treatment of obesity. Viewing obe... more Multiple factors contribute to the development, maintenance and treatment of obesity. Viewing obesity through a gender relations approach helps to understand how an individual's interactions with others and society contributes to health opportunities and constraints, resulting in excess body weight. In gender relations theory, the body is viewed as both an agent and a product of social practice, whereby lifestyle behaviours influenced by an individual's context may impact on the physical body. This chapter presents life histories of two men in their 20s who have experience with obesity. Analysis of the production and power relations, relationships and symbolism reveal the marginalising effect of their obesity, and how gender interacts with other social structures including ethnicity and class. A holistic approach that considers how an individual configures their masculinity or femininity may assist in promoting and maintaining weight loss in obese individuals as it addresses the struggle in society experienced by many obese people. Despite significant advances in nutrition, health and weight-loss treatments, there is a global epidemic of overweight and obesity [1]. Obesity is the result of significantly greater energy consumption than expenditure, and it is associated with long-term health problems including diabetes, cardiovascular disease, high-blood pressure, high cholesterol and some cancers [2]. Excess body weight has also been associated with depression, anxiety and low self-esteem [3]. Colagiuri and colleagues [4] estimate that the total direct cost of overweight and obesity in Australia was a substantial A$21 billion in 2005. Obesity is a serious issue and current treatment strategies are modest at best with limited long-term success [5], making it critical to investigate new approaches to the prevention and treatment of obesity.
This paper discusses considerations for falls risk screening tool selection vs. the need to devel... more This paper discusses considerations for falls risk screening tool selection vs. the need to develop new tools. Inpatient falls are a complex patient safety issue that represent a significant burden for the healthcare system. In the inpatient context, falls risk screening tools are most often used for predicting falls, but in some populations assessment tools are more suited, however in others, a clinician's clinical judgment may be just as effective. Limited external validity is a central issue with falls risk screening tools when used in different populations than the original study. There is clinical need for guidance regarding screening tool selection vs. the need to development new tools and how to effect change in relation to the prediction of falls. Discussion paper. This discussion paper is based on our own experiences and research and is supported by literature. This paper provides clinicians with a better understanding of considerations for falls risk screening tool selection vs. the need to develop new tools. In doing so, it provides clinicians guidance on how to critique the efficacy and utility of their falls risk screening tool. This paper equips clinicians for effecting change in relation to the prediction of falls. Falls risk prediction is a particularly complex patient safety issue. Clinicians need to be aware of the limitations of their tool used to predict falls.
Http Dx Doi Org 10 5172 Conu 1999 8 3 65, Dec 17, 2014
Sex role stereotypes are widely held concepts that attribute unique sets of characteristics to ea... more Sex role stereotypes are widely held concepts that attribute unique sets of characteristics to each sex. The feminine sex role stereotype coupled with the nature of nursing work, renders the profession more appropriate for females. Due to the pressures imposed by hegemonic masculinities, it is perceived that male nurses, as a consequence of their biological sex, are unable to possess the feminine sex role. A survey design was used to ascertain differences in sex role identity between male and female nurses in a contemporary Australian work force. The short form of the Bem Sex Role Inventory (BSRI) was distributed to 98 nurses to determine their perceived sex role identity. There was no significant difference between male and female nurses in masculine and feminine scores, and sex type categories. The results of this preliminary investigation supports the view that a significant proportion of male nurses see themselves having the personal attributes synonymous with the feminine sex role.
Http Dx Doi Org 10 5172 Conu 2011 39 1 36, Dec 17, 2014
There continue to be assumptions within the nursing literature that nursing is synonymous with a ... more There continue to be assumptions within the nursing literature that nursing is synonymous with a feminine sex role identity. A comparative cross-sectional survey consisting of the Bem Sex Role Inventory and the Australian sex role scale was used to determine sex difference in gender characteristics of Australian nurses and with male engineers. A statistically signifi cant difference in femininity was found between all the samples (F (2,908) = 20.24, p < 0.00001; F (2,908) = 60.13, p < 0.00001). A statistical difference in masculinity was found between female nurses and the two male samples on the two masculine scales (F (2,908) = 12.48, p < 0.000001; F (2,908) = 6.94, p = 0.001). Path analysis found strong significant direct relationships between the samples and expressive orientation (t = 27.67) and self display (t = 12.42). Whilst differences in expressive characteristics were found between male and female nurses, a similar difference was found between male nurses and male engineers, supporting the notion that male nurses perceive themselves as having feminine characteristics essentially required for nursing.
To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Fa... more To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited. Five-year retrospective cohort study design. Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes; nursing shift data were retrieved from the local rostering system. The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers. Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s first fall occurred earlier in their admission than a single faller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s. Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk of falling is not static and in fact, may increase over time.
