Final Project Milestone Three: Literature Review and Methods
Samantha Gilchrist
NUR 506: Evidence Based Practice
Southern New Hampshire University, Department of Nursing
Dr. Bonnie Beardsley
September 16, 2021
Literature Review: Interpretation
Patient falls are a sentinel event studied broadly throughout various healthcare settings;
and has been investigated within the setting of the Emergency Department (ED). A busy
environment such as the ED is susceptible to patient falls and may necessitate point of contact
and preventative interventions. Defining what constitutes a fall, as well as who is typically one to
sustain a fall was first needed to complete a project of fall prevention in the Emergency
Department. Faul, M. et al (2016) acknowledged older adults as those that most commonly fall
or sustain injury from falls and give insight into what constitutes a fall -- however, mentioned in
this is the account that the definition of a fall can vary slightly between facilities. Additionally,
Florence, C. et al (2018) recognize the financial burden a patient fall incurs on the healthcare
facility and patient -- observing the importance in preventing future falls. Fall prevention
strategies within the ED are investigated by many authors via study designs including qualitative
and quantitative methodologies. ED specific interventions include GAPcare (Golderg, E. et al,
2019), fall prevention bundles (Pop, H. et al, 2020), fall assessments (Stevens, J. et al, 2017),
KINDER 1 (Townsend, A. et al, 2016), and intentional rounding (Kirk, K. & Kane, R. 2016)
Many strategies exist in the prevention of falls in various settings including home, inpatient
wards, outpatient appointments, nursing homes, and Emergency Departments -- the ED specific
application of the above interventions allows researchers to determine which are most feasible
and reliable in keeping patient safety a top priority. Interestingly, little research has been
conducted regarding patient, caregiver, or clinician impression of falls or fall intervention
implementation. Few articles examining these include Skankar, K. et al (2017) Exploring Older
Adult ED Fall Patients ' Understanding of Their Fall: A Qualitative Study; Fruth, S. & Wiley, S.
(2016) Physician Impression of Physical Therapist Practice in the Emergency Department:
Descriptive, Comparative Analysis Over Time; and Porter, R. et al (2018) Exploring Clinicians
Perceptions About Sustaining an Evidence-Based Fall Prevention Program. A fall in the
Emergency Department affects the patient, the patient's family, and the multidisciplinary team
caring for the patient -- therefore, the task and responsibility of fall prevention in this setting
mandates the participation of all.
Literature Review: Research
The research on falls and fall prevention in the healthcare setting is plentiful; but specific
focus on Emergency Department falls and fall prevention is less so. Leading to the need for the
PICO-T question investigated here: Amongst Emergency Department (ED) staff nurses, does an
educational program on prevention of falls in the ED affect the knowledge of fall risk prevention.
Multiple hospital wide strategies exist, however adopting them to the environment of the ED is
not always reasonable. Current interventions listed previously include assessments, fall
prevention bundles and huddles, and rounding. Noticeably, mu