The purpose of the study was to describe the characteristics of patients who fall in the inpatien... more The purpose of the study was to describe the characteristics of patients who fall in the inpatient traumatic brain injury (TBI) rehabilitation setting. Specialized inpatient TBI rehabilitation unit. Fifty-four patients with history of falls and 55 nonequivalent patients without history of falls. Retrospective nonequivalent case-control study. The Functional Independence Measure, Glasgow Coma Scale, Westmead Post-traumatic Amnesia Scale, demographic and functional characteristics, and behavior and medication variables. No significant difference between patients with and without history of falls for age, sex, medication class or total number of medications administered on admission, and median admission Westmead Post-traumatic Amnesia Scale score was observed. Patients with history of falls had a significantly longer duration of post-traumatic amnesia, rehabilitation length of stay, and lower mean total admission Functional Independence Measure score and median Glasgow Coma Scale score at the time of injury. Patients with history of falls were more than 10 times more likely than patients without history of falls to require assistance on admission for activities of daily living, transfers, and continence/toileting. Neurobehaviors including noncompliance and anosognosia were significantly associated with patients with history of falls. A patient in the rehabilitation setting with a more severe TBI characterized by multisystem impairments is at an increased risk of falling, whereas some traditional fall risk factors were not associated with patients who fall. Rehabilitation settings should consider cohort-specific fall risk profiling. The Ontario STRATIFY Falls Risk Screening Tool is perhaps not the best tool to screen for falls in this inpatient population.
This paper describes the background to the development of a Medication Incident Report pro forma,... more This paper describes the background to the development of a Medication Incident Report pro forma, for use throughout the Liverpool Health Service. This pro forma is used by Medical, Pharmacy and Nursing staff to report prescription, dispensing and administration of medication errors.
Background: Different definitions of constipation have been used to estimate its prevalence in th... more Background: Different definitions of constipation have been used to estimate its prevalence in the community but this creates difficulties when comparing results from various studies. This study explores the impact of different definitions on prevalence estimates in the same population and compares the performance of simple definitions with the Rome III criteria. Methods: The prevalence of constipation in a large nationally representative sample of community-dwelling adults was estimated using five simple definitions of constipation and compared with definitions based on the Rome III criteria. The sensitivity, specificity, and positive and negative predictive values, were calculated for each definition using the Rome III criteria as the gold standards for chronic and sub-chronic constipation. Results: Prevalence estimates for the five simple definitions ranged from 9.4 to 58.9%, while the prevalence estimates using the Rome III criteria were 24.0% (95%CI: 22.1, 25.9) for chronic constipation and 39.6% (95%CI: 37.5, 41.7) for sub-chronic constipation. None of the simple definitions were adequate compared to the Rome III criteria. Self-reported constipation over the past 12 months had the highest sensitivity (91.1%, 95%CI: 88.8, 93.4) and negative predictive value (94.5%, 95%CI: 93.1, 96.1) compared to the Rome III criteria for chronic constipation but an unacceptably low specificity (51.3%, 95%CI: 48.8, 53.8) and positive predictive value (37.1%, 95%CI: 34.4, 39.9). Conclusions: The definition used to identify constipation within a population has a considerable impact on the prevalence estimate obtained. Simple definitions, commonly used in research, performed poorly compared with the Rome III criteria. Studies estimating population prevalence of constipation should use definitions based on the Rome criteria where possible.
A comparison of patients managed in specialist versus non-specialist A comparison of patients man... more A comparison of patients managed in specialist versus non-specialist A comparison of patients managed in specialist versus non-specialist inpatient A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia rehabilitation units in Australia
To develop a falls risk screening tool (FRST) sensitive to the traumatic brain injury rehabilitat... more To develop a falls risk screening tool (FRST) sensitive to the traumatic brain injury rehabilitation population. Falls are the most frequently recorded patient safety incident within the hospital context. The inpatient traumatic brain injury rehabilitation population is one particular population that has been identified as at high risk of falls. However, no FRST has been developed for this patient population. Consequently in the traumatic brain injury rehabilitation population, there is the real possibility that nurses are using falls risk screening tools that have a poor clinical utility. Multisite prospective cohort study. Univariate and multiple logistic regression modelling techniques (backward elimination, elastic net and hierarchical) were used to examine each variable&amp;amp;amp;amp;amp;amp;#39;s association with patients who fell. The resulting FRST&amp;amp;amp;amp;amp;amp;#39;s clinical validity was examined. Of the 140 patients in the study, 41 (29%) fell. Through multiple logistic regression modelling, 11 variables were identified as predictors for falls. Using hierarchical logistic regression, five of these were identified for inclusion in the resulting falls risk screening tool: prescribed mobility aid (such as, wheelchair or frame), a fall since admission to hospital, impulsive behaviour, impaired orientation and bladder and/or bowel incontinence. The resulting FRST has good clinical validity (sensitivity = 0.9; specificity = 0.62; area under the curve = 0.87; Youden index = 0.54). The tool was significantly more accurate (p = .037 on DeLong test) in discriminating fallers from nonfallers than the Ontario Modified STRATIFY FRST. A FRST has been developed using a comprehensive statistical framework, and evidence has been provided of this tool&amp;amp;amp;amp;amp;amp;#39;s clinical validity. The developed tool, the Sydney Falls Risk Screening Tool, should be considered for use in brain injury rehabilitation populations.
Nursing students have reported bioscience to be challenging and difficult to understand. This mig... more Nursing students have reported bioscience to be challenging and difficult to understand. This might have a negative impact upon their ability to understand patients' clinical conditions and nursing practice. We sought information about students' experiences with bioscience. A total of 126 final year nursing students completed a questionnaire. The findings showed that the majority of participants considered bioscience subjects to require more work compared to nursing subjects (65.9%), and that they would like a better understanding of bioscience (73.8%), but understood that bioscience forms the foundation of nursing practice (76.2%). Younger participants without secondary school science rated bioscience harder than nursing subjects and spent more time studying bioscience compared to older participants. Participants without any secondary school science lacked an ability to apply bioscience concepts to patient conditions. These results showed that nursing students, especially those without secondary school science, would benefit from improved bioscience integration with nursing practice. Nursing and bioscience educators should consider greater alignment of bioscience with nursing practice subjects, especially earlier in the curriculum.
To examine patient characteristics that contribute to falls in the inpatient traumatic brain inju... more To examine patient characteristics that contribute to falls in the inpatient traumatic brain injury (TBI) rehabilitation setting. A three-round modified Delphi technique that engaged a multidisciplinary panel of 11 health experts was used. Group median score and disagreement index were used to measure agreement between participants about patient characteristics that contribute to falls. All panel members participated in each questionnaire round. Several factors (such as, a fall since admission to hospital, cognitive impairment and motor impairment) were interpreted as contributing to falls in the TBI rehabilitation setting; but others were not (such as, antecedent falls and medication class). Some salient themes identified in participants&amp;amp;amp;amp;#39; comments include: (1) the need to differentiate between what is an activity (e.g., mobility) and impairment (e.g., ataxic gait)-based falls risk factor; (2) over the course of a 24-h day and inpatient rehabilitation stay, a patient&amp;amp;amp;amp;#39;s risk of falling is not linear; and (3) Functional Independence Measure and predictors of TBI severity have varied sensitivity in predicting falls. In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient&amp;amp;amp;amp;#39;s rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance. Implications for Rehabilitation Clinicians should be mindful that the rehabilitation context can present unique falls risk factors, some of which emerge at different times during a patient&amp;amp;amp;amp;#39;s rehabilitation. Over the course of a patient&amp;amp;amp;amp;#39;s rehabilitation their risk of falling is not linear; therefore, rehabilitation clinicians should undertake periodic falls risk screening. The utility value and statistical significance of falls risk factors are both important aspects to consider when determining their clinical utility.
Multiple factors contribute to the development, maintenance and treatment of obesity. Viewing obe... more Multiple factors contribute to the development, maintenance and treatment of obesity. Viewing obesity through a gender relations approach helps to understand how an individual's interactions with others and society contributes to health opportunities and constraints, resulting in excess body weight. In gender relations theory, the body is viewed as both an agent and a product of social practice, whereby lifestyle behaviours influenced by an individual's context may impact on the physical body. This chapter presents life histories of two men in their 20s who have experience with obesity. Analysis of the production and power relations, relationships and symbolism reveal the marginalising effect of their obesity, and how gender interacts with other social structures including ethnicity and class. A holistic approach that considers how an individual configures their masculinity or femininity may assist in promoting and maintaining weight loss in obese individuals as it addresses the struggle in society experienced by many obese people. Despite significant advances in nutrition, health and weight-loss treatments, there is a global epidemic of overweight and obesity [1]. Obesity is the result of significantly greater energy consumption than expenditure, and it is associated with long-term health problems including diabetes, cardiovascular disease, high-blood pressure, high cholesterol and some cancers [2]. Excess body weight has also been associated with depression, anxiety and low self-esteem [3]. Colagiuri and colleagues [4] estimate that the total direct cost of overweight and obesity in Australia was a substantial A$21 billion in 2005. Obesity is a serious issue and current treatment strategies are modest at best with limited long-term success [5], making it critical to investigate new approaches to the prevention and treatment of obesity.
This paper discusses considerations for falls risk screening tool selection vs. the need to devel... more This paper discusses considerations for falls risk screening tool selection vs. the need to develop new tools. Inpatient falls are a complex patient safety issue that represent a significant burden for the healthcare system. In the inpatient context, falls risk screening tools are most often used for predicting falls, but in some populations assessment tools are more suited, however in others, a clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical judgment may be just as effective. Limited external validity is a central issue with falls risk screening tools when used in different populations than the original study. There is clinical need for guidance regarding screening tool selection vs. the need to development new tools and how to effect change in relation to the prediction of falls. Discussion paper. This discussion paper is based on our own experiences and research and is supported by literature. This paper provides clinicians with a better understanding of considerations for falls risk screening tool selection vs. the need to develop new tools. In doing so, it provides clinicians guidance on how to critique the efficacy and utility of their falls risk screening tool. This paper equips clinicians for effecting change in relation to the prediction of falls. Falls risk prediction is a particularly complex patient safety issue. Clinicians need to be aware of the limitations of their tool used to predict falls.
Http Dx Doi Org 10 5172 Conu 1999 8 3 65, Dec 17, 2014
Sex role stereotypes are widely held concepts that attribute unique sets of characteristics to ea... more Sex role stereotypes are widely held concepts that attribute unique sets of characteristics to each sex. The feminine sex role stereotype coupled with the nature of nursing work, renders the profession more appropriate for females. Due to the pressures imposed by hegemonic masculinities, it is perceived that male nurses, as a consequence of their biological sex, are unable to possess the feminine sex role. A survey design was used to ascertain differences in sex role identity between male and female nurses in a contemporary Australian work force. The short form of the Bem Sex Role Inventory (BSRI) was distributed to 98 nurses to determine their perceived sex role identity. There was no significant difference between male and female nurses in masculine and feminine scores, and sex type categories. The results of this preliminary investigation supports the view that a significant proportion of male nurses see themselves having the personal attributes synonymous with the feminine sex role.
Http Dx Doi Org 10 5172 Conu 2011 39 1 36, Dec 17, 2014
There continue to be assumptions within the nursing literature that nursing is synonymous with a ... more There continue to be assumptions within the nursing literature that nursing is synonymous with a feminine sex role identity. A comparative cross-sectional survey consisting of the Bem Sex Role Inventory and the Australian sex role scale was used to determine sex difference in gender characteristics of Australian nurses and with male engineers. A statistically signifi cant difference in femininity was found between all the samples (F (2,908) = 20.24, p < 0.00001; F (2,908) = 60.13, p < 0.00001). A statistical difference in masculinity was found between female nurses and the two male samples on the two masculine scales (F (2,908) = 12.48, p < 0.000001; F (2,908) = 6.94, p = 0.001). Path analysis found strong significant direct relationships between the samples and expressive orientation (t = 27.67) and self display (t = 12.42). Whilst differences in expressive characteristics were found between male and female nurses, a similar difference was found between male nurses and male engineers, supporting the notion that male nurses perceive themselves as having feminine characteristics essentially required for nursing.
To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Fa... more To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited. Five-year retrospective cohort study design. Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes; nursing shift data were retrieved from the local rostering system. The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers. Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s first fall occurred earlier in their admission than a single faller&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s. Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk of falling is not static and in fact, may increase over time.
The purpose of the study was to describe the characteristics of patients who fall in the inpatien... more The purpose of the study was to describe the characteristics of patients who fall in the inpatient traumatic brain injury (TBI) rehabilitation setting. Specialized inpatient TBI rehabilitation unit. Fifty-four patients with history of falls and 55 nonequivalent patients without history of falls. Retrospective nonequivalent case-control study. The Functional Independence Measure, Glasgow Coma Scale, Westmead Post-traumatic Amnesia Scale, demographic and functional characteristics, and behavior and medication variables. No significant difference between patients with and without history of falls for age, sex, medication class or total number of medications administered on admission, and median admission Westmead Post-traumatic Amnesia Scale score was observed. Patients with history of falls had a significantly longer duration of post-traumatic amnesia, rehabilitation length of stay, and lower mean total admission Functional Independence Measure score and median Glasgow Coma Scale score at the time of injury. Patients with history of falls were more than 10 times more likely than patients without history of falls to require assistance on admission for activities of daily living, transfers, and continence/toileting. Neurobehaviors including noncompliance and anosognosia were significantly associated with patients with history of falls. A patient in the rehabilitation setting with a more severe TBI characterized by multisystem impairments is at an increased risk of falling, whereas some traditional fall risk factors were not associated with patients who fall. Rehabilitation settings should consider cohort-specific fall risk profiling. The Ontario STRATIFY Falls Risk Screening Tool is perhaps not the best tool to screen for falls in this inpatient population.
This paper describes the background to the development of a Medication Incident Report pro forma,... more This paper describes the background to the development of a Medication Incident Report pro forma, for use throughout the Liverpool Health Service. This pro forma is used by Medical, Pharmacy and Nursing staff to report prescription, dispensing and administration of medication errors.
